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Vogel B, Chandrasekhar J, Baber U, Mastoris I, Sartori S, Aquino M, Krucoff MW, Moliterno DJ, Henry TD, Weisz G, Gibson CM, Iakovou I, Kini AS, Farhan S, Sorrentino S, Faggioni M, Colombo A, Steg PG, Witzenbichler B, Chieffo A, Cohen DJ, Stuckey T, Ariti C, Dangas GD, Pocock S, Mehran R. Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry. Thromb Haemost 2019; 119:1704-1711. [PMID: 31365942 DOI: 10.1055/s-0039-1693463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe. METHODS Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization. RESULTS Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65-1.01, p = 0.065). CONCLUSION DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.
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Faggioni M, Baber U, Chandrasekhar J, Sartori S, Weintraub W, Rao SV, Vogel B, Claessen B, Kini A, Effron M, Ge Z, Keller S, Strauss C, Snyder C, Toma C, Weiss S, Aquino M, Baker B, Defranco A, Bansilal S, Muhlestein B, Kapadia S, Pocock S, Poddar KL, Henry TD, Mehran R. Use of prasugrel and clinical outcomes in African-American patients treated with percutaneous coronary intervention for acute coronary syndromes. Catheter Cardiovasc Interv 2019; 94:53-60. [PMID: 30656812 DOI: 10.1002/ccd.28033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/02/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the use of prasugrel after percutaneous coronary intervention (PCI) in African American (AA) patients presenting with acute coronary syndrome (ACS). BACKGROUND AA patients are at higher risk for adverse cardiovascular outcomes after PCI and may derive greater benefit from the use of potent antiplatelet therapy. METHODS Using the multicenter PROMETHEUS observational registry of ACS patients treated with PCI, we grouped patients by self-reported AA or other races. Clinical outcomes at 90-day and 1-year included non-fatal myocardial infarction (MI), major adverse cardiac events (composite of death, MI, stroke, or unplanned revascularization) and major bleeding. RESULTS The study population included 2,125 (11%) AA and 17,707 (89%) non-AA patients. AA patients were younger, more often female (46% vs. 30%) with a higher prevalence of diabetes mellitus, chronic kidney disease, and prior coronary intervention than non-AA patients. Although AA patients more often presented with troponin (+) ACS, prasugrel use was much less common in AA vs. non-AA (11.9% vs. 21.4%, respectively, P = 0.001). In addition, the use of prasugrel increased with the severity of presentation in non-AA but not in AA patients. Multivariable logistic regression showed AA race was an independent predictor of reduced use of prasugrel (0.42 [0.37-0.49], P < 0.0001). AA race was independently associated with a significantly higher risk of MI at 90-days and 1 year after PCI. CONCLUSIONS Despite higher risk clinical presentation and worse 1-year ischemic outcomes, AA race was an independent predictor of lower prasugrel prescription in a contemporary population of ACS patients undergoing PCI.
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Joyce LC, Baber U, Claessen BE, Sartori S, Chandrasekhar J, Cohen DJ, Henry TD, Ariti C, Dangas G, Faggioni M, Aoi S, Gibson CM, Aquino M, Krucoff MW, Vogel B, Moliterno DJ, Sorrentino S, Colombo A, Chieffo A, Kini A, Guedeney P, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Dual-Antiplatelet Therapy Cessation and Cardiovascular Risk in Relation to Age. JACC Cardiovasc Interv 2019; 12:983-992. [DOI: 10.1016/j.jcin.2019.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 01/29/2023]
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Faggioni M, Baber U, Sartori S, Chandrasekhar J, Cohen DJ, Henry TD, Claessen BE, Dangas GD, Gibson CM, Krucoff MW, Vogel B, Moliterno DJ, Sorrentino S, Colombo A, Chieffo A, Kini A, Farhan S, Ariti C, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Influence of Baseline Anemia on Dual Antiplatelet Therapy Cessation and Risk of Adverse Events After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007133. [DOI: 10.1161/circinterventions.118.007133] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mehran R, Vogel B, Ortega R, Cooney R, Horton R. The Lancet Commission on women and cardiovascular disease: time for a shift in women's health. Lancet 2019; 393:967-968. [PMID: 30765122 DOI: 10.1016/s0140-6736(19)30315-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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Farhan S, Vogel B, Baber U, Sartori S, Aquino M, Chandrasekhar J, Sorrentino S, Giustino G, Sharma M, Guedeney P, Rohla M, Bhandari R, Barman N, Sweeny J, Dangas G, Mehran R, Kini A, Sharma S. Calculated Serum Osmolality, Acute Kidney Injury, and Relationship to Mortality after Percutaneous Coronary Intervention. Cardiorenal Med 2019; 9:160-167. [PMID: 30844810 DOI: 10.1159/000494807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the associations between serum osmolality (sOsmo) and acute kidney injury (AKI) as well as short- and long-term mortality in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are limited. OBJECTIVES To investigate the association between sOsmo and development of AKI and clinical outcomes in patients undergoing PCI. METHODS We investigated 1,927 consecutive patients undergoing PCI from the registry of a single center. Patients were divided into quartiles according to sOsmo at admission (Q1-Q4). sOsmo was calculated using the following equation: (1.86 × serum sodium [mmol/L]) + (glucose [mg/dL] / 18) + (blood urea nitrogen [mg/dL] / 2.8) + 9. The primary endpoint was AKI, per Kidney Disease: Improving Global Outcomes (KDIGO) definition. The secondary endpoints were 30-day and 1-year all-cause mortality. RESULTS Patients with the highest sOsmo (Q4) were older and more likely female, with significantly more cardiovascular risk factors and comorbidities compared to those with lower sOsmo (Q1-Q3). Incidence of AKI was highest in Q4 and lowest in Q2. In the multivariate logistic regression model, high sOsmo independently predicted the development of AKI (OR 2.00, 95% CI 1.26-3.19, p = 0.003). Patients with Q4 had a higher risk of 1-year mortality compared to patients with Q2 (HR 2.11, 95% CI 1.10-4.15; p = 0.031), but not after adding AKI to the multivariate model (HR 1.71, 95% CI 0.87-3.39; p = 0.12). CONCLUSION sOsmo is a valid and easily obtainable predictor of AKI after PCI. High sOsmo is associated with increased risk of AKI and 1-year mortality in patients undergoing PCI. Further research is warranted to clarify whether the use of an sOsmo-directed hydration protocol might reduce the incidence of AKI in patients undergoing PCI.
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Camaj A, Giustino G, Claessen B, Hinohara T, Baber U, Aquino M, Guedeney P, Sorrentino S, Kalkman D, Vogel B, Farhan S, Shah S, Barman N, Vijay P, Kovacic J, Sweeny J, Dangas G, Kini A, Mehran R, Sharma S. EFFECT OF SYSTEMIC INFLAMMATION ON OUTCOMES AFTER COMPLEX PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Joyce L, Baber U, Claessen B, Sartori S, Chandrasekhar J, Cohen D, Henry T, Ariti C, Dangas G, Faggioni M, Gibson CM, Aquino M, Krucoff M, Vogel B, Moliterno D, Sorrentino S, Colombo A, Chieffo A, Kini A, Guedeney P, Witzenbichler B, Weisz G, Steg P, Pocock S, Mehran R. DUAL ANTIPLATELET THERAPY (DAPT) CESSATION AND CARDIOVASCULAR RISK IN RELATION TO AGE: ANALYSIS FROM THE PARIS (PATTERNS OF NON-ADHERENCE TO ANTI-PLATELET REGIMENS IN STENTED PATIENTS) REGISTRY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Blum M, Guedeney P, Claessen B, Aquino M, Kalkman D, Sorrentino S, Chandiramani R, Elsayed S, Goel R, Vogel B, Barman N, Sweeny J, Kovacic J, Kini A, Dangas G, Baber U, Sharma S, Mehran R. RESIDUAL INFLAMMATORY RISK IN PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guedeney P, Claessen B, Kalkman D, Aquino M, Sorrentino S, Blum M, Giustino G, Farhan S, Vogel B, Sartori S, Montalescot G, Sweeny J, Kovacic J, Barman N, Dangas G, Kini A, Baber U, Sharma S, Mehran R. IMPACT OF RESIDUAL INFLAMMATORY RISK IN PATIENTS WITH LOW LDL-CHOLESTEROL UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHT FROM A LARGE SINGLE-CENTER REGISTRY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Faggioni M, Baber U, Chandrasekhar J, Sartori S, Claessen BE, Rao SV, Vogel B, Effron MB, Poddar K, Farhan S, Kini A, Weintraub W, Toma C, Sorrentino S, Weiss S, Snyder C, Muhlestein JB, Kapadia S, Keller S, Strauss C, Aquino M, Baker B, Defranco A, Pocock S, Henry T, Mehran R. Use of prasugrel vs clopidogrel and outcomes in patients with and without diabetes mellitus presenting with acute coronary syndrome undergoing percutaneous coronary intervention. Int J Cardiol 2019; 275:31-35. [DOI: 10.1016/j.ijcard.2018.10.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 01/30/2023]
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Leutner M, Tscharre M, Farhan S, Taghizadeh Waghefi H, Harreiter J, Vogel B, Tentzeris I, Szekeres T, Fritzer-Szekeres M, Huber K, Kautzky-Willer A. A Sex-Specific Analysis of the Predictive Value of Troponin I and T in Patients With and Without Diabetes Mellitus After Successful Coronary Intervention. Front Endocrinol (Lausanne) 2019; 10:105. [PMID: 30881344 PMCID: PMC6405417 DOI: 10.3389/fendo.2019.00105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Elevated levels of troponin are associated with future major adverse cardiac events (MACE). Data on the prognostic value of high sensitive troponin T (hs-TnT) compared to high sensitive troponin I (hs-TnI) in diabetic and non-diabetic patients are sparse. Methods: We analyzed patients of a single-center registry undergoing coronary stenting between 2003 and 2006. As a primary endpoint we assessed MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke according to sex and diabetes status using log-rank. As a second endpoint, we assessed the prognostic impact of hs-TnT and hs-TnI on MACE, adjusting for known confounders using Cox regression analysis. Results: Out of 818 investigated patients, 267 (32.6%) were female. Diabetes mellitus type 2 (T2DM) was diagnosed in 206 (25.2%) patients. After a mean follow-up of 6.6 ± 3.7 years, MACE occurred in 235 (28.7%) patients. The primary endpoint components of cardiovascular death occurred in 115 (14.1%) patients, MI in 75 (9.2%), and ischemic stroke in 45 (5.5%). Outcomes differed significantly according to sex and diabetes status (p = 0.003). In descending order, MACE rates were as follows: female diabetic patients (40.8%), female non-diabetic patients (32.7%), male diabetic patients (28.9%), and male non-diabetic patients (24.8%). Additionally, females with diabetes were at higher risk of cardiovascular death compared to diabetic men (28 vs. 15%). Hs-TnI (HR 1.477 [95% CI 1.100-1.985]; p = 0.010) and hs-TnT (HR 1.615 [95%CI 1.111-2.348]; p = 0.012) above the 99th percentile were significantly associated with MACE. Both assays showed tendency toward association with MACE in all subgroups. Conclusion: Diabetic patients, particularly females, with known coronary artery disease had a higher risk of subsequent MACE. Both, hs-TnI and hs-TnT significantly correlated with MACE.
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Guedeney P, Baber U, Claessen B, Aquino M, Camaj A, Sorrentino S, Vogel B, Farhan S, Faggioni M, Chandrasekhar J, Kalkman DN, Kovacic JC, Sweeny J, Barman N, Moreno P, Vijay P, Shah S, Dangas G, Kini A, Sharma S, Mehran R. Temporal trends, determinants, and impact of high-intensity statin prescriptions after percutaneous coronary intervention: Results from a large single-center prospective registry. Am Heart J 2019; 207:10-18. [PMID: 30404046 DOI: 10.1016/j.ahj.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting. METHODS All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg. RESULTS A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P < .001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non-ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P < .001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P < .001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P < .001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P < .001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P = .006), Asian races (OR 0.73, 95% CI 0.65-0.83, P < .001), and older age (OR 0.90, 95% CI 0.88-0.92, P < .001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P = .84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P = .05). CONCLUSION Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.
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Tscharre M, Vogel B, Tentzeris I, Freynhofer M, Rohla M, Wojta J, Weiss T, Ay C, Huber K, Farhan S. Prognostic Impact of Soluble P-Selectin on Long-Term Adverse Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention. Thromb Haemost 2018; 119:340-347. [DOI: 10.1055/s-0038-1676563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background Soluble P-selectin (sP-selectin), a biomarker of inflammatory pathologies including cardiovascular disease, is known to have pro-atherosclerotic effects such as the ability to increase leukocyte recruitment and modulate thrombotic response. We aimed to assess the impact of sP-selectin on long-term major adverse cardiovascular events (MACE) in patients after coronary stenting for coronary artery disease.
Methods We analysed 733 patients of a single-centre registry undergoing percutaneous coronary intervention (PCI) between 2003 and 2006. Plasma samples were analysed for sP-selectin antigen concentration with an enzyme-linked immunoassay. The study population was categorized according to sP-selectin quartiles. Endpoint of the study was long-term MACE, a composite of all-cause death, myocardial infarction (MI) and stroke.
Results Of the total patient cohort, 361 (49.2%) patients were admitted for stable coronary artery disease and 372 (50.8%) for acute coronary syndrome. Median age was 64 years and 70.7% were male. After a mean follow-up period of 9.7 years, MACE occurred in 344 (46.9%) patients. The primary endpoint components of all-cause death occurred in 211 (28.8%), MI in 88 (12.0%) and ischaemic stroke in 45 (6.1%) patients. After adjustment for confounders, patients in the 2nd, 3rd and 4th quartile were at higher risk for MACE compared with the 1st quartile (hazard ration [HR], 1.234 [0.899–1.695], p = 0.193; HR, 1.480 [1.085–2.019], p = 0.013; and HR, 1.571 [1.115–2.152], p = 0.004). sP-selectin as continuous variable model was significantly associated with MACE after adjustment (HR per 1 ng/mL increase of 1.009 [95% confidence interval, 1.002–1.017]; p = 0.016).
Conclusion Elevated levels of sP-selectin were associated with increased risk for long-term MACE in patients undergoing PCI.
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Kalkman DN, Aquino M, Claessen BE, Baber U, Guedeney P, Sorrentino S, Vogel B, de Winter RJ, Sweeny J, Kovacic JC, Shah S, Vijay P, Barman N, Kini A, Sharma S, Dangas GD, Mehran R. Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions. Eur Heart J 2018; 39:4101-4108. [PMID: 30358832 DOI: 10.1093/eurheartj/ehy633] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/22/2018] [Indexed: 11/14/2022] Open
Abstract
Aims It remains unknown what percentage of patients treated with percutaneous coronary artery intervention (PCI) have high residual inflammatory risk (RIR). Moreover, the impact of RIR on clinical outcomes has not been established. The objective of this study is to determine the prevalence of patients with persistent high levels of inflammation after PCI and to evaluate clinical outcomes according to inflammatory response. Methods and results This is a retrospective cohort study assessing patients undergoing PCI between 2009 and 2016 with serial inflammatory status assessment from a large, prospective, and single-centre PCI registry. Assessment of inflammation status with at least two high sensitive C-reactive protein (hsCRP) measurements at baseline and follow-up with >4 weeks apart. High RIR was defined as an hsCRP≥ 2 mg/L. Patients were divided into four groups: persistent high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistent low RIR. The primary endpoint was all-cause mortality at 1 year follow-up. Occurrence of myocardial infarction (MI) was assessed as secondary outcome. Seven thousand and twenty-six patients were identified with serial hsCRP measurements (30.8% of all PCI patients). Of these patients 2654 (38%) had persistent high RIR, 719 patients (10%) had increased RIR, 1088 patients (15%) had attenuated RIR, and persistent low RIR was seen in 2565 patients (37%). All-cause mortality at 1 year was 2.6% in patients with persistent high RIR, compared with 1.0% in increased RIR, 0.3% in attenuated RIR, and 0.7% in persistent low RIR patients, P < 0.01. MI at 1 year was observed in 7.5% of persistent high RIR, compared with 6.4% in increased RIR, 4.6% in attenuated RIR, and 4.3% in persistent low RIR, P < 0.01. In an adjusted model, including accounting for diabetes mellitus, acute coronary syndrome, and baseline low-density lipoprotein, results were sustained. Conclusion Persistent high RIR is observed frequently in patients undergoing PCI. In these patients, significantly higher all-cause mortality and MI rates are observed at 1 year follow-up. Residual inflammatory risk in patients undergoing PCI should be identified and treatment options should be further explored.
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Guedeney P, Tchétché D, Petronio AS, Mehilli J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Sorrentino S, Claessen BEPM, Chandrasekhar J, Vogel B, Kalkman DN, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer-Grazia MC, Naber C, Kievit P, Baber U, Sharma S, Morice MC, Chieffo A, Mehran R. Impact of coronary artery disease and percutaneous coronary intervention in women undergoing transcatheter aortic valve replacement: From the WIN-TAVI registry. Catheter Cardiovasc Interv 2018; 93:1124-1131. [PMID: 30511802 DOI: 10.1002/ccd.28012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the impact of coronary artery disease (CAD) with or without recent (≤ 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear. METHODS The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (≤30 days). All events were adjudicated according to the VARC-2 criteria. RESULTS A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (≤ 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD (adj HR 1.56, 95%CI 1.03-2.39, P = 0.038 and adj HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death (adj HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke (adj HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD. CONCLUSION The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes.
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Guedeney P, Chieffo A, Snyder C, Mehilli J, Petronio AS, Claessen BE, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchétché D, Iadanza A, Sardella G, Van Mieghem NM, Chandrasekhar J, Vogel B, Sorrentino S, Kalkman DN, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer MC, Naber C, Kievit P, Baber U, Sharma S, Morice MC, Mehran R. Impact of Baseline Atrial Fibrillation on Outcomes Among Women Who Underwent Contemporary Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry). Am J Cardiol 2018; 122:1909-1916. [PMID: 30318417 DOI: 10.1016/j.amjcard.2018.08.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Pre-existing atrial fibrillation (AF) is common among patients who underwent transcatheter aortic valve implantation (TAVI) and has been associated with adverse outcomes. The specific impact of AF at baseline in women who underwent TAVI, however, remains unknown. The Women's International Transcatheter Aortic Valve Implantation is a prospective, multinational registry evaluating the safety and performance of contemporary TAVI in women in 19 centers between January 2013 and December 2015. Patients with available electrocardiogram at baseline were compared according to the presence of AF. All events were adjudicated according to the Valve Academic Research Consortium 2 criteria. Associations between AF and outcomes were tested using multivariate Cox regression model. Of the 993 women with available baseline electrocardiogram included in the study, 200 (20.1%) presented with AF. Patients with AF at baseline had higher Euroscore I score values and more frequently had chronic kidney disease or prior stroke. Patients without AF more frequently had coronary artery disease. There was no difference regarding in-hospital events between the two groups aside from longer length of stay for patients with AF (13.3 ± 11 vs 11.5 ± 7.1 days, p = 0.01). In multivariate analysis, AF at baseline was associated with an increase of all-cause and cardiovascular death at 12 months (adjHR 1.67 95%CI 1.11 to 2.50, p = 0.013 and adjHR 1.85 95%CI 1.19 to 2.86, p = 0.006 respectively). In conclusion, in this prospective registry of women who underwent contemporary TAVI, the presence of AF at baseline was associated with significantly increased 12-month mortality.
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Sorrentino S, Giustino G, Baber U, Sartori S, Cohen DJ, Henry TD, Farhan S, Sharma M, Ariti C, Dangas G, Gibson M, Faggioni M, Krucoff MW, Aquino M, Chandrasekhar J, Moliterno DJ, Colombo A, Vogel B, Chieffo A, Kini AS, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry). Am J Cardiol 2018; 122:1638-1646. [PMID: 30270177 DOI: 10.1016/j.amjcard.2018.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 01/12/2023]
Abstract
The impact of dual antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention with drug eluting stent implantation in patients at high atherothrombotic risk remains unclear. We aimed to characterize the risk for adverse events, and its relation with the mode of DAPT cessation in patients at high atherothrombotic risk (HATR). Considering patients treated with drug-eluting stents among those enrolled in the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients registry, we defined subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR). DAPT cessation-modes were defined as physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance. Compared to patients with LATR (n = 2867; 68.2%), patients with HATR (n = 1340; 31.8%) were older with a higher prevalence of cardiovascular risk factors. Over 2 years, HATR patients had lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p = 0.002) and trend for disruption (11.5% vs 13.7%, p = 0.051), though no significant difference in the rate of DAPT interruption. Patients with HATR had higher 2-year rates of cardiac death, MI, or stent thrombosis compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001). Disruption of DAPT was associated with greater risk for cardiac death, MI, or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 to 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 to 4.80) patients (pinteraction = 0.40). The degree of atherothrombotic risk influences the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Atherothrombotic risk status does not influence the association between DAPT cessation and cardiac risk.
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Ge Z, Baber U, Claessen BE, Farhan S, Chandrasekhar J, Li SX, Sartori S, Kini AS, Rao SV, Weiss S, Henry TD, Vogel B, Sorrentino S, Faggioni M, Kapadia S, Muhlestein B, Strauss C, Toma C, DeFranco A, Effron MB, Keller S, Baker BA, Pocock S, Dangas G, Mehran R. The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry. Catheter Cardiovasc Interv 2018; 93:E112-E119. [DOI: 10.1002/ccd.27860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2018] [Indexed: 11/10/2022]
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Guedeney P, Sorrentino S, Vogel B, Baber U, Claessen BE, Mehran R. Assessing and minimizing the risk of percutaneous coronary intervention in patients with chronic kidney disease. Expert Rev Cardiovasc Ther 2018; 16:825-835. [DOI: 10.1080/14779072.2018.1526082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sorrentino S, Baber U, Claessen BE, Camaj A, Vogel B, Sartori S, Guedeney P, Chandrasekhar J, Farhan S, Barman N, Sweeny J, Giustino G, Dangas G, Kini A, Sharma S, Mehran R. Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention. Thromb Haemost 2018; 118:1997-2005. [PMID: 30312975 DOI: 10.1055/s-0038-1673687] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. METHODS We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. RESULTS In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk. CONCLUSION Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.
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Vogel B, Claessen B, Baber U, Sorrentino S, Zhao W, Krucoff M, Kozuma K, Ge J, Seth A, Makkar R, Bangalore S, Bhatt D, Angiolillo D, Saito S, Neumann FJ, Hermiller J, Valgimigli M. TCT-539 Clinical outcomes in high bleeding risk patients undergoing complex PCI with the Xience everolimus eluting stent: a patient-level pooled analysis from four Xience post-approval trials. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sorrentino S, Baber U, Claessen B, Camaj A, Vogel B, Sartori S, Paul Guedeney, Chandrasekhar J, Farhan S, Barman N, Joseph Sweeny, Giustino G, Dangas G, Kini A, Sharma S, Mehran R. TCT-736 Prevalence and Impact of Bleeding Determinants on Risks for out-of-hospital bleeding and coronary thrombosis in patients undergoing percutaneous coronary intervention: Results from a large single-center PCI Registry. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paul Guedeney, Sorrentino S, Claessen B, Baber U, Vogel B, Krucoff M, Kozuma K, Ge J, Seth A, Makkar R, Bangalore S, Bhatt D, Angiolillo D, Rau V, Saito S, Neumann FJ, Hermiller J, Valgimigli M, Mehran R. TCT-304 Long term clinical outcomes in acute coronary syndrome patients at high bleeding risk undergoing PCI with implantation of everolimus-eluting stents: Results from the Patient-Level Pooled Analysis of EES Post Approval Studies. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Camaj A, Giustino G, Baber U, Aquino M, Paul Guedeney, Sorrentino S, Vogel B, Farhan S, Barman N, Vijay P, Kovacic J, Joseph Sweeny, Dangas G, Kini A, Sharma S, Mehran R. TCT-320 Impact of Pre-Procedural High-Sensitivity C-Reactive Protein, LDL-C and SYNTAX Score on Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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