51
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Shiono Y. Benefits of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention. JACC. ASIA 2022; 2:604-606. [PMID: 36624787 PMCID: PMC9823274 DOI: 10.1016/j.jacasi.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Yasutsugu Shiono
- Address for correspondence: Dr Yasutsugu Shiono, Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8509, Japan.
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52
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Clinical outcomes and echocardiographic characteristics between African American and Caucasian patients with acute pulmonary embolism. Phlebology 2022; 37:678-685. [DOI: 10.1177/02683555221128120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Despite socioeconomic disparities, no association between clinical presentation and poor outcomes explains a higher mortality in African Americans with pulmonary embolism (PE). The objective is to identify the co-morbidities and echocardiographic characteristics associated with increased mortality in African American patients. Methods This is a cross-sectional study of Caucasian or African American patients with PE diagnosed between October 2015 and December 2017 at University of Maryland Medical Center. The outcomes were in-hospital death, length of stay, and bleeding. Results There were 303 African Americans and 343 Caucasians. Caucasians were older ( p = 0.007), males ( p = 0.01) with history of coronary artery revascularization (CABG ( p = 0.001), coronary stents ( p = 0.001)), trauma ( p = 0.007), and/or recent surgeries ( p = 0.0001). African Americans exhibited higher rates of diabetes ( p = 0.01), chronic kidney disease ( p = 0.0005), and smoking ( p = 0.04). Severity of PE was similar between groups and there was no difference in clot burden size. African Americans had more right ventricular strain on Computer Tomography ( p = 0.001) and echocardiogram ( p = 0.004); also, underfilled left ventricles ( p = 0.02) and higher right ventricular systolic pressures ( p = 0.001). There was no difference in hospital mortality (7.1% vs. 7.9%, p = 0.71), length of stay (13.1 ± 16.7 vs 12.8 ± 14.9, p = 0.80) and bleeding (9.0% vs.8.3%. p = 0.72). Mortality was higher in African Americans who received advanced therapies (3.8% vs. 18.8%, p = 0.02). The risk of death increased with age (OR 1.04; 95%CI 1.020–1.073) and with advanced therapies (OR 2.43; 95%CI 1.029–5.769). Conclusions Differences in co-morbidities, radiologic findings, and echocardiographic characteristics that may contribute to higher mortality in African American patients, specifically those receiving advanced therapies.
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53
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Spirito A, Cao D, Mehran R. Subjective angina or myocardial ischaemia to justify PCI? Never mistake the finger for the moon. Eur Heart J 2022; 43:3145-3147. [PMID: 35789263 DOI: 10.1093/eurheartj/ehac353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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54
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Bittl JA, Tamis-Holland JE, Lawton JS. Does Bypass Surgery or Percutaneous Coronary Intervention Improve Survival in Stable Ischemic Heart Disease? JACC Cardiovasc Interv 2022; 15:1243-1248. [PMID: 35583361 DOI: 10.1016/j.jcin.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Affiliation(s)
- John A Bittl
- Scientific Publishing Committee, American College of Cardiology, Washington, DC, USA.
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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55
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Harris E, Conway D, Jimenez-Aranda A, Butts J, Hedley-Takhar P, Thomson R, Astin F. Development and user-testing of a digital patient decision aid to facilitate shared decision-making for people with stable angina. BMC Med Inform Decis Mak 2022; 22:143. [PMID: 35624456 PMCID: PMC9137092 DOI: 10.1186/s12911-022-01882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research shows that people with stable angina need decision support when considering elective treatments. Initial treatment is with medicines but patients may gain further benefit with invasive percutaneous coronary intervention (PCI). Choosing between these treatments can be challenging for patients because both confer similar benefits but have different risks. Patient decision aids (PtDAs) are evidence-based interventions that support shared decision-making (SDM) when making healthcare decisions. This study aimed to develop and user-test a digital patient decision aid (CONNECT) to facilitate SDM for people with stable angina considering invasive treatment with elective PCI. Methods A multi-phase study was conducted to develop and test CONNECT (COroNary aNgioplasty dECision Tool) using approaches recommended by the International Patient Decision Aid Standards Collaboration: (i) Steering Group assembled, (ii) review of clinical guidance, (iii) co-design workshops with patients and cardiology health professionals, (iv) first prototype developed and ‘alpha’ tested (semi-structured cognitive interviews and 12-item acceptability questionnaire) with patients, cardiologists and cardiac nurses, recruited from two hospitals in Northern England, and (v) final PtDA refined following iterative user-feedback. Quantitative data were analysed descriptively and qualitative data from the interviews analysed using deductive content analysis. Results CONNECT was developed and user-tested with 34 patients and 29 cardiology health professionals. Findings showed that CONNECT was generally acceptable, usable, comprehensible, and desirable. Participants suggested that CONNECT had the potential to improve care quality by personalising consultations and facilitating SDM and informed consent. Patient safety may be improved as CONNECT includes questions about symptom burden which can identify asymptomatic patients unlikely to benefit from PCI, as well as those who may need to be fast tracked because of worsening symptoms. Conclusions CONNECT is the first digital PtDA for people with stable angina considering elective PCI, developed in the UK using recommended processes and fulfilling international quality criteria. CONNECT shows promise as an approach to facilitate SDM and should be evaluated in a clinical trial. Further work is required to standardise the provision of probabilistic risk information for people considering elective PCI and to understand how CONNECT can be accessible to underserved communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01882-x.
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Affiliation(s)
- Emma Harris
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Dwayne Conway
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angel Jimenez-Aranda
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,NIHR Devices for Dignity MedTech Co-Operative, Sheffield, UK
| | - Jeremy Butts
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Philippa Hedley-Takhar
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,NIHR Devices for Dignity MedTech Co-Operative, Sheffield, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Felicity Astin
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK. .,Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK.
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56
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Rocha ASCD, Silva PRDD. Chronic Coronary Syndrome: Medical Therapy or Myocardial Revascularization? INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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57
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Weintraub WS. Revascularization for stable ischemic heart disease: the beat goes on. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40:48-49. [DOI: 10.1016/j.carrev.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
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58
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Guo X, Ji Q, Wu M, Ma W. Naringin attenuates acute myocardial ischemia-reperfusion injury via miR- 126/GSK-3β/β-catenin signaling pathway. Acta Cir Bras 2022; 37:e370102. [PMID: 35416858 PMCID: PMC9000977 DOI: 10.1590/acb370102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/06/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction: Myocardial ischemia-reperfusion (I/R) injury is one of the mechanisms
contributing to the high mortality rate of acute myocardial infarction. Purpose: This study intended to study the role of naringin in cardiac I/R injury. Methods: AC16 cells (human cardiomyocyte cell line) were subjected to oxygen-glucose
deprivation/recovery (OGD/R) treatment and/or naringin pretreatment. Then,
the apoptosis was examined by flow cytometry and Western blotting. The
concentration of IL-6, IL-8 and TNF-α was measured by enzyme-linked
immunosorbent assay (ELISA) kits. How naringin influenced microRNA
expression was examined by microarrays and quantitative real-time polymerase
chain reaction (qRT-PCR). Dual luciferase reporter assay was employed to
evaluate the interaction between miR-126 and GSK-3β. The GSK-3β/β-catenin
signaling pathway was examined by Western blotting. Finally, rat myocardial
I/R model was created to examine the effects of naringin in
vivo. Results: Naringin pretreatment significantly decreased the cytokine release and
apoptosis of cardiomyocytes exposed to OGD/R. Bioinformatical analysis
revealed that naringin upregulated miR-126 expression considerably. Also, it
was found that miR-126 can bind GSK-3β and downregulate its expression,
suggesting that naringin could decrease GSK-3β activity. Next, we discovered
that naringin increased β-catenin activity in cardiomyocytes treated with
OGD/R by inhibiting GSK-3β expression. Our animal experiments showed that
naringin pre-treatment or miR-126 agomir alleviated myocardial I/R. Conclusions: Naringin preconditioning can reduce myocardial I/R injury via regulating
miR-126/GSK-3β/β-catenin signaling pathway, and this chemical can be used to
treat acute myocardial infarction.
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Affiliation(s)
| | | | - Mei Wu
- Shandong University, China
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59
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Hinton J, Bashar H, Curzen N. Atheroma or ischemia: which is more important for managing patients with stable chest pain? Future Cardiol 2022; 18:417-429. [PMID: 35360934 DOI: 10.2217/fca-2021-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the evaluation and management of patients with stable chest pain/chronic coronary syndrome, cardiologists need to be able to weigh up the relative merits of managing these patients using either optimal therapy alone or optimal therapy plus revascularization. These decisions rely on an understanding of both the presence and the degree of coronary atheroma and myocardial ischemia, and the impact that these have on patients' symptoms and their prognosis. In this review the authors examine the relative impact of the anatomical and physiological assessment of patients with chronic coronary syndrome and how it can be used to achieve optimal and tailored therapy.
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Affiliation(s)
- Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Hussein Bashar
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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60
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Bangalore S, Spertus JA, Stevens SR, Jones PG, Mancini GBJ, Leipsic J, Reynolds HR, Budoff MJ, Hague CJ, Min JK, Boden WE, O'Brien SM, Harrington RA, Berger JS, Senior R, Peteiro J, Pandit N, Bershtein L, de Belder MA, Szwed H, Doerr R, Monti L, Alfakih K, Hochman JS, Maron DJ. Outcomes With Intermediate Left Main Disease: Analysis From the ISCHEMIA Trial. Circ Cardiovasc Interv 2022; 15:e010925. [PMID: 35411785 DOI: 10.1161/circinterventions.121.010925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with significant (≥50%) left main disease (LMD) have a high risk of cardiovascular events, and guidelines recommend revascularization to improve survival. However, the impact of intermediate LMD (stenosis, 25%-49%) on outcomes is unclear. METHODS Randomized ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) participants who underwent coronary computed tomography angiography at baseline were categorized into those with (25%-49%) and without (<25%) intermediate LMD. The primary outcome was a composite of cardiovascular mortality, myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. The primary quality of life outcome was the Seattle Angina Questionnaire summary score. RESULTS Among the 3699 participants who satisfied the inclusion criteria, 962 (26%) had intermediate LMD. Among invasive strategy participants with intermediate LMD on coronary computed tomography angiography, 49 (7.0%) had significant (≥50% stenosis) left main stenosis on invasive angiography. Patients with intermediate LMD had a higher risk of cardiovascular events in the unadjusted but not in the fully adjusted model compared with those without intermediate LMD. An invasive strategy increased procedural MI and decreased nonprocedural MI with no significant difference for other outcomes including the primary end point. There was no meaningful heterogeneity of treatment effect based on intermediate LMD status except for nonprocedural MI for which there was a greater absolute reduction with invasive management in the intermediate LMD group (-6.4% versus -2.0%; Pinteraction=0.049). The invasive strategy improved angina-related quality of life and the benefit was durable throughout follow-up without significant heterogeneity based on intermediate LMD status. CONCLUSIONS In the ISCHEMIA trial, there was no meaningful heterogeneity of treatment benefit from an invasive strategy regardless of intermediate LMD status except for a greater absolute risk reduction in nonprocedural MI with invasive management in those with intermediate LMD. An invasive strategy increased procedural MI, reduced nonprocedural MI, and improved angina-related quality of life. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01471522.
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Affiliation(s)
- Sripal Bangalore
- Department of Medicine, New York University Grossman School of Medicine (S.B., H.R.R., J.S.B., J.S.H.)
| | - John A Spertus
- Department(s) of Biomedical and Health Informatics, UMKC School of Medicine, Kansas City, MO (J.A.S.)
| | - Susanna R Stevens
- Department of Biostatistics & Bioinformatics, Duke Clinical Research Institute, Durham, NC (S.R.S., S.M.O.)
| | - Philip G Jones
- Department of Cardiology, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (P.G.J.)
| | - G B John Mancini
- Division of Cardiology (G.B.J.M.), Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology (J.L., C.J.H.), Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | - Harmony R Reynolds
- Department of Medicine, New York University Grossman School of Medicine (S.B., H.R.R., J.S.B., J.S.H.)
| | - Matthew J Budoff
- Division of Cardiology, Lundquist Institute, Torrance, CA (M.J.B.)
| | - Cameron J Hague
- Department of Radiology (J.L., C.J.H.), Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | | | - William E Boden
- Department of Medicine, VA New England Healthcare System, Boston, MA (W.E.B.)
| | - Sean M O'Brien
- Department of Biostatistics & Bioinformatics, Duke Clinical Research Institute, Durham, NC (S.R.S., S.M.O.)
| | | | - Jeffrey S Berger
- Department of Medicine, New York University Grossman School of Medicine (S.B., H.R.R., J.S.B., J.S.H.)
| | - Roxy Senior
- Department of Medicine, Northwick Park Hospital-Royal Brompton Hospital, London, United Kingdom (R.S.)
| | - Jesus Peteiro
- Department of Cardiology, CHUAC, Universidad de A Coruña, CIBER-CV, A Coruna, Spain (J.P.)
| | - Neeraj Pandit
- Department of Cardiology, Ram Manohar Lohia Hospital, Delhi, India (N.P.)
| | - Leonid Bershtein
- Department of Cardiology, North-Western State Medical University I.I. Mechnikov, Saint Petersburg, Russian Federation (L.B.)
| | - Mark A de Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.)
| | - Hanna Szwed
- Department of Cardiology, National Institute of Cardiology, Warsaw, Poland (H.S.)
| | - Rolf Doerr
- Department of Cardiology, Praxislinik Herz und Gefaesse, Dresden, Germany (R.D.)
| | - Lorenzo Monti
- Department of Radiology, Istituto Clinico Humanitas, Rozzano, Milano, Italy (L.M.)
| | - Khaled Alfakih
- Department of Cardiology, King's College Hospital, London, United Kingdom (K.A.)
| | - Judith S Hochman
- Department of Medicine, New York University Grossman School of Medicine (S.B., H.R.R., J.S.B., J.S.H.)
| | - David J Maron
- Department of Medicine, Stanford University, CA (R.A.H., D.J.M.)
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61
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Ruel M, Williams A, Ouzounian M, Sun L, Légaré JF, Poirier P, Malas T, Farkouh ME, Chedrawy E, Hassan A, Higgins J, Connelly K, McClure RS, Bewick D, Whitlock R, Graham M, Arora RC. Missing the Goal with the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. Can J Cardiol 2022; 38:705-708. [PMID: 35341903 DOI: 10.1016/j.cjca.2022.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON.
| | - Anne Williams
- Division of Cardiology, Department of Medicine, Memorial University, St. John's, NL
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, ON
| | | | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, QC
| | - Tarek Malas
- Département de Chirurgie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, QC
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, ON
| | - Edgar Chedrawy
- Division of Cardiac Surgery, QEII Health Sciences Centre, Halifax, NS
| | - Ansar Hassan
- Department of Cardiovascular Surgery, Maine Medical Center, Portland, Maine, USA
| | - Jennifer Higgins
- Division of Cardiac Surgery, St. Mary's General Hospital, Kitchener, ON
| | - Kim Connelly
- Keenan Research Centre for Biomedical Science, UnityHealth, University of Toronto, ON
| | - R Scott McClure
- Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, AB
| | - David Bewick
- Department of Medicine, New Brunswick Heart Center, Saint John, NB
| | | | - Michelle Graham
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB
| | - Rakesh C Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, MB
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62
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Nakano S, Kohsaka S, Chikamori T, Fukushima K, Kobayashi Y, Kozuma K, Manabe S, Matsuo H, Nakamura M, Ohno T, Sawano M, Toda K, Ueda Y, Yokoi H, Gatate Y, Kasai T, Kawase Y, Matsumoto N, Mori H, Nakazato R, Niimi N, Saito Y, Shintani A, Watanabe I, Watanabe Y, Ikari Y, Jinzaki M, Kosuge M, Nakajima K, Kimura T. JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease. Circ J 2022; 86:882-915. [DOI: 10.1253/circj.cj-21-1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shintaro Nakano
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University
| | | | - Ken Kozuma
- Cardiology, Teikyo University School of Medicine
| | - Susumu Manabe
- Cardiac Surgery, International University of Health and Welfare Mita Hospital
| | | | - Masato Nakamura
- Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Koichi Toda
- Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Hiroyoshi Yokoi
- Cardiovascular Center, International University of Health and Welfare Fukuoka Sanno Hospital
| | - Yodo Gatate
- Cardiology, Self-Defense Forces Central Hospital
| | | | | | | | - Hitoshi Mori
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Yuichi Saito
- Cardiovascular Medicine, Chiba University School of Medicine
| | - Ayumi Shintani
- Medical Statistics, Osaka City University Graduate School of Medicine
| | - Ippei Watanabe
- Cardiovascular Medicine, Toho University School of Medicine
| | | | - Yuji Ikari
- Cardiology, Tokai University School of Medicine
| | | | | | - Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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63
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Hart A, Wang J. Routine Cardiac Stress Testing in Potential Kidney Transplant Candidates Is Only Appropriate in Symptomatic Individuals: COMMENTARY. KIDNEY360 2022; 3:2017-2018. [PMID: 36594900 PMCID: PMC9802561 DOI: 10.34067/kid.0001692022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Allyson Hart
- Hennepin Healthcare, Division of Nephrology, Minneapolis, Minnesota,University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jeffrey Wang
- Hennepin Healthcare, Division of Nephrology, Minneapolis, Minnesota,University of Minnesota Medical School, Minneapolis, Minnesota
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64
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Sharif A. Routine Cardiac Stress Testing in Potential Kidney Transplant Candidates Is Only Appropriate in Symptomatic Individuals: PRO. KIDNEY360 2022; 3:2008-2012. [PMID: 36591364 PMCID: PMC9802564 DOI: 10.34067/kid.0007592020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, United Kingdom,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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65
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Sharp AL, Kawatkar AA, Baecker AS, Redberg RF, Lee MS, Ferencik M, Wu YL, Shen E, Zheng C, Park S, Goodacre S, Thokala P, Sun BC. Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome? J Gen Intern Med 2022; 37:745-752. [PMID: 33987795 PMCID: PMC8904710 DOI: 10.1007/s11606-021-06841-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes. OBJECTIVE The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) evaluation for suspected acute coronary syndrome. DESIGN A retrospective, multi-site, cohort study of adult encounters with chest pain presenting to one of 13 Kaiser Permanente Southern California EDs between January 1, 2015, and December 1, 2017. Instrumental variable analysis was used to mitigate potential confounding by unobserved factors. PATIENTS All adult patients presenting to an ED with chest pain, in whom an acute myocardial infarction was not diagnosed in the ED, were included. MAIN MEASURES The primary outcome was 30-day acute myocardial infarction or all-cause mortality, and secondary outcomes included 30-day revascularization and major adverse cardiac events. KEY RESULTS In total, 77,652 patient encounters were included in the study (n=11,026 admitted, 14.2%). Three hundred twenty-two (0.4%) had an acute myocardial infarction (n=193, 0.2%) or death (n=137, 0.2%) within 30 days of ED visit (1.5% hospitalized versus 0.2% discharged). Very few (0.3%) patients underwent coronary revascularization within 30 days (0.7% hospitalized versus 0.2% discharged). Instrumental variable analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI -0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI -0.002 to 0.007). CONCLUSION Among ED patients with chest pain not diagnosed with an acute myocardial infarction, risk of major adverse cardiac events is quite low, and there does not appear to be any benefit in 30-day outcomes for those admitted or observed in the hospital compared to those discharged with outpatient follow-up.
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Affiliation(s)
- Adam L Sharp
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA.
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, CA, Pasadena, USA.
| | - Aniket A Kawatkar
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Aileen S Baecker
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rita F Redberg
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Ming-Sum Lee
- Division of Cardiology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Yi-Lin Wu
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ernest Shen
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Chengyi Zheng
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Stacy Park
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, Regent Street, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, Regent Street, Sheffield, UK
| | - Benjamin C Sun
- Department of Emergency Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Yadava OP, Narayan P, Padmanabhan C, Sajja LR, Sarkar K, Varma PK, Jawali V. IACTS position statement on "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization": section 7.1-a consensus document. Indian J Thorac Cardiovasc Surg 2022; 38:126-133. [PMID: 35221551 PMCID: PMC8857365 DOI: 10.1007/s12055-022-01329-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
American College of Cardiology (ACC), American Heart Association (AHA) and Society for Cardiovascular Angiography and Interventions (SCAI) recently released the Clinical Practice Guidelines for myocardial revascularization [1]. The guidelines were the felt need of the fraternity and this single all-encompassing document, relegating the previous six guidelines on the subject to archives, is indeed welcome. However, the downgrading of coronary artery bypass surgery for stable multivessel coronary artery disease and its bracketing with percutaneous coronary interventions has caused a lot of anguish in the surgical fraternity. This document presents the official viewpoint of the Indian Association of Cardiovascular and Thoracic Surgeons on the matter.
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Affiliation(s)
| | - Pradeep Narayan
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | | | - Praveen Kerala Varma
- Dept of Cardio-Thoracic and Vascular Surgery, Amrita Institute of Medical Sciences, Cochin, India
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Outcomes with revascularization and medical therapy in patients with coronary disease and chronic kidney disease: A meta-analysis. Atherosclerosis 2022; 351:41-48. [DOI: 10.1016/j.atherosclerosis.2022.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/28/2021] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
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Lansky A, Baron SJ, Grines CL, Tremmel JA, Al-Lamee R, Angiolillo DJ, Chieffo A, Croce K, Jacobs AK, Madan M, Maehara A, Mehilli J, Mehran R, Ng V, Parikh PB, Saw J, Abbott JD. SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100016. [PMID: 39132570 PMCID: PMC11307953 DOI: 10.1016/j.jscai.2021.100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Affiliation(s)
| | | | - Cindy L. Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | | | | | - Alaide Chieffo
- University of Florida Health Sciences Center, Jacksonville, Florida
| | - Kevin Croce
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Alice K. Jacobs
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Akiko Maehara
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Ng
- Columbia University Irving Medical Center, New York, New York
| | - Puja B. Parikh
- Stony Brook University Medical Center, Stony Brook, New York
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - J. Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Verreault-Julien L, Bhatt DL, Jung RG, Di Santo P, Simard T, Avram R, Hibbert B. Predictors of angina resolution after percutaneous coronary intervention in stable coronary artery disease. Coron Artery Dis 2022; 33:98-104. [PMID: 34148973 DOI: 10.1097/mca.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Elective percutaneous coronary intervention (PCI) is performed to relieve symptoms of angina. Identifying patients who will benefit symptomatically after PCI would be clinically advantageous but robust predictors of symptom resolution are ill-defined. METHODS Prospective indexing of baseline angina status, clinical, and procedural characteristics were collected over a 5-year period in a regional revascularization registry. At 1-year follow-up, angina resolution was assessed. We performed a stepwise selection algorithm to identify predictors of persistent angina at 1 year. RESULTS A total of 777 patients were included in the analysis and the median follow-up was 387 days. Mean age of the cohort was 66.6 years, 23.8% were female and 23.3% had baseline Canadian Cardiovascular Society class 3 or 4 angina. Overall, 13.1% had persistent angina. The only predictor of persistent angina was the presence of a residual chronic total occlusion after PCI with odds ratio of 3.06 (95% confidence interval, 1.81-5.17). Residual stenoses 50-69%, 70-89%, and 90-99% were not associated with residual angina after PCI. CONCLUSION Most patients achieved symptom resolution with PCI and optimal medical therapy. A residual chronic total occlusion after PCI was associated with persistent angina. Other degrees of stenoses were not associated with persistent angina.
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Affiliation(s)
- Louis Verreault-Julien
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Harvard University
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center
- Harvard Medical School, Boston, MA, USA
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine
- School of Epidemiology and Public Health
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Avram
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine
- School of Epidemiology and Public Health
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Liao GZ, Li YM, Bai L, Ye YY, Peng Y. Revascularization vs. Conservative Medical Treatment in Patients With Chronic Kidney Disease and Coronary Artery Disease: A Meta-Analysis. Front Cardiovasc Med 2022; 8:818958. [PMID: 35198607 PMCID: PMC8858980 DOI: 10.3389/fcvm.2021.818958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022] Open
Abstract
BackgroundAs a strong risk factor for coronary artery disease (CAD), chronic kidney disease (CKD) indicates higher mortality in patients with CAD. However, the optimal treatment for the patients with two coexisting diseases is still not well defined.MethodsTo conduct a meta-analysis, PubMed, Embase, and the Cochrane database were searched for studies comparing medical treatment (MT) and revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] in adults with CAD and CKD. Long-term all-cause mortality was evaluated, and subgroup analyses were performed.ResultsA total of 13 trials met our selection criteria. Long-term (with at least a 1-year follow-up) mortality was significantly lower in the revascularization arm [relative risk (RR) = 0.66; 95% CI = 0.60–0.72] by either PCI (RR = 0.61; 95% CI = 0.55–0.68) or CABG (RR = 0.62; 95% CI = 0.46–0.84). The results were consistent in dialysis patients (RR = 0.68; 95% CI = 0.59–0.79), patients with stable CAD (RR = 0.75; 95% CI = 0.61–0.92), patients with acute coronary syndrome (RR = 0.62; 95% CI = 0.58–0.66), and geriatric patients (RR = 0.57; 95% CI = 0.54–0.61).ConclusionIn patients with CKD and CAD, revascularization is more effective in reducing mortality than MT alone. This observed benefit is consistent in patients with stable CAD and elderly patients. However, future randomized controlled trials (RCTs) are required to confirm these findings.
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Koshy AN, Dinh DT, Fulcher J, Brennan AL, Murphy AC, Duffy SJ, Reid CM, Ajani AE, Freeman M, Hiew C, Oqueli E, Farouque O, Yudi MB, Clark DJ. Long-term mortality in asymptomatic patients with stable ischemic heart disease undergoing percutaneous coronary intervention. Am Heart J 2022; 244:77-85. [PMID: 34780716 DOI: 10.1016/j.ahj.2021.10.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/27/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Patients with stable ischemic heart disease (SIHD) may present with a variety of symptoms including typical angina, angina equivalents such as dyspnea or no symptoms. We sought to determine whether symptom status affects periprocedural safety and long-term mortality in patients undergoing PCI. METHODS Prospectively enrolled consecutive patients undergoing PCI for SIHD at six hospitals in Australia between 2005 to 2018 as part of the Melbourne Interventional Group registry. Symptom status was recorded at the time of PCI and patients undergoing staged PCI were excluded. RESULTS Overall, 11,730 patients with SIHD were followed up for a median period of 5 years (maximum 14.0 years, interquartile range 2.2-9.0 years) with 1,317 (11.2%) being asymptomatic. Asymptomatic patients were older, and more likely to be male, have triple-vessel disease, with multiple comorbidities including renal failure, diabetes and heart failure (all P < .01). These patients had significantly higher rates of periprocedural complications and major adverse cardiovascular events at 30-days. Long-term mortality was significantly higher in asymptomatic patients (27.2% vs 18.0%, P < .001). On cox regression for long-term mortality, after adjustment for more important clinical variables, asymptomatic status was an independent predictor (Hazard ratio (HR) 1.39 95% CI 1.16-1.66, P < .001). CONCLUSIONS In a real-world cohort of patients undergoing revascularization for SIHD, absence of symptoms was associated with higher rates of periprocedural complications and, after adjustment for more important clinical variables, was an independent predictor of long-term mortality. As the primary goal of revascularization in SIHD remains angina relief, the appropriateness of PCI in the absence of symptoms warrants justification.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Diem T Dinh
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Jordan Fulcher
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Stephen J Duffy
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- The University of Melbourne, Parkville, Victoria; Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria; School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 596] [Impact Index Per Article: 298.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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73
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Yong J, Tian J, Zhao X, Yang X, Zhang M, Zhou Y, He Y, Song X. Revascularization or medical therapy for stable coronary artery disease patients with different degrees of ischemia: a systematic review and meta-analysis of the role of myocardial perfusion. Ther Adv Chronic Dis 2022; 13:20406223211056713. [PMID: 35070247 PMCID: PMC8777334 DOI: 10.1177/20406223211056713] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study explored the best treatment strategies for stable coronary artery disease (SCAD) patients with differing levels of ischemic severity. METHODS We conducted a comprehensive search of the PubMed, EMBASE, and Cochrane databases - searching for relevant articles through 4 February 2021. We selected studies comparing different treatments for patients with SCAD who had received ischemia assessments. The primary outcome was death. The secondary outcomes were major adverse cardiovascular events (MACEs) and myocardial infarction (MI). RESULTS A total of 11 studies, including 35,607 subjects, were selected for this meta-analysis. Results showed that, compared with medical therapy, revascularization could reduce MACE incidence (odds ratio (OR) 0.73, 95% confidence interval (CI): 0.57-0.94, p < 0.05) in SCAD patients with myocardial ischemia, but that it was not effective for patients without ischemia. For mild ischemia, the incidence of death (OR 0.78, 95% CI: 0.59-1.01, p = 0.063), MACE (OR 0.91, 95% CI: 0.48-1.70, p = 0.762), or MI (OR 1.44, 95% CI: 0.94-2.19, p = 0.093) was the same whether they were treated with revascularization or medical therapy. For moderate to severe ischemia, revascularization reduced the incidence of MACE (OR 0.59, 95% CI: 0.42-0.83, p < 0.05) and MI (OR 0.83, 95% CI: 0.71-0.98, p < 0.05), but the incidence of death (OR 0.73, 95% CI: 0.47-1.12, p = .145) was similar. For SCAD patients with severe ischemia, revascularization may confer survival benefits (OR 0.46, 95% CI: 0.21-1.00, p = 0.05). CONCLUSION For SCAD patients with moderate to severe ischemia, revascularization reduces the MACE and MI incidences, but does not change the incidence of death. Evaluation for myocardial ischemia is vital when selecting a therapeutic strategy.
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Affiliation(s)
- JingWen Yong
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - JinFan Tian
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - XueYao Yang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - MingDuo Zhang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhou
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship
Hospital, Capital Medical University, Yongan Road 95, Beijing 100050,
China
| | - XianTao Song
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District,
Beijing 100029, China
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Park H, Kang DY, Lee CW. Functional Angioplasty: Definitions, Historical Overview, and Future Perspectives. Korean Circ J 2022; 52:34-46. [PMID: 34989193 PMCID: PMC8738709 DOI: 10.4070/kcj.2021.0363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 01/09/2023] Open
Abstract
Percutaneous coronary intervention (PCI) is used to treat obstructive coronary artery disease (CAD). The role of PCI is well defined in acute coronary syndrome, but that for stable CAD remains debatable. Although PCI generally relieves angina in patients with stable CAD, it may not change its prognosis. The extent and severity of CAD are major determinants of prognosis, and complete revascularization (CR) of all ischemia-causing lesions might improve outcomes. Several studies have shown better outcomes with CR than with incomplete revascularization, emphasizing the importance of functional angioplasty. However, different definitions of inducible myocardial ischemia have been used across studies, making their comparison difficult. Various diagnostic tools have been used to estimate the presence, extent, and severity of inducible myocardial ischemia. However, to date, there are no agreed reference standards of inducible myocardial ischemia. The hallmarks of inducible myocardial ischemia such as electrocardiographic changes and regional wall motion abnormalities may be more clinically relevant as the reference standard to define ischemia-causing lesions. In this review, we summarize studies regarding myocardial ischemia, PCI guidance, and possible explanations for similar findings across studies. Also, we provide some insights into the ideal definition of inducible myocardial ischemia and highlight the appropriate PCI strategy.
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Bittl JA, Bangalore S, DiMaio JM, Grant MC, Lawton JS, Tamis Holland JE. Putting the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization Into Practice. JACC Case Rep 2022; 4:31-35. [PMID: 35036940 PMCID: PMC8743811 DOI: 10.1016/j.jaccas.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
This case series shows how the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization can be used to decide between revascularization or optimal medical therapy to reduce mortality or cardiovascular events in selected subsets of patients with stable ischemic heart disease and complex coronary disease with or without left ventricular dysfunction. (Level of Difficulty: Advanced.)
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Affiliation(s)
- John A. Bittl
- Cardiac Catheterization Laboratory, AdventHealth Ocala, Ocala, Florida, USA
- Address for correspondence: Dr John A. Bittl, 32 Boardwalk, Groton, Connecticut 06340, USA. @BittlMd
| | - Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York, USA
| | - J. Michael DiMaio
- Department of Surgery, Baylor Scott & White Health System, Plano, Texas, USA
| | - Michael C. Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer S. Lawton
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1155-1161. [DOI: 10.1093/ejcts/ezac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 01/09/2023] Open
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Kumar A, Doshi R, Khan SU, Shariff M, Baby J, Majmundar M, Kanaa'N A, Hedrick DP, Puri R, Reed G, Mehran R, Kapadia S, Khot UN, Kalra A. Revascularization or optimal medical therapy for stable ischemic heart disease: A Bayesian meta-analysis of contemporary trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:42-47. [PMID: 35210188 DOI: 10.1016/j.carrev.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The role of revascularization in patients with stable ischemic heart disease (SIHD) has been controversial, more so in the present era of drug-eluting stents. AIMS To examine the absolute risk difference (ARD) between revascularization plus optimal medical therapy (OMT) versus OMT alone among patients with SIHD using Bayesian approach. METHODS PubMed/MEDLINE and Cochrane citation indices were utilized to identify randomized controlled trials (RCTs) through March 31, 2020. Among trials comparing initial revascularization plus OMT with initial OMT alone, revascularization arm must have comprised >50% of patients receiving either percutaneous or surgical revascularization, and >50% of patients must have received aspirin and statin as OMT in both arms. RESULTS Seven RCTs (12,494) were included in the final analysis. The ARD of all-cause mortality for revascularization with respect to OMT was centred at -0.002 (95% CrI: -0.01; 0.01, Tau: 0.01, 67% probability of ARD of revascularization vs. OMT < 0). The ARD for cardiac mortality was centred at -0.0025 (95%CrI: -0.01; 0.01, Tau: 0.01, 77% probability of ARD of revascularization vs. OMT < 0). The ARD for MI was -0.02 (95% CrI: -0.06; 0.00, Tau: 0.02, 97% probability of ARD for revascularization vs. OMT < 0). There was 96% probability of ARD for unstable angina with revascularization vs. OMT < 0, 4.5% probability of ARD for freedom from angina with revascularization vs. OMT < 0, and 6% probability of ARD for stroke with revascularization vs. OMT < 0. CONCLUSIONS Bayesian analysis demonstrated minimal probability of difference in all-cause mortality and cardiac mortality in patients with SIHD who underwent revascularization compared with OMT alone. However, revascularization was associated with lower probability of MI, unstable angina, and increased freedom from angina, but a higher risk of stroke compared with OMT alone. PROSPERO The protocol of this systematic review and meta-analysis was registered in PROSPERO [CRD42020160540].
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's Medical Centre, Paterson, NJ, USA
| | - Safi U Khan
- Department of Internal Medicine, West Virginia University, Morgantown, WV, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeswin Baby
- Division of Epidemiology and Biostatistics, St John's Research Institute, Bangalore, India; Department of Statistical Sciences, Kannur University, Kerala, India
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, NYC, USA
| | - Anmar Kanaa'N
- Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - David P Hedrick
- Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Umesh N Khot
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e4-e17. [PMID: 34882436 DOI: 10.1161/cir.0000000000001039] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.
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80
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2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:197-215. [PMID: 34895951 DOI: 10.1016/j.jacc.2021.09.005] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.
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81
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (DGK). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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82
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Alperi A, Mohammadi S, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Faroux L, Veiga G, Serra V, Fischer Q, Pascual I, Asmarats L, Gutiérrez E, Regueiro A, Vilalta V, Ribeiro HB, Matta A, Munoz-Garcia A, Armijo G, Metz D, De la Torre Hernandez JM, Rodenas-Alesina E, Urena M, Moris C, Arzamendi D, Perez-Fuentes P, Fernandez-Nofrerias E, Campanha-Borges DC, Mesnier J, Voisine P, Dumont E, Kalavrouziotis D, Rodés-Cabau J. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease. JACC Cardiovasc Interv 2021; 14:2490-2499. [PMID: 34794656 DOI: 10.1016/j.jcin.2021.08.073] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Henrique B Ribeiro
- Instituto do Coração (InCor), Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic de Barcelona, Barcelona, Spain.
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83
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Winkler MA, Patel R, Fu W, Arora V, Weintraub NL. Three Technologies That Will Guide Revascularization of Chronic Coronary Syndrome Patients into the 21st Century: A Review. Int J Angiol 2021; 30:212-220. [PMID: 34776821 DOI: 10.1055/s-0041-1735201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Although medical therapy is the preferred first-line treatment for patients with chronic coronary syndrome (CCS), revascularization remains an important consideration. We present a review that identifies the three diagnostic technologies most important to guiding the decision to revascularize patients with CCS: (1) cardiac computed tomography, (2) intracoronary imaging, and (3) lesion-specific physiological guidance.
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Affiliation(s)
- Michael A Winkler
- Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia.,Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Ripa Patel
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Weibo Fu
- Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Vishal Arora
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Neal L Weintraub
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.,Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia
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84
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Bershtein LL, Zbyshevskaya EV, Gumerova VE. Optimum Treatment Strategy in Chronic Coronary Syndromes: the New Trials vs the Current Guidelines. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Coronary revascularization is one of the most studied types of interventions in cardiology, but there is no consensus among specialists about the indications for its implementation in patients with chronic coronary syndromes (CCS). The data of recently completed clinical trials on the role of revascularization in CCS clearly contradict the current Guidelines, emphasizing the high effectiveness of modern conservative therapy. This paper discusses the main recommendations of the most significant American and European Guidelines on myocardial revascularization, and also analyzes the appropriateness of revascularization to improve the prognosis and symptoms in chronic coronary syndromes in view of the new research data, primarily the ISCHEMIA study (NCT01471522). Its strengths and limitations are discussed in detail. The data on the expediency of revacularization in CCS, obtained after the completion of ISCHEMIA and its potential significance, as well as subgroup analyses of ISCHEMIA, including in the most important ‘problem’ subgroups (3-vessel disease, proximal LAD disease, severe ischemia on stress test, etc.) are discussed. The paper also discusses the important achievements in modern drug therapy of chronic coronary syndromes, primarily antithrombotic therapy. The data of the COMPASS study (NCT01776424) are discussed, based on which the addition of a second antithrombotic drug – rivaroxaban in a small dose (2.5 mg BID) – is recommended for patients with CCS without atrial fibrillation who have high-risk characteristics. Indications the administration of dual antithrombotic therapy to patients with CCS, comparative results of its various regimens in relation to the prevention of cardiovascular complications, the risk of bleeding and the net clinical effect are given.
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Affiliation(s)
- L. L. Bershtein
- Northwestern State Medical University named after I.I. Mechnikov
| | | | - V. E. Gumerova
- Northwestern State Medical University named after I.I. Mechnikov
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85
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Messerli FH, Shalaeva EV, Rexhaj E. Optimal BP Targets to Prevent Stroke and MI: Is There a Lesser of 2 Evils? J Am Coll Cardiol 2021; 78:1679-1681. [PMID: 34674812 DOI: 10.1016/j.jacc.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Franz H Messerli
- Swiss Cardiovascular Center, Inselspital, University of Bern, Bern, Switzerland.
| | | | - Emrush Rexhaj
- Departments of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
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86
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Newman JD, Anthopolos R, Mancini GJ, Bangalore S, Reynolds HR, Kunichoff DF, Senior R, Peteiro J, Bhargava B, Garg P, Escobedo J, Doerr R, Mazurek T, Gonzalez-Juanatey J, Gajos G, Briguori C, Cheng H, Vertes A, Mahajan S, Guzman LA, Keltai M, Maggioni AP, Stone GW, Berger JS, Rosenberg YD, Boden WE, Chaitman BR, Fleg JL, Hochman JS, Maron DJ. Outcomes of Participants With Diabetes in the ISCHEMIA Trials. Circulation 2021; 144:1380-1395. [PMID: 34521217 PMCID: PMC8545918 DOI: 10.1161/circulationaha.121.054439] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among patients with diabetes and chronic coronary disease, it is unclear if invasive management improves outcomes when added to medical therapy. METHODS The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trials (ie, ISCHEMIA and ISCHEMIA-Chronic Kidney Disease) randomized chronic coronary disease patients to an invasive (medical therapy + angiography and revascularization if feasible) or a conservative approach (medical therapy alone with revascularization if medical therapy failed). Cohorts were combined after no trial-specific effects were observed. Diabetes was defined by history, hemoglobin A1c ≥6.5%, or use of glucose-lowering medication. The primary outcome was all-cause death or myocardial infarction (MI). Heterogeneity of effect of invasive management on death or MI was evaluated using a Bayesian approach to protect against random high or low estimates of treatment effect for patients with versus without diabetes and for diabetes subgroups of clinical (female sex and insulin use) and anatomic features (coronary artery disease severity or left ventricular function). RESULTS Of 5900 participants with complete baseline data, the median age was 64 years (interquartile range, 57-70), 24% were female, and the median estimated glomerular filtration was 80 mL·min-1·1.73-2 (interquartile range, 64-95). Among the 2553 (43%) of participants with diabetes, the median percent hemoglobin A1c was 7% (interquartile range, 7-8), and 30% were insulin-treated. Participants with diabetes had a 49% increased hazard of death or MI (hazard ratio, 1.49 [95% CI, 1.31-1.70]; P<0.001). At median 3.1-year follow-up the adjusted event-free survival was 0.54 (95% bootstrapped CI, 0.48-0.60) and 0.66 (95% bootstrapped CI, 0.61-0.71) for patients with diabetes versus without diabetes, respectively, with a 12% (95% bootstrapped CI, 4%-20%) absolute decrease in event-free survival among participants with diabetes. Female and male patients with insulin-treated diabetes had an adjusted event-free survival of 0.52 (95% bootstrapped CI, 0.42-0.56) and 0.49 (95% bootstrapped CI, 0.42-0.56), respectively. There was no difference in death or MI between strategies for patients with diabetes versus without diabetes, or for clinical (female sex or insulin use) or anatomic features (coronary artery disease severity or left ventricular function) of patients with diabetes. CONCLUSIONS Despite higher risk for death or MI, chronic coronary disease patients with diabetes did not derive incremental benefit from routine invasive management compared with initial medical therapy alone. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
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Affiliation(s)
| | | | - G.B. John Mancini
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, CA
| | | | | | | | - Roxy Senior
- Northwick Park Hospital-Royal Brompton Hospital, London, UK
| | - Jesus Peteiro
- CHUAC, Universidad de A Coruña, CIBER-CV, A Coruna, Spain
| | | | - Pallav Garg
- London Health Sciences Center, Western University, London, Ontario, Canada
| | - Jorge Escobedo
- Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rolf Doerr
- Praxisklinik Herz und Gefaesse, Dresden, Germany
| | | | - Jose Gonzalez-Juanatey
- Cardiology Department. Hospital Clínico Universitario. IDIS, CIBERCV Institution, Santiago de Compostela, Spain
| | - Grzegorz Gajos
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Hong Cheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Andras Vertes
- DPC Hospital, National Institute of Hematology and Infectious Disease, Cardiovascular Department, Budapest, Hungary
| | | | | | | | | | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - William E. Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Bernard R. Chaitman
- St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St. Louis, MO, USA
| | | | | | - David J. Maron
- Department of Medicine, Stanford University, Stanford, CA, USA
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87
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Ventriculo-arterial coupling in patients with stable ischemic heart disease undergoing percutaneous coronary intervention. Int J Cardiovasc Imaging 2021; 38:571-577. [PMID: 34655349 DOI: 10.1007/s10554-021-02437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
To investigate ventriculo-arterial coupling (VAC) and its components (Ea, Ees) in patients with stable ischemic heart disease and changes following percutaneous coronary intervention (PCI). 129 patients with stable ischemic heart disease (SIHD) undergoing PCI (study group) and 40 individuals without IHD (control group) were enrolled. VAC was calculated using echocardiography method at baseline and 1, 3, and 6 months after PCI. A linear mixed-effects models with restricted maximum likelihood were used to assess the impact of PCI on Ea, Ees, VAC over 6-month follow-up. Mean age of the SIHD group was 67.8 ± 8.1 (years), and predominantly men (73.6%). In the SIHD group, baseline median Ea, Ees and VAC were 2.52 (IQR 1.89-3.28) (mmHg/ml), 3.87 (IQR 2.90-4.95) (mmHg/ml), and 0.64 (IQR 0.54-0.79), respectively. Patients with SIHD had significantly lower Ees and higher VAC when compared to the control group (p < 0.05). Ees (p = 0.01) and VAC (p < 0.001) were significantly improved over 6 month follow-up after PCI. Notably, the degree of VAC improvement appears to be related to stented artery (Table 3). VAC obtained from echocardiographic methodology demonstrated a significant increase in patients with SIHD at baseline. This observation may represent a plausible mechanism for the benefit of PCI in SIHD. Hence, VAC may be a feasible parameter in the assessment of patients with SIHD.
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88
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Lehrke M, Niemann B. [Coronary revascularization: Interventional therapy or coronary bypass surgery]. Dtsch Med Wochenschr 2021; 146:1051-1058. [PMID: 34416772 DOI: 10.1055/a-1241-6645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Coronary artery disease remains the leading cause of death and is responsible for myocardial infarction, heart failure and angina. Therapy combines optimal control of cardiovascular risk factors with coronary revascularization performed by interventional therapy or bypass surgery. While interventional therapy is preferred for single or two vessel disease, interdisciplinary heart team decision should be reached for complex lesion, three vessel or left main disease. Both revascularization strategies perform similar for low level complexity three vessel or left main disease while coronary bypass surgery proved superior for more complex coronary artery disease. Heart team decision should be based on vascular anatomy and expected revascularization success under consideration of operative risk and patient preference.
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89
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Völz S, Redfors B, Angerås O, Ioanes D, Odenstedt J, Koul S, Valeljung I, Dworeck C, Hofmann R, Hansson E, Venetsanos D, Ulvenstam A, Jernberg T, Råmunddal T, Pétursson P, Fröbert O, Erlinge D, Jeppsson A, Omerovic E. Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J 2021; 42:2657-2664. [PMID: 34023903 PMCID: PMC8282315 DOI: 10.1093/eurheartj/ehab273] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/15/2020] [Accepted: 04/23/2021] [Indexed: 01/17/2023] Open
Abstract
Aims To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41–0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17–1.38, P
trend < 0.001). Conclusion In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Sasha Koul
- Department of Cardiology, Skåne University Hospital, 22242 Lund, Sweden
| | - Inger Valeljung
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Robin Hofmann
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, 11861 Stockholm, Sweden
| | - Emma Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Dimitrios Venetsanos
- Division of Cardiology, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Karolinska Solna, 171 76 Stockholm, Sweden
| | - Anders Ulvenstam
- Department of Cardiology, Östersund Hospital, 831 83 Östersund, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, 182 88 Stockholm, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Faculty of Health, 781 85 Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, 22242 Lund, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
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90
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Parco C, Brockmeyer M, Kosejian L, Quade J, Tröstler J, Bader S, Lin Y, Sokolowski A, Hoss A, Heinen Y, Schulze V, Icks A, Jung C, Kelm M, Wolff G. National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort. J Nephrol 2021; 34:1491-1500. [PMID: 34363595 PMCID: PMC8494719 DOI: 10.1007/s40620-021-01124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study. METHODS AND RESULTS Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72-0.78; vs. Mehran c-index 0.69, 95% CI 0.66-0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12-0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79-0.91; vs. Mehran c-index 0.75, 95% CI 0.66-0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk. CONCLUSION In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the GRACE model while showing less accurate calibration. Results for the outcome 'need for dialysis' were equivocal.
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Affiliation(s)
- Claudio Parco
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Lucin Kosejian
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Julia Quade
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jennifer Tröstler
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Selina Bader
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yingfeng Lin
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Sokolowski
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Hoss
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yvonne Heinen
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Volker Schulze
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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91
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Unfathomed Nanomessages to the Heart: Translational Implications of Stem Cell-Derived, Progenitor Cell Exosomes in Cardiac Repair and Regeneration. Cells 2021; 10:cells10071811. [PMID: 34359980 PMCID: PMC8307947 DOI: 10.3390/cells10071811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Exosomes formed from the endosomal membranes at the lipid microdomains of multivesicular bodies (MVBs) have become crucial structures responsible for cell communication. This paracrine communication system between a myriad of cell types is essential for maintaining homeostasis and influencing various biological functions in immune, vasculogenic, and regenerative cell types in multiple organs in the body, including, but not limited to, cardiac cells and tissues. Characteristically, exosomes are identifiable by common proteins that participate in their biogenesis; however, many different proteins, mRNA, miRNAs, and lipids, have been identified that mediate intercellular communication and elicit multiple functions in other target cells. Although our understanding of exosomes is still limited, the last decade has seen a steep surge in translational studies involving the treatment of cardiovascular diseases with cell-free exosome fractions from cardiomyocytes (CMs), cardiosphere-derived cells (CDCs), endothelial cells (ECs), mesenchymal stromal cells (MSCs), or their combinations. However, most primary cells are difficult to culture in vitro and to generate sufficient exosomes to treat cardiac ischemia or promote cardiac regeneration effectively. Pluripotent stem cells (PSCs) offer the possibility of an unlimited supply of either committed or terminally differentiated cells and their exosomes for treating cardiovascular diseases (CVDs). This review discusses the promising prospects of treating CVDs using exosomes from cardiac progenitor cells (CPCs), endothelial progenitor cells (EPCs), MSCs, and cardiac fibroblasts derived from PSCs.
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92
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Ako E, Nijjer S, Al-Hussaini A, Kaprielian R. The ISCHEMIA Trial: What is the Message for the Interventionalist? Eur Cardiol 2021; 16:e24. [PMID: 34135994 PMCID: PMC8201464 DOI: 10.15420/ecr.2020.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Emmanuel Ako
- Chelsea and Westminster NHS Trust London, UK.,Royal Brompton NHS Hospital London, UK
| | - Sukhjinder Nijjer
- Chelsea and Westminster NHS Trust London, UK.,Hammersmith Hospital London, UK
| | - Abtehale Al-Hussaini
- Chelsea and Westminster NHS Trust London, UK.,Royal Brompton NHS Hospital London, UK
| | - Raffi Kaprielian
- Chelsea and Westminster NHS Trust London, UK.,Hammersmith Hospital London, UK
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93
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Brown DL, Boden WE. Impact of revascularisation on outcomes in chronic coronary syndromes: a new meta-analysis with the same old biases? Eur Heart J 2021; 42:4652-4655. [PMID: 34110408 DOI: 10.1093/eurheartj/ehab330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David L Brown
- Department of Medicine (Cardiovascular Division), Washington University School of Medicine, St. Louis, MO
| | - William E Boden
- VA New England Health Care System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, Boston University School of Medicine, Boston, MA
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94
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Boden WE, Stone PH. To stent or not to stent? Treating angina after ISCHEMIA-why a conservative approach with optimal medical therapy is the preferred initial management strategy for chronic coronary syndromes: insights from the ISCHEMIA trial. Eur Heart J 2021; 42:1394-1400. [PMID: 33827137 DOI: 10.1093/eurheartj/ehab069.002] [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: 01/09/2023] Open
Affiliation(s)
- William E Boden
- VA New England Healthcare System, Boston University School of Medicine, VA Boston Campus, 150 S. Huntington Avenue, Boston, MA 02130, USA
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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95
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Navarese EP, Lansky AJ, Kereiakes DJ, Kubica J, Gurbel PA, Gorog DA, Valgimigli M, Curzen N, Kandzari DE, Bonaca MP, Brouwer M, Umińska J, Jaguszewski MJ, Raggi P, Waksman R, Leon MB, Wijns W, Andreotti F. Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis. Eur Heart J 2021; 42:4638-4651. [PMID: 34002203 PMCID: PMC8669551 DOI: 10.1093/eurheartj/ehab246] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
Aims The value of elective coronary revascularisation plus medical therapy over medical therapy alone in managing stable patients with coronary artery disease is debated. We reviewed all trials comparing the two strategies in this population. Methods and results From inception through November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were searched for randomised trials comparing revascularisation against medical therapy alone in clinically stable coronary artery disease patients. Treatment effects were measured by rate ratios (RRs) with 95% confidence intervals, using random-effects models. Cardiac mortality was the pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and its association with cardiac mortality were secondary endpoints. Further endpoints included all-cause mortality, any MI, and stroke. Longest follow-up data were abstracted. The study is registered with PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients (10 023 randomised to revascularisation plus medical therapy and 9783 to medical therapy alone) were included. Compared with medical therapy alone, revascularisation yielded a lower risk of cardiac death [RR 0.79 (0.67–0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64–0.86), P < 0.01]. By meta-regression, the cardiac death risk reduction after revascularisation, compared with medical therapy alone, was linearly associated with follow-up duration [RR per 4-year follow-up: 0.81 (0.69–0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and percentage of multivessel disease at baseline (P = 0.004). Trial sequential and sensitivity analyses confirmed the reliability of the cardiac mortality findings. All-cause mortality [0.94 (0.87–1.01), P = 0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ significantly between strategies. Conclusion In stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.,Faculty of Medicine, University of Alberta, Edmonton, Canada.,SIRIO MEDICINE research network, Poland
| | | | - Dean J Kereiakes
- Christ Hospital and Lindner Research Center, Cincinnati, OH, USA
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.,SIRIO MEDICINE research network, Poland
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital Universitätsspital, Bern, Switzerland
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton, Southampton, UK
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | - Marc P Bonaca
- CPC Clinical Research, University of Colorado School of Medicine, USA
| | - Marc Brouwer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Julia Umińska
- Department of Geriatrics, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Paolo Raggi
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Martin B Leon
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Felicita Andreotti
- Direzione Scientifica, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.,Cardiovascular Medicine, Catholic University Medical School, Rome, Italy
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96
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Miñana G, Núñez J, Monmeneu JV, López-Lereu MP, Gavara J, Marcos-Garcés V, Ríos-Navarro C, Pérez N, de Dios E, Fernández-Cisnal A, Núñez E, Chorro FJ, Sanchis J, Bodi V. Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance. Open Heart 2021; 8:openhrt-2021-001619. [PMID: 34001655 PMCID: PMC8130753 DOI: 10.1136/openhrt-2021-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We assessed the influence of the ischaemic burden (IB) as derived from vasodilator stress cardiovascular magnetic resonance (CMR) on the risk of death and the effect of revascularisation across sex. METHODS We evaluated 6237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischaemia was defined as >5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used. RESULTS A total of 2371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularisation. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived IB across sex (p value for interaction=0.039). Women exhibited an adjusted lower risk of death and only equaled men's risk when extensive ischaemia was present. Likewise, CMR-related revascularisation was shown to be differentially associated with the risk of mortality across sex (p value for interaction=0.025). In patients with non-extensive ischaemia, revascularisation was associated with a higher risk of death, with a greater extent in women. At higher IB, revascularisation was associated with a lower risk in men, with more uncertain results in women. CONCLUSIONS CMR-derived IB allows predicting the risk of death and gives insight into the potential effect of revascularisation in men and women with CCS. Compared with men, women with non-extensive ischaemia displayed a lower risk and a similar risk with a higher IB. The impact of CMR-related revascularisation on mortality risk was also significantly different according to IB and sex. Further research will be needed to confirm these hypothesis-generating findings.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Jose V Monmeneu
- Cardiac Imaging Unit, ERESA, Unidad de Imagen Cardiaca Valencia, ES, Valencia, Spain
| | - Maria P López-Lereu
- Cardiac Imaging Unit, ERESA, Unidad de Imagen Cardiaca Valencia, ES, Valencia, Spain
| | - Jose Gavara
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | | | - Nerea Pérez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Elena de Dios
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Eduardo Núñez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Juan Sanchis
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Vicente Bodi
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
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97
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Bonnet S, Prévot G, Mornet S, Jacobin-Valat MJ, Mousli Y, Hemadou A, Duttine M, Trotier A, Sanchez S, Duonor-Cérutti M, Crauste-Manciet S, Clofent-Sanchez G. A Nano-Emulsion Platform Functionalized with a Fully Human scFv-Fc Antibody for Atheroma Targeting: Towards a Theranostic Approach to Atherosclerosis. Int J Mol Sci 2021; 22:ijms22105188. [PMID: 34068875 PMCID: PMC8153629 DOI: 10.3390/ijms22105188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is at the onset of the cardiovascular diseases that are among the leading causes of death worldwide. Currently, high-risk plaques, also called vulnerable atheromatous plaques, remain often undiagnosed until the occurrence of severe complications, such as stroke or myocardial infarction. Molecular imaging agents that target high-risk atheromatous lesions could greatly improve the diagnosis of atherosclerosis by identifying sites of high disease activity. Moreover, a "theranostic approach" that combines molecular imaging agents (for diagnosis) and therapeutic molecules would be of great value for the local management of atheromatous plaques. The aim of this study was to develop and characterize an innovative theranostic tool for atherosclerosis. We engineered oil-in-water nano-emulsions (NEs) loaded with superparamagnetic iron oxide (SPIO) nanoparticles for magnetic resonance imaging (MRI) purposes. Dynamic MRI showed that NE-SPIO nanoparticles decorated with a polyethylene glycol (PEG) layer reduced their liver uptake and extended their half-life. Next, the NE-SPIO-PEG formulation was functionalized with a fully human scFv-Fc antibody (P3) recognizing galectin 3, an atherosclerosis biomarker. The P3-functionalized formulation targeted atheromatous plaques, as demonstrated in an immunohistochemistry analyses of mouse aorta and human artery sections and in an Apoe-/- mouse model of atherosclerosis. Moreover, the formulation was loaded with SPIO nanoparticles and/or alpha-tocopherol to be used as a theranostic tool for atherosclerosis imaging (SPIO) and for delivery of drugs that reduce oxidation (here, alpha-tocopherol) in atheromatous plaques. This study paves the way to non-invasive targeted imaging of atherosclerosis and synergistic therapeutic applications.
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Affiliation(s)
- Samuel Bonnet
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
- Institut de Chimie de la Matière Condensée, CNRS UMR 5026, Université de Bordeaux, Bordeaux INP, ICMCB, 33600 Pessac, France; (S.M.); (M.D.)
- Correspondence:
| | - Geoffrey Prévot
- ARNA, ARN, Régulations Naturelle et Artificielle, ChemBioPharm, INSERM U1212, CNRS UMR 5320, Université de Bordeaux, 33076 Bordeaux, France; (G.P.); (Y.M.); (S.C.-M.)
| | - Stéphane Mornet
- Institut de Chimie de la Matière Condensée, CNRS UMR 5026, Université de Bordeaux, Bordeaux INP, ICMCB, 33600 Pessac, France; (S.M.); (M.D.)
| | - Marie-Josée Jacobin-Valat
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | - Yannick Mousli
- ARNA, ARN, Régulations Naturelle et Artificielle, ChemBioPharm, INSERM U1212, CNRS UMR 5320, Université de Bordeaux, 33076 Bordeaux, France; (G.P.); (Y.M.); (S.C.-M.)
| | - Audrey Hemadou
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | - Mathieu Duttine
- Institut de Chimie de la Matière Condensée, CNRS UMR 5026, Université de Bordeaux, Bordeaux INP, ICMCB, 33600 Pessac, France; (S.M.); (M.D.)
| | - Aurélien Trotier
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | - Stéphane Sanchez
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | | | - Sylvie Crauste-Manciet
- ARNA, ARN, Régulations Naturelle et Artificielle, ChemBioPharm, INSERM U1212, CNRS UMR 5320, Université de Bordeaux, 33076 Bordeaux, France; (G.P.); (Y.M.); (S.C.-M.)
| | - Gisèle Clofent-Sanchez
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
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98
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Núñez J, Lorenzo M, Miñana G, Palau P, Monmeneu JV, López-Lereu MP, Gavara J, Marcos-Garcés V, Ríos-Navarro C, Pérez N, de Dios E, Núñez E, Sanchis J, Chorro FJ, Bayés-Genís A, Bodí V. Sex differences on new-onset heart failure in patients with known or suspected coronary artery disease. Eur J Prev Cardiol 2021; 28:1711-1719. [PMID: 33970216 DOI: 10.1093/eurjpc/zwab078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/03/2021] [Indexed: 12/13/2022]
Abstract
AIMS The impact of sex in patients with CAD has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with known or suspected CAD. We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected coronary artery disease (CAD) undergoing vasodilator stress cardiac magnetic resonance (CMR). METHODS AND RESULTS We prospectively evaluated 5899 consecutive HF-free patients submitted to stress CMR for known or suspected CAD. Ischaemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional hazards regression model adjusted for competing events [death, myocardial infarction (MI), and revascularization]. A total of 2289 (38.8%) patients were women. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered an MI, 905 (15.3%) underwent revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs. 0.83 per 100 person-years, P = 0.001). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (hazard ratio 1.58, 95% confidence interval 1.18-2.10; P = 0.002). We found a sex-differential effect along the continuum of LVEF (P-value for interaction = 0.007). At lower LVEF, there was an increased risk in both sexes. However, compared with men, the risk of new-onset HF was higher in women with LVEF >55%. CONCLUSION Women with known or suspected CAD are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.
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Affiliation(s)
- Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiológicas Especiales (ERESA), Colón, 1, 46004 Valencia, Spain
| | - Maria P López-Lereu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiológicas Especiales (ERESA), Colón, 1, 46004 Valencia, Spain
| | - Jose Gavara
- Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Victor Marcos-Garcés
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Cesar Ríos-Navarro
- Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Nerea Pérez
- Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Elena de Dios
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
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Abstract
IMPORTANCE Nearly 10 million US adults experience stable angina, which occurs when myocardial oxygen supply does not meet demand, resulting in myocardial ischemia. Stable angina is associated with an average annual risk of 3% to 4% for myocardial infarction or death. Diagnostic tests and medical therapies for stable angina have evolved over the last decade with a better understanding of the optimal use of coronary revascularization. OBSERVATIONS Coronary computed tomographic angiography is a first-line diagnostic test in the evaluation of patients with stable angina due to higher sensitivity and comparable specificity compared with imaging-based stress testing. Moreover, coronary computed tomographic angiography allows detection of nonobstructive atherosclerosis that would not be identified with other noninvasive imaging modalities, improving risk assessment and potentially triggering more appropriate allocation of preventive therapies. Novel therapies treating lipids (proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, and icosapent ethyl) and type 2 diabetes (sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists) have improved cardiovascular outcomes in patients with stable ischemic heart disease when added to usual care. Randomized clinical trials showed no improvement in the rates of mortality or myocardial infarction with revascularization (largely by percutaneous coronary intervention) compared with optimal medical therapy alone, even in the setting of moderate to severe ischemia. In contrast, revascularization provides a meaningful benefit on angina and quality of life compared with antianginal therapies. Measures of the effect of angina on a patient's quality of life should be integrated into the clinic encounter to assist with the decision to proceed with revascularization. CONCLUSIONS AND RELEVANCE For patients with stable angina, emphasis should be placed on optimizing lifestyle factors and preventive medications such as lipid-lowering and antiplatelet agents to reduce the risk for cardiovascular events and death. Antianginal medications, such as β-blockers, nitrates, or calcium channel blockers, should be initiated to improve angina symptoms. Revascularization with percutaneous coronary intervention should be reserved for patients in whom angina symptoms negatively influence quality of life, generally after a trial of antianginal medical therapy. Shared decision-making with an informed patient is important for effective treatment of stable angina.
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Affiliation(s)
- Parag H Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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100
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Vij A, Kassab K, Chawla H, Kaur A, Kodumuri V, Jolly N, Doukky R. Invasive therapy versus conservative therapy for patients with stable coronary artery disease: An updated meta-analysis. Clin Cardiol 2021; 44:675-682. [PMID: 33742721 PMCID: PMC8119834 DOI: 10.1002/clc.23592] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/21/2021] [Accepted: 03/03/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Heart disease remains the leading cause of death in the United States. Although there are clear indications for revascularization in patients with acute coronary syndromes, there is debate regarding the benefits of revascularization in stable ischemic heart disease. We sought to perform a comprehensive meta-analysis to assess the role of revascularization compared to conservative medical therapy alone in patients with stable ischemic heart disease. HYPOTHESIS There is no significant difference in all-cause mortality or cardiovascular mortality between invasive and medical arms. METHODS We performed a systematic literature search from January 2000 to June 2020. Our literature search yielded seven randomized controlled trials. We analyzed a total of 12 013 patients (6109 in revascularization arm and 5904 in conservative medical therapy arm). Primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac events (MACE) (death, myocardial infarction [MI], or stroke), cardiovascular mortality, MI, and stroke. Additional subgroup analysis for all-cause mortality was performed comparing percutaneous coronary intervention (PCI) with bare metal stent versus conservative therapy; and PCI with drug eluting stent versus conservative therapy. RESULTS There was no statistically significant difference in primary outcome of all-cause mortality between either arm (odds ratio [OR] = 0.95; 95% CI [confidence interval], 0.83 to 1.08; p = .84). There were statistically significant lower rates of MACE (death, MI or stroke) in the revascularization arm when compared to conservative arm. CONCLUSIONS Our analysis did not show any survival advantage of an initial invasive strategy over conservative medical therapy in patients with stable coronary artery disease (CAD).
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Affiliation(s)
- Aviral Vij
- Division of CardiologyCook County HealthChicagoIllinoisUSA
- Department of MedicineRush Medical collegeChicagoIllinoisUSA
| | - Kameel Kassab
- Division of CardiologyCook County HealthChicagoIllinoisUSA
| | - Hitesh Chawla
- Division of CardiologyMedStar Union Memorial HospitalBaltimoreMarylandUSA
| | - Amandeep Kaur
- Department of PathologyUniversity of Chicago‐NorthshoreEvanstonIllinoisUSA
| | - Vamsi Kodumuri
- Division of CardiologyAscension All Saints HospitalRacineWisconsinUSA
| | - Neeraj Jolly
- Division of CardiologyRush University Medical CenterChicagoIllinoisUSA
| | - Rami Doukky
- Division of CardiologyCook County HealthChicagoIllinoisUSA
- Department of MedicineRush Medical collegeChicagoIllinoisUSA
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