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Kirigaya J, Matsuzawa Y, Ebina T, Abe T, Iwahashi N, Fukui K, Maeda A, Akashi Y, Ako J, Ikari Y, Namiki A, Michishita I, Sugano T, Tamura K, Hibi K, Kimura K, Suzuki H. Benefit of prehospital electrocardiogram on door-to-device time in ST-segment elevation myocardial infarction with cardiogenic shock: Data from the Kanagawa Acute Cardiovascular Registry. J Cardiol 2024:S0914-5087(24)00156-4. [PMID: 39153660 DOI: 10.1016/j.jjcc.2024.08.004] [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: 02/29/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI. METHODS This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (-) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups. RESULTS The patient backgrounds of the PH-ECG (+) and PH-ECG (-) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (-) group [2756 (1292-6009) IU/ml vs. 2270 (957-5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20-33) min vs. 27 (20-35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52-103) min vs. 83 (62-111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24-2.83), p = 0.003]. CONCLUSIONS PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.
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Affiliation(s)
- Jin Kirigaya
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeru Abe
- Integrated Center for Science and Humanities, Fukushima Medical University Medical Center, Fukushima, Japan
| | - Noriaki Iwahashi
- Department of Cardiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuki Fukui
- Division of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, Yokohama, Japan
| | - Yoshihiro Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junya Ako
- Division of Cardiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Atsuo Namiki
- Division of Cardiology, Kanto Rosai Hospital, Kawasaki, Japan
| | - Ichiro Michishita
- Division of Cardiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Teruyasu Sugano
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiovascular Medicine, Yokosuka City Hospital, Yokosuka, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan
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102
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Chen G, Westra J, Yang X, Zhang Y, Luo D, Hu X, Li G, Zhou Y, Tu S, Dong H. A simple angio-based coronary flow assessment of culprit vessels in primary percutaneous coronary intervention is associated with long-term prognosis after ST-segment-elevation myocardial infarction. Int J Cardiol 2024; 409:132199. [PMID: 38782068 DOI: 10.1016/j.ijcard.2024.132199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite prompt reperfusion, the risk of adverse clinical outcomes following ST-segment-elevation myocardial infarction (STEMI) remains pronounced, owing partly to suboptimal reperfusion. However, coronary functional evaluation is seldom feasible during primary percutaneous coronary intervention (PPCI). We aimed to examine the clinical implication of a simple coronary assessment based on single-angiographic view (μQFR) during PPCI in discriminating impaired coronary flow and adverse outcomes for STEMI. METHODS STEMI Patients undergoing successful PPCI were enrolled and followed up prospectively from 4 medical centers in China. Post-PPCI μQFR of culprit vessels were analyzed. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal MI, ischemia-driven target-vessel revascularization and readmission for heart failure. RESULTS A total of 570 patients with STEMI were enrolled, and post-PCI μQFR was analyzable in 557 (97.7%) patients, with a median of 0.94. Patients with low post-PCI μQFR showed higher incidence of adverse outcomes than those with high μQFR, showing a 2.5-fold increase in the risk for MACE (hazard ratio: 2.51, 95% confidence intervals: 1.33 to 4.72; P = 0.004). Moreover, post-PCI μQFR significantly increased discriminant ability for the occurrence of MACE when added to traditional GRACE risk score for STEMI (integrated discrimination improvement: 0.029; net reclassification index: 0.229; P < 0.05). CONCLUSIONS A low μQFR of culprit vessel in PPCI is independently associated with worse clinical outcomes in patients with STEMI. The single-angiographic-view-based coronary evaluation is a feasible tool for discriminating poor prognosis and could serve as a valuable complement in risk stratification for STEMI.
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Affiliation(s)
- Guo Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Xing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Youti Zhang
- Department of Cardiology, Jiexi People's Hospital, Jiexi, China
| | - Demou Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiangming Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Cardiology, Nyingchi People's Hospital, Nyingchi, China.
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103
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Chen J, Shang J, Liu H, Li X, Lai X, Lou Y, Zhou H. Comparative effectiveness and safety of four traditional Chinese medicine injections with invigorating blood circulation, equivalent effect of anticoagulation or antiplatelet in acute myocardial infarction: a Bayesian network meta-analysis. Front Pharmacol 2024; 15:1400990. [PMID: 39206257 PMCID: PMC11349691 DOI: 10.3389/fphar.2024.1400990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Background: Traditional Chinese medicine injections with invigorating blood circulation (TCMI-IBCs), which have been used as antithrombosis therapies, are widely employed by Chinese clinicians as adjuvant therapy for acute myocardial infarction (AMI). Objective: A Bayesian network meta-analysis was conducted to contrast the effectiveness and safety of four TCMI-IBCs in AMI. Methods: Eight Databases were thoroughly searched before 31 December 2023, for randomized controlled trials (RCTs) focusing on the application of TCMI-IBCs combined with conventional treatments (CT) to treat AMI. All-cause mortality (ACM) was the major endpoint. Secondary outcomes included bleeding events, malignant arrhythmia (MA), recurrent myocardial infarction (RMI), left ventricular ejection fraction (LVEF), and adverse events. Stata17.0 and GeMTC software were employed for Bayesian network meta-analysis. Results: A total of 73 eligible RCTs involving 7,504 patients were enrolled. Puerarin injection (PI), Danhong injection (DI), sodium Tanshinone IIA Sulfonate injection (STSI), and Danshen Chuanxiongqin injection (DCI) combined with CT can significantly reduce the occurrence of ACM and improve LVEF in AMI (P < 0.05), while without significant impact on bleeding events or MA (P > 0.05). STSI + CT would be the optimal treatment strategy in lowering RMI and ACM. DI + CT was the most likely to be the optimal strategy in reducing MA occurrence and improving LVEF. CT was likely the most effective strategy in reducing bleeding events. However, DI + CT exhibited the least favorable safety. Conclusion: TCMI-IBCs + CT had potential benefits in the treatment of AMI. STSI + CT showed the most favorable performance in treating AMI, followed by DI combined with CT. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=384067, identifier CRD42022384067.
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Affiliation(s)
| | | | | | - Xiang Li
- Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
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Wu C, Li Q, Ma J, Xu X, Sun S, Yang L, Li Y, Li P, Li W, Yu Y. Thrombus aspiration is associated with improved platelet inhibition rate following dual antiplatelet therapy in acute myocardial infarction patients. Eur J Med Res 2024; 29:420. [PMID: 39143607 PMCID: PMC11323623 DOI: 10.1186/s40001-024-02018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND It is well-established that thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) indicates a higher thrombus burden and necessitates more intensive antithrombotic therapy. The bidirectional association between adverse events in AMI patients and platelet reactivity is typically observed during dual antiplatelet therapy (DAPT). OBJECTIVE To investigate platelet reactivity after DAPT in AMI patients with thrombus aspiration performed during PCI. METHODS In this retrospective study, we examined 269 consecutive AMI patients who underwent PCI and recorded their demographic, clinical and laboratory data. The platelet reactivity was measured with thromboelastogram (TEM). RESULTS Ultimately, 208 patients were included in this study and divided into a Thrombus Aspiration group (N = 97) and a PCI Alone group (N = 111) based on whether thrombus aspiration was performed or not. The adenosine diphosphate (ADP)-induced platelet inhibition rate in the Thrombus Aspiration group was higher than that in the PCI Alone group (P < 0.001). Furthermore, multivariate linear regression analysis revealed that the ADP-induced platelet inhibition rate was independently associated with leukocyte count, thrombus aspiration and the combination of aspirin and ticagrelor as DAPT after adjusting for potential covariates in all AMI patients. CONCLUSION In conclusion, clinicians should exercise heightened attention towards the bleeding risk among patients undergoing PCI concomitant with Thrombus Aspiration postoperatively.
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Affiliation(s)
- Chunxuan Wu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qianyi Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Ma
- Department of Laboratory Medicine, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxing Xu
- Clinical Epidemiology Unit, CEU of INCLEN, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shiqun Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingchao Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Li
- Department of Pharmacy, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Ying Yu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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105
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Zhao Y, Ling F, Qin Y, Xie W, Qi W, Nie Q, Zhang H, Han M, Zhao J, Liu L, Hu L, Xiao J, Li W, Liang F, Zheng Q. The effect and safety of acupuncture as adjunctive therapy for STEMI patients after PCI: study protocol of a randomized controlled trial. BMC Complement Med Ther 2024; 24:306. [PMID: 39143484 PMCID: PMC11325820 DOI: 10.1186/s12906-024-04608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) is a common acute ischemia heart disease that causes serious damage to human health worldwide. Even though morbidity and mortality have significantly decreased by percutaneous coronary intervention (PCI), an additional cardiac protection strategy is still required. Acupuncture therapy has presented a dominant cardiac protection in many studies lately. Thus, we aim to evaluate the effect and safety of acupuncture as an adjunctive therapy in STEMI patients after PCI through a randomized controlled trial. METHODS/DESIGN This study describes a protocol of multicenter, double-blinded, parallel-controlled, randomized controlled trial. Ninety-six patients with STEMI aged 18-85 years who undergoing PCI will be recruited from the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, The Affiliated Third Hospital of Chengdu Traditional Chinese Medicine University/Chengdu Pidu District Hospital of Traditional Chinese Medicine, and Zhaotong Municipal Hospital of Traditional Chinese Medicine. Participants will be randomly assigned (1:1 ratio) to the verum acupuncture plus basic therapy (i.e., treatment) group or the sham acupuncture plus basic therapy (i.e., control) group. These participants will be treated for 5 days and then will be followed up for 24 weeks. Any adverse events will be recorded throughout the study to evaluate safety. DISCUSSION The present study aims to investigate the effect and safety of acupuncture for patients with STEMI after PCI and set up standardized treatment programs for acupuncture of these patients. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400081117]), on February 22, 2024.
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Affiliation(s)
- Yi Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Fayang Ling
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Acupuncture and Tuina School, Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Yalu Qin
- Department of Cardiology, the Affiliated Third Hospital of Chengdu Traditional Chinese Medicine University/Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Wen Xie
- Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Wenchuan Qi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Qian Nie
- Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Hongcai Zhang
- Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Mingjun Han
- Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Jue Zhao
- Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Lei Liu
- Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Lin Hu
- Department of Cardiology, the Affiliated Third Hospital of Chengdu Traditional Chinese Medicine University/Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Juan Xiao
- Department of Cardiology, Zhaotong Municipal Hospital of Traditional Chinese Medicine, Zhaotong, People's Republic of China
| | - Wufeng Li
- Department of Cardiology, Zhaotong Municipal Hospital of Traditional Chinese Medicine, Zhaotong, People's Republic of China
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.
- Acupuncture and Tuina School, Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.
- Acupuncture and Tuina School, Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.
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106
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Zhang S, Lin Z, Yu B, Liu J, Jin J, Li G, Dong H. Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention. BMC Cardiovasc Disord 2024; 24:427. [PMID: 39143506 PMCID: PMC11323606 DOI: 10.1186/s12872-024-04093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 08/01/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The Smoking paradox has generated inconsistent findings concerning the clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients, while providing limited insights into coronary anatomy and function which are crucial prognostic factors. Therefore, this study aimed to further investigate the existence of smoking paradox in coronary anatomy and function. METHODS This study divided STEMI patients into smokers and non-smokers. Quantitative coronary angiography, angiography‑derived microcirculatory resistance (AMR) and quantitative flow ratio (QFR) were utilized to analyze coronary anatomy and function. These parameters were compared using multivariable analysis and propensity score matching. The clinical outcomes were evaluated using Kaplan-Meier curve and Cox regression. RESULTS The study included 1258 patients, with 730 in non-smoker group and 528 in smoker group. Smokers were significantly younger, predominantly male, and had fewer comorbidities. Without adjusting for confounders, smokers exhibited larger lumen diameter [2.03(1.45-2.57) vs. 1.90(1.37-2.49), P = 0.033] and lower AMR [244(212-288) vs. 260(218-301), P = 0.006]. After matching and multivariate adjustment, smokers exhibited inversely smaller lumen diameter [1.97(1.38-2.50) vs. 2.15(1.63-2.60), P = 0.002] and higher incidence of coronary microvascular dysfunction [233(53.9%) vs. 190(43.6%), P = 0.002], but showed similar AMR and clinical outcomes compared to non-smokers. There was no difference in QFR between two groups. CONCLUSION Smoking among STEMI patients undergoing pPCI was associated with smaller lumen diameter and higher occurrence of coronary microvascular dysfunction, although it had no further impact on clinical prognosis. The smoking paradox observed in coronary anatomy or function may be explained by younger age, gender, and lower prevalence of comorbidities.
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Affiliation(s)
- Shanghong Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- Medical College, Shantou University, Shantou, Guangdong, 515041, China
| | - Ziqiang Lin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- Department of Preventive Medicine, School of Basic Medicine and Public Health, Jinan University, Guangzhou, 510632, China
| | - Bingyan Yu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Jieliang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Junguo Jin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China
| | - Guang Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Haojian Dong
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China.
- Nyingchi People's Hospital, Nyingchi, Tibet, 860000, China.
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107
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Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Park S, Kang DO, Choi SY, Cha J, Hyun SJ, Cho JR, Kim MW, Park JY, Park SH, Jeong MH. Renin-angiotensin system inhibitors and non-ST-elevation myocardial infarction outcomes based on left ventricular ejection fraction. Hellenic J Cardiol 2024:S1109-9666(24)00175-1. [PMID: 39151659 DOI: 10.1016/j.hjc.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND We assessed left ventricular ejection fraction (LVEF) to compare the effects of renin-angiotensin system inhibitors (RASI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS We categorized 4558 patients with NSTEMI as either RASI users (3752 patients) or non-users (806 patients). The 3-year patient-oriented composite outcome (POCO), which included all-cause death, recurrent myocardial infarction, any repeat revascularization, or hospitalization for heart failure (HF), was the primary outcome. To compare clinical outcomes, a multivariable-adjusted hazard ratio (aHR) was calculated after performing multicollinearity tests on all significant confounding variables (P < 0.05). RESULTS Among RASI users, the aHRs for POCO, all-cause death, and cardiac death were significantly higher in the HF with reduced EF (HFrEF) subgroup than in the HF with mildly reduced EF (HFmrEF) (1.610, 2.120, and 2.489; P < 0.001, <0.001, and <0.001; respectively) and HF with preserved EF (HFpEF) (2.234, 3.920, and 5.215; P < 0.001, <0.001, and <0.001; respectively) subgroups. The aHRs for these variables were significantly higher in the HFmrEF subgroup than the HFpEF subgroup (1.416, 1.843, and 2.172, respectively). Among RASI non-users, the aHRs for these variables were significantly higher in the HFrEF subgroup than the HFmrEF (2.573, 3.172, and 3.762, respectively) and HFpEF (2.425, 3.805, and 4.178, respectively) subgroups. In three LVEF subgroups, RASI users exhibited lower aHRs for POCO and all-cause death than RASI non-users. CONCLUSION In the RASI users group, the aHRs for POCO and mortality were highest in the HFrEF subgroup, intermediate in the HFmrEF subgroup, and lowest in the HFpEF subgroup.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea.
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Jinah Cha
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Su Jin Hyun
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 0744, Republic of Korea
| | - Min-Woong Kim
- Department of Cardiology, Changwon Hanmaeum Hospital, Hanyang University College of Medicine, Changwon 51139, Republic of Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
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Wang S, Huang X, Xiao Q, Xu Y, Wei X. Delayed ventricular septal rupture complicated with ventricular aneurysm in a case of myocardial infarction with non-obstructive coronary arteries. BMC Cardiovasc Disord 2024; 24:419. [PMID: 39134991 PMCID: PMC11321109 DOI: 10.1186/s12872-024-04100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare cause of heart attack, which may not receive sufficient attention from patients during post-discharge treatment, especially among those with normal coronary angiography results. CASE PRESENTATION We present the case of a 65-year-old woman who was readmitted to the hospital with ventricular septal rupture (VSR) complicated by ventricular aneurysm, occurring 2 weeks after myocardial infarction. During the initial admission, coronary angiography revealed normal coronary arteries, leading to a diagnosis of MINOCA. Epicardial coronary vasospasm or coronary embolism was considered as potential causes; however, the patient did not adhere to standardized treatment upon initial discharge. The delayed VSR led to a decline in cardiac function but did not result in severe hemodynamic impairment. Following correction of heart failure with medications, the patient underwent percutaneous VSR repair 19 days after diagnosis and was discharged with a favorable recovery. CONCLUSIONS The occurrence of delayed VSR complicated with ventricular aneurysm in patients with MINOCA is rare, highlighting the possibility of serious complications in MINOCA cases. Both cardioprotective therapies and cause-targeted therapies are essential in the management of patients with MINOCA.
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Affiliation(s)
- Si Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, China
| | - Xu Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, China
| | - Qianfeng Xiao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, China
| | - Ying Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, China.
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, China.
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109
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Bourlond B, Dupré M, Carron PN, Liaudet L, Eeckhout E. Outcomes and relevance of emergency percutaneous coronary angiography and intervention after resuscitated cardiac arrest: a retrospective study. BMC Cardiovasc Disord 2024; 24:425. [PMID: 39138425 PMCID: PMC11321191 DOI: 10.1186/s12872-024-04052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established. METHODS We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses. RESULTS We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients. CONCLUSIONS Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
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Affiliation(s)
- Baudouin Bourlond
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marion Dupré
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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110
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Inan D, Genc D, Şimsek B, Tanık O, Akdeniz E, Korkmaz B, Aydogdu U, Vatanoglu EG, Zeren G, Ceylan B, Yumurtaş Ç, Yüksel G, Pay L, Tanboga H, Karabay CY. Relationship Between CHA₂DS₂-VASc Score on Admission and In-Hospital Major Adverse Cardiovascular Events in Patients Diagnosed With ST-Elevation Myocardial Infarction. Angiology 2024:33197241273382. [PMID: 39133527 DOI: 10.1177/00033197241273382] [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: 08/13/2024]
Abstract
The CHA₂DS₂-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA₂DS₂-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA₂DS₂-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA₂DS₂-VASc score without dichotomization was the main difference of this study from others.
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Affiliation(s)
- Duygu Inan
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Duygu Genc
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Barış Şimsek
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozan Tanık
- Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Evliya Akdeniz
- Department of Cardiology, Istanbul Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Betül Korkmaz
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ufuk Aydogdu
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif G Vatanoglu
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gönül Zeren
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Büşra Ceylan
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çağdaş Yumurtaş
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gizem Yüksel
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Levent Pay
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Halil Tanboga
- Department of Cardiology, Hisar Intercontinental Hospital, Nişantaşı University, Istanbul, Turkey
| | - Can Y Karabay
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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111
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Chen QF, Wang L, Katsouras CS, Gong M, Liu C, Lian L, Chen X, Zhu X, Chen C, Feng X, Lin WH, Zhou XD. Clinical characteristics and prognostic importance of anticoagulant use in ischemic left ventricular aneurysm: a retrospective cohort study. Nat Commun 2024; 15:6883. [PMID: 39128927 PMCID: PMC11317478 DOI: 10.1038/s41467-024-51121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 07/30/2024] [Indexed: 08/13/2024] Open
Abstract
There is insufficient data on systemic embolic events (SSEs) in patients with ischemic left ventricular aneurysm (LVA) concerning the impact of anticoagulation therapy. In this retrospective cohort study with 1043 patients with ischemic LVA, SSEs occurred in 7.2% over 2.4 years. After adjusting for relevant factors, the use of anticoagulants was independently associated with a lower incidence of SSE (3.1% vs. 9.0%, P < 0.001; subdistribution hazard ratios (SHR) 0.21, 95% confidence intervals (CI) 0.10-0.44, P < 0.001), with no significant difference in net adverse clinical events (NACEs) (10.6% vs. 13.3%, P = 0.225). Specifically, anticoagulation in patients with apical segment akinesis significantly reduced SSEs (3.9% vs. 13.6%, P = 0.002) and NACE rates (7.8% vs. 19.4%, P = 0.002). Major bleeding rates did not significantly differ between groups (5.6% vs. 3.5%, P = 0.111). These findings highlight the SSE risk in ischemic LVA and suggest potential benefits of anticoagulation, particularly in those with apical segment akinesis. These findings need to be validated in independent datasets.
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Affiliation(s)
- Qin-Fen Chen
- Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, 325000, China
| | - Liangguo Wang
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Christos S Katsouras
- Second Department of Cardiology, University Hospital of Ioannina Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Mengge Gong
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chenyang Liu
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Liyou Lian
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiaoyan Chen
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xuemeng Zhu
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chen Chen
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiaofang Feng
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Wei-Hong Lin
- Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiao-Dong Zhou
- Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Lee YJ, Cho DK, Lee JW, Shin S, Kwon SW, Suh Y, Kang TS, Park JK, Bae JW, Kang WC, Kim S, Lee SJ, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Yun KH, Hong MK. Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials. MED 2024:S2666-6340(24)00301-5. [PMID: 39153473 DOI: 10.1016/j.medj.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/13/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Patients with ST-elevation myocardial infarction (STEMI) tend to be excluded or under-represented in randomized clinical trials evaluating the effects of potent P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (DAPT). METHODS Individual patient data were pooled from randomized clinical trials that included STEMI patients undergoing drug-eluting stent (DES) implantation and compared ticagrelor monotherapy after short-term (≤3 months) DAPT versus ticagrelor-based 12-month DAPT in terms of centrally adjudicated clinical outcomes. The co-primary outcomes were efficacy outcome (composite of all-cause death, myocardial infarction, or stroke) and safety outcome (Bleeding Academic Research Consortium type 3 or 5 bleeding) at 1 year. FINDINGS The pooled cohort contained 2,253 patients with STEMI. The incidence of the primary efficacy outcome did not differ between the ticagrelor monotherapy group and the ticagrelor-based DAPT group (1.8% versus 2.0%; hazard ratio [HR] = 0.88; 95% confidence interval [CI] = 0.49-1.61; p = 0.684). There was no difference in cardiac death between the groups (0.6% versus 0.7%; HR = 0.89; 95% CI = 0.32-2.46; p = 0.822). The incidence of the primary safety outcome was significantly lower in the ticagrelor monotherapy group (2.3% versus 4.0%; HR = 0.56; 95% CI = 0.35-0.92; p = 0.020). No heterogeneity of treatment effects was observed for the primary outcomes across subgroups. CONCLUSIONS In patients with STEMI treated with DES implantation, ticagrelor monotherapy after short-term DAPT was associated with lower major bleeding without an increase in the risk of ischemic events compared with ticagrelor-based 12-month DAPT. Further research is necessary to extend these findings to non-Asian patients. FUNDING This study was funded by Biotronik (Bülach, Switzerland).
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Affiliation(s)
- Yong-Joon Lee
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Deok-Kyu Cho
- Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jun-Won Lee
- Department of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sanghoon Shin
- Department of Cardiology, Ewha Womans University College of Medicine Seoul Hospital, Seoul, Korea
| | - Sung Woo Kwon
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Yongsung Suh
- Department of Cardiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Tae Soo Kang
- Department of Cardiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jong-Kwan Park
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jang-Whan Bae
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Woong Cheol Kang
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seunghwan Kim
- Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seung-Jun Lee
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA University College of Medicine, Seongnam, Korea
| | - Kyeong Ho Yun
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea.
| | - Myeong-Ki Hong
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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113
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Zhang J, Chen Z, Rao L, He Y. Coronary bioresorbable metallic stents: Advancements and future perspectives. J Cardiol 2024:S0914-5087(24)00149-7. [PMID: 39134302 DOI: 10.1016/j.jjcc.2024.08.003] [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: 03/31/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 10/04/2024]
Abstract
Percutaneous coronary intervention is a critical treatment for coronary artery disease, particularly myocardial infarction, and is highly recommended in clinical guidelines. Traditional metallic stents, although initially effective, remain permanently in the artery and can lead to complications such as in-stent restenosis, late thrombosis, and chronic inflammation. Given the temporary need for stenting and the potential for late complications, bioresorbable stents have emerged as a promising alternative. However, bioresorbable polymeric stents have encountered significant clinical challenges due to their low mechanical strength and ductility, which increase the risks of thrombosis and local inflammation. Consequently, bioresorbable metals are being considered as a superior option for coronary stents. This review examines the progress of bioresorbable metallic stents from both preclinical and clinical perspectives, aiming to provide a theoretical foundation for future research. Iron, zinc, and magnesium are the primary materials used for these stents. Zinc-based bioresorbable stents have shown promise in preclinical studies due to their biocompatibility and vascular protective properties, although human clinical studies are still limited. Magnesium-based stents have demonstrated positive clinical outcomes, being fully absorbed within 12 months and showing low rates of late lumen loss and target lesion failure at 6- and 12-months post-implantation. Initial trials of iron-based stents have indicated favorable mid-term safety and efficacy, with complete absorption by the body within three years and consistent luminal expansion beyond six months post-implantation. Despite these advancements, further trials are needed for comprehensive validation. In conclusion, while current materials do not fully meet the ideal requirements, ongoing research should focus on developing bioresorbable stents with enhanced performance characteristics to better meet clinical needs.
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Affiliation(s)
- Junyan Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Rao
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
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114
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Chen Y, Li M, Wu Y. The optimal timing for intervention in patients with ST-segment elevation myocardial infarction and multivessel disease: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1389017. [PMID: 39185134 PMCID: PMC11341378 DOI: 10.3389/fcvm.2024.1389017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
Purpose The optimal timing for nonculprit vascular reconstruction surgery in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still controversial. Our aim was to explore the optimal intervention time for percutaneous coronary intervention (PCI) in STEMI patients who underwent MVD. Methods The PubMed/Medline, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched from inception to January 1, 2024 for clinical studies comparing immediate multivessel PCI and staged multivessel PCI in patients with STEMI. The primary outcomes were death from any cause, cardiovascular death, noncardiac death, myocardial infarction (MI) and unplanned ischemia-driven revascularization. The secondary outcomes were ischemic stroke, stent thrombosis, renal dysfunction and major bleeding. The risk ratios (RRs) and odds ratios (ORs) were calculated with fixed-effects models and random-effects models, and 95% confidence intervals (CIs) were calculated. Findings Five randomized trials with 2,782 patients and six prospective observational studies with 3,131 patients were selected for inclusion in this meta-analysis. The staged PCI group had significantly lower pooled RRs for myocardial infarction (0.43, 95% CI = 0.27-0.67; P = 0.0002) and unplanned ischemia-driven revascularization (0.57, 95% CI = 0.41-0.78; P = 0.0004). There were no significant differences in any cause of death, cardiovascular cause of death, or noncardiac cause of death. However, the results of prospective observational studies in the real world indicated that the staged PCI group had significantly lower pooled ORs for all-cause mortality (2.30, 95% CI = 1.22-4.34; P = 0.01), cardiovascular death (2.29, 95% CI = 1.10-4.77; P = 0.03), and noncardiovascular death (3.46, 95% CI = 1.40-8.56; P = 0.007). Implications According to our randomized trial analysis, staged multivessel PCI significantly reduces the risk of myocardial infarction and unplanned ischemia-driven revascularization compared to immediate multivessel PCI. There was no significant difference between the two groups in terms of all-cause mortality, cardiovascular mortality, or noncardiovascular mortality risk. However, prospective non-randomized studies suggest there might be a benefit in mortality in the staged PCI group. Therefore, staged multivessel PCI may be the optimal PCI strategy for STEMI patients with MVD.
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Affiliation(s)
| | - Meng Li
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yanqing Wu
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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115
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Bhatty A, Wilkinson C, Batra G, Alfredsson J, Erlinge D, Ferreira J, Guðmundsdóttir IJ, Hrafnkelsdóttir ÞJ, Ingimarsdóttir IJ, Irs A, Járai Z, Jánosi A, Popescu BA, Santos M, Vasko P, Vinereanu D, Yap J, Maggioni AP, Wallentin L, Casadei B, Gale CP. Cohort profile: the European Unified Registries On Heart Care Evaluation and Randomized Trials (EuroHeart)-acute coronary syndrome and percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:386-390. [PMID: 38609345 DOI: 10.1093/ehjqcco/qcae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/25/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
AIMS The European Unified Registries On Heart Care Evaluation and Randomized Trials (EuroHeart) aims to improve the quality of care and clinical outcomes for patients with cardiovascular disease. The collaboration of acute coronary syndrome/percutaneous coronary intervention (ACS/PCI) registries is operational in seven vanguard European Society of Cardiology member countries. METHODS AND RESULTS Adults admitted to hospitals with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) are included, and individual patient-level data collected and aligned according to the internationally agreed EuroHeart data standards for ACS/PCI. The registries provide up to 155 variables spanning patient demographics and clinical characteristics, in-hospital care, in-hospital outcomes, and discharge medications. After performing statistical analyses on patient data, participating countries transfer aggregated data to EuroHeart for international reporting. Between 1st January 2022 and 31st December 2022, 40 021 admissions (STEMI 46.7%, NSTEMI 53.3%) were recorded from 192 hospitals in the seven vanguard countries: Estonia, Hungary, Iceland, Portugal, Romania, Singapore, and Sweden. The mean age for the cohort was 67.9 (standard deviation 12.6) years, and it included 12 628 (31.6%) women. CONCLUSION The EuroHeart collaboration of ACS/PCI registries prospectively collects and analyses individual data for ACS and PCI at a national level, after which aggregated results are transferred to the EuroHeart Data Science Centre. The collaboration will expand to other countries and provide continuous insights into the provision of clinical care and outcomes for patients with ACS and undergoing PCI. It will serve as a unique international platform for quality improvement, observational research, and registry-based clinical trials.
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Affiliation(s)
- Asad Bhatty
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris Wilkinson
- Hull York Medical School, University of York, York, UK
- Academic Cardiovascular Unit, South Tees NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Gorav Batra
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | | | | | - Jorge Ferreira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Portugal
| | | | | | - Inga Jóna Ingimarsdóttir
- Department of Cardiology, Landspitali University Hospital, Reykjavik, Iceland
- Department of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Alar Irs
- Tartu University Hospital, Estonia
| | - Zoltán Járai
- South Buda Center Hospital, Szent Imre Teaching Hospital, Hungary
| | - András Jánosi
- György Gottsegen National Cardiovascular Institute, Hungary
| | - Bogdan A Popescu
- University of Medicine and Pharmacy Carol Davila, Emergency Institute for Cardiovascular Diseases Prof Dr C C Iliescu, Bucharest, Romania
| | | | - Peter Vasko
- Linköping University Hospital, Linköping, Sweden
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, Emergency Institute for Cardiovascular Diseases Prof Dr C C Iliescu, Bucharest, Romania
- University and Emergency Hospital, Bucharest, Romania
| | | | - Aldo P Maggioni
- ANMCO Research Centre, Heart Care Foundation, 50121 Florence, Italy
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Barabara Casadei
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abusharekh M, Kampf J, Dykun I, Souri K, Backmann V, Al-Rashid F, Jánosi RA, Totzeck M, Lawo T, Rassaf T, Mahabadi AA. Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:402-410. [PMID: 38192031 DOI: 10.1093/ehjqcco/qcae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Acute total occlusion (ATO) is diagnosed in a substantial proportion of patients with non-ST-elevation myocardial infarction (NSTEMI). We compared procedural outcomes and long-term mortality in patients with STEMI with NSTEMI with vs. without ATO. METHODS AND RESULTS We included patients with acute myocardial infarction (AMI) undergoing invasive coronary angiography between 2004 and 2019 at our centre. Acute total occlusion was defined as thrombolysis in myocardial infarction (TIMI) 0-1 flow in the infarct-related artery or TIMI 2-3 flow with highly elevated peak troponin (>100-folds the upper reference limit). Association between presentation and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. From 2269 AMI patients (mean age 66 ± 13.2 years, 74% male), 664 patients with STEMI and 1605 patients with NSTEMI (471 [29.3%] with ATO) were included. ATO(+)NSTEMI patients had a higher frequency of cardiogenic shock and no reflow than ATO(-)NSTEMI with similar rates compared with STEMI patients (cardiogenic shock: 2.76 vs. 0.27 vs. 2.86%, P < 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P < 0.0001, P = 0.54). ATO(+)NSTEMI and STEMI were associated with 60 and 55% increased incident mortality, respectively, as compared with ATO(-)NSTEMI (ATO(+)NSTEMI: 1.60 [1.27-2.02], P < 0.0001, STEMI: 1.55 [1.24-1.94], P < 0.0001). Likewise, left ventricular ejection fraction (48.5 ± 12.7 vs. 49.1±11 vs. 50.6 ± 11.8%, P = 0.5, P = 0.018) and global longitudinal strain (-15.2 ± -5.74 vs. -15.5 ± -4.84 vs. -16.3 ± -5.30%, P = 0.48, P = 0.016) in ATO(+)NSTEMI were comparable to STEMI but significantly worse than in ATO(-)NSTEMI. CONCLUSION Non-ST-elevation myocardial infarction patients with ATO have unfavourable procedural outcomes, resulting in increased long-term mortality, resembling STEMI. Our findings suggest that the occlusion perspective provides a more appropriate classification of AMI than differentiation into STEMI vs. NSTEMI.
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Affiliation(s)
- Mohammed Abusharekh
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Jürgen Kampf
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Iryna Dykun
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Kashif Souri
- Department of Cardiology, The Elisabeth Hospital Recklinghausen, Röntgen Street 10, 45661 Recklinghausen, Germany
| | - Viktoria Backmann
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Thomas Lawo
- Department of Cardiology, The Elisabeth Hospital Recklinghausen, Röntgen Street 10, 45661 Recklinghausen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
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Cartanya-Bonvehi J, Pericas-Vila A, Subirana I, García-García C, Tizón-Marcos H, Elosua R. Effectiveness of STEMI networks with out-of-hospital triage: a systematic review and meta-analysis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00245-7. [PMID: 39121993 DOI: 10.1016/j.rec.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION AND OBJECTIVES Primary percutaneous coronary intervention (pPCI) is recommended for ST elevation myocardial infarction (STEMI). Countries have designed various STEMI network models to optimize out-of-hospital triage, timely treatment, and patient outcomes. The aim of this study was to evaluate the effectiveness of STEMI network implementation including out-of-hospital triage in improving STEMI case-fatality and long-term mortality, and its effect on the proportion of patients presenting with heart failure, their ischemia time, and time to pPCI. METHODS Systematic review and meta-analysis. Searches of PubMed, Scopus, and Web of Science databases covering January 2000 to December 2023, study selection, and data extraction were completed by 3 independent reviewers. RESULTS A total of 32 articles were selected. STEMI network implementation with out-of-hospital triage was associated with reductions of 35% in case-fatality (95%CI, -23% to -45%), 27% in long-term mortality (95%CI, -22% to -32%), and in the proportion of patients with Killip III-IV at admission, ischemia, time and time to pPCI (-17%, 95%CI, -35% +6%; -19%, 95%CI, -6% to -31%; -33%, 95%CI, -16% to -47%, respectively). Networks based on emergency transport systems and those involving the entire health system, including primary care centers and hospitals without pPCI capabilities, showed similar effectiveness. Greater effectiveness was observed in urban vs rural areas and high-income vs middle- and low-income countries. CONCLUSIONS The implementation of out-of-hospital triage-based STEMI networks is effective in reducing STEMI case-fatality and long-term mortality, independently of the geographic and socioeconomic conditions of the region. Participation of the emergency transport system is the key element of successful networks.
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Affiliation(s)
- Joan Cartanya-Bonvehi
- Centro de Atención Primaria Vic Nord, Instituto Catalán de la Salud, Vic, Barcelona, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain; Instituto de Investigación e Innovación en Ciencias de la Vida y de la Salud en la Cataluña Central (IRIS-CC), Vic, Barcelona, Spain
| | - Anna Pericas-Vila
- Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital del Mar Research Institute, Barcelona, Spain
| | - Cosme García-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Helena Tizón-Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital del Mar Research Institute, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Roberto Elosua
- Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital del Mar Research Institute, Barcelona, Spain.
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Goyal A, Tariq MD, Singh A, Thakkar KU, Brateanu A, Mahalwar G. Systematic review and meta-analysis comparing complete versus incomplete or culprit-only revascularization by percutaneous coronary intervention in elderly patients with acute coronary syndrome. Curr Probl Cardiol 2024; 49:102790. [PMID: 39127434 DOI: 10.1016/j.cpcardiol.2024.102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Complete revascularization (CR) is favored over culprit-only or incomplete revascularization (IR) for patients with acute coronary syndrome (ACS) and multi-vessel disease (MVD) due to better long-term outcomes. However, the optimal revascularization strategy is currently uncertain in elderly patients, where frailty, polypharmacy, multi-morbidity, inherent bleeding risk and presumed cognitive decline can often burden the decision-making process. METHODS We searched Medline, PubMed, and Google Scholar from inception to April 2024. The search of databases identified relevant studies that reported the comparative effects of CR and IR in the elderly population undergoing percutaneous coronary intervention (PCI). Data was pooled for individual studies using random-effects models on Comprehensive Meta-Analysis software, with statistical significance set at p < 0.05. RESULTS The meta-analysis included 14 studies and 62577 patients. CR demonstrated a significant reduction in all-cause mortality [RR: 0.680; 95 % CI: 0.57-0.82; p=<0.001], cardiovascular-related mortality [RR: 0.620; 95 % CI: 0.478-0.805; p=<0.001], and myocardial infarction [RR: 0.675; 95 % CI: 0.553-0.823; p=<0.001] rates. There was no difference between the risk of stroke [RR: 1.044; 95 % CI: 0.733-1.486; p = 0.81], major bleeding [RR: 1.001; 95 % CI: 0.787-1.274; p = 0.991], stent thrombosis [RR: 1.015; 95 % CI: 0.538-1.916; p = 0.936], and contrast-induced acute kidney injury [RR: 1.187; 95 % CI: 0.963-1.464; p = 0.109]. CONCLUSION The meta-analysis suggests that CR may be a favorable revascularization strategy for elderly patients undergoing PCI, displaying a significant decrease in mortality and repeat myocardial infarction risk.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Muhammad Daoud Tariq
- Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan
| | - Ajeet Singh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Kamya Uday Thakkar
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Eshraghi R, Sadati S, Bahrami A, Mirjalili SR, Farrokhian A, Mahjoubin-Tehran M, Mirzaei H. Unveiling the role of long non-coding RNA MALAT1: a comprehensive review on myocardial infarction. Front Cardiovasc Med 2024; 11:1429858. [PMID: 39171328 PMCID: PMC11335503 DOI: 10.3389/fcvm.2024.1429858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Myocardial infarction (MI) stands at top global causes of death in developed countries, owing mostly to atherosclerotic plaque growth and endothelial injury-induced reduction in coronary blood flow. While early reperfusion techniques have improved outcomes, long-term treatment continues to be difficult. The function of lncRNAs extends to regulating gene expression in various conditions, both physiological and pathological, such as cardiovascular diseases. The objective of this research is to extensively evaluate the significance of the lncRNA called Metastasis associated lung adenocarcinoma transcript 1 (MALAT1) in the development and management of MI. According to research, MALAT1 is implicated in processes such as autophagy, apoptosis, cell proliferation, and inflammation in the cardiovascular system. This investigation examines recent research examining the effects of MALAT1 on heart function and its potential as a mean of diagnosis and treatment for post- MI complications and ischemic reperfusion injury.
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Affiliation(s)
- Reza Eshraghi
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Sina Sadati
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Ashkan Bahrami
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Reza Mirjalili
- Yazd Cardiovascular Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Alireza Farrokhian
- Department of Cardiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Mahjoubin-Tehran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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120
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Azazy A, Farid WA, Ibrahim WA, El Shafey WELDH. Survival benefit of IABP in pre- versus post-primary percutaneous coronary intervention in patients with cardiogenic shock. Egypt Heart J 2024; 76:99. [PMID: 39107654 PMCID: PMC11303647 DOI: 10.1186/s43044-024-00527-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). However, little evidence is available regarding the optimal order of intra-aortic balloon counter-pulsation (IABP) insertion and primary percutaneous coronary intervention (PPCI). The aim of this study was to assess the hospital and short-term survival benefits of two different IABP insertion approaches, before versus after PPCI in patients with acute myocardial infarction and cardiogenic shock. RESULTS Total mortality was 80 patients representing 48.4% of the total 165 studied patients; 60 patients died during the hospital admission period, while the remaining 20 patients died post-discharge. In-hospital mortality was significantly higher in Post-PPCI-IABP group 40 (49.4%) versus Pre-PPCI-IABP group 20 (23.8%) (P = 0.001). Moreover, the mortality difference between the two groups was sustained over six-month follow-up period, where 15 patients (18.5%) died in the Post-PPCI-IABP group, while only 5 patients 6.0% died in the Pre-PPCI-IABP (P = 0.001). CONCLUSIONS Early IABP insertion before PPCI is associated with improved in-hospital and long-term survival when used for patients presenting with AMI complicated by hemodynamic instability.
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Affiliation(s)
- Ahmed Azazy
- Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Walaa Abdaziz Farid
- Department of Cardiology, Menofiya University Hospital, Shebin El Kom, Egypt
| | - Walid Abdu Ibrahim
- Department of Cardiology, Menofiya University Hospital, Shebin El Kom, Egypt
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121
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Correia JL, Ferreira GRM, Fiuza JG, Almeida MD, Coelho J, Correia E, Correia JM, Moreira D, Craveiro N, Gonçalves ML, Neto VD. Left ventricular thrombus routine screening with contrast echocardiography in patients with anterior ST-elevation myocardial infarction: is it worth it? J Cardiovasc Imaging 2024; 32:21. [PMID: 39103940 PMCID: PMC11299253 DOI: 10.1186/s44348-024-00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/07/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Left ventricular (LV) thrombus has a higher incidence among patients with anterior ST-elevation myocardial infarction (STEMI) when compared to other types of acute myocardial infarction and is associated with worse prognosis. The management of LV thrombus diagnosis remains challenging. Contrast echocardiography (transthoracic echocardiography, TTE) has shown potential in improving the accuracy for its diagnosis, thereby influencing treatment strategies concerning antithrombotic/anticoagulation therapy. The aim of this study was to assess the effectiveness of contrast TTE as a routine screening method for detecting LV thrombus in the acute phase of anterior STEMI. METHODS A prospective, single center, randomized controlled trial was conducted among patients with anterior STEMI. The study group underwent contrast TTE, while the control group received a conventional approach. Demographical, clinical, and diagnostic data were collected. Thrombus detection rates were compared between groups. RESULTS A total of 68 patients were included (32 in the study group and 36 in the control group). No substantial baseline differences were observed between groups. Thrombus detection rate was 25.0% in the study group and 13.9% in the control group, however these results did not reach statistical significance (P = 0.24). The prevalence of anterior/apical aneurysm was higher in the study group (46.9% vs. 22.2%, P = 0.03). CONCLUSIONS Conventional TTE may be adequate for diagnosing LV thrombus in the acute phase of anterior STEMI; however, further larger-scale and multicenter studies are necessary to obtain more robust and conclusive results. Ultrasound contrast may play a significant role in the detection of anterior/apical aneurysms, which are known risk factors for the subsequent development of thrombus. TRIAL REGISTRATION NCT06480929 (ClinicalTrials.gov, Retrospectively registered).
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Affiliation(s)
| | | | | | | | - Joana Coelho
- Internal Medicine Department, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Emanuel Correia
- Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | | | - Davide Moreira
- Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Nuno Craveiro
- Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | | | - Vanda Devesa Neto
- Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
- Universidade da Beira Interior, Covilhã, Portugal
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Kim J, Kang D, Park H, Park TK, Lee JM, Yang JH, Song YB, Choi JH, Choi SH, Gwon HC, Guallar E, Cho J, Hahn JY. Angiotensin Receptor Blockers Versus Angiotensin Converting Enzyme Inhibitors in Acute Myocardial Infarction Without Heart Failure. Am J Med 2024:S0002-9343(24)00477-7. [PMID: 39103006 DOI: 10.1016/j.amjmed.2024.07.020] [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: 03/01/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Whether angiotensin II receptor blockers (ARBs) can be an alternative to angiotensin-converting enzyme inhibitors (ACEIs) in patients without heart failure (HF) after acute myocardial infarction (MI) remains controversial. The aim of this study was to compare clinical outcomes between initial ARB and ACEI therapy in patients with MI without HF. METHODS Between 2010 and 2016, a total of 31,013 patients who underwent coronary revascularization for MI with prescription of ARBs or ACEIs at hospital discharge were enrolled from the Korean nationwide medical insurance data. Patients who had HF at index MI were excluded. The primary outcome was all-cause death. The secondary outcomes included recurrent MI, hospitalization for new heart HF, stroke, and a composite of each outcome. RESULTS Of 31,013 patients, ARBs were prescribed in 12,685 (40.9%) and ACEIs in 18,328 (59.1%). Patients receiving ARBs had a lower discontinuation rate compared with those receiving ACEIs (28.2% vs 43.5%, adjusted hazard ratio [HR] 0.34; 95% confidence interval [CI] 0.31-0.37; P < .01). During a median follow-up of 2.2 years, 2480 patients died. The incidence rate of all-cause death in patients receiving ARBs and those receiving ACEIs was 27.7 and 22.9 per 1000 person-years, respectively (adjusted HR 1.04; 95% CI 0.95-1.13; P = .40). There were no significant differences in the secondary outcomes between patients receiving ARBs and those receiving ACEIs, except stroke (19.2 vs 13.6 per 1000 person-years; adjusted HR 1.17; 95% CI 1.04-1.32; P = .01). In a subgroup analysis, a higher mortality was observed with ARBs compared with ACEIs in patients with diabetes. CONCLUSIONS In this nationwide cohort, there was no significant difference in the incidence of all-cause death between ARBs and ACEIs as discharge medications in patients with myocardial infarction without heart failure. Angiotensin II receptor blockers would be an alternative to ACEIs for those intolerant to ACEI therapy.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eliseo Guallar
- Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Iacobescu L, Ciobanu AO, Macarie R, Vadana M, Ciortan L, Tucureanu MM, Butoi E, Simionescu M, Vinereanu D. Diagnostic and Prognostic Role of Circulating microRNAs in Patients with Coronary Artery Disease-Impact on Left Ventricle and Arterial Function. Curr Issues Mol Biol 2024; 46:8499-8511. [PMID: 39194717 DOI: 10.3390/cimb46080500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024] Open
Abstract
Recent studies reported that circulating microRNAs (miRNAs) can target different metalloproteases (MMPs) involved in matrix remodeling and plaque vulnerability. Consequently, they might have a role in the diagnosis and prognosis of coronary artery disease. To quantify circulating miRNAs (miRNA126, miRNA146, and miRNA21) suggested to have possible cardiovascular implications, as well as levels of MMP-1 and MMP-9, and to determine their association with left ventricular (LV) function and with arterial function, in patients with either ST-segment elevation acute myocardial infarction (STEMI) or stable ischemic heart disease (SIHD). A total of 90 patients with coronary artery disease (61% men, 58 ± 12 years), including 60 patients with STEMI and 30 patients with SIHD, were assessed within 24 h of admission, by measuring serum microRNAs, and serum MMP-1 and MMP-9. LV function was assessed by measuring ejection fraction (EF) by 2D and 3D echocardiography, and global longitudinal strain (GLS) by speckle tracking. Arterial function was assessed by echo tracking, CAVI, and peripheral Doppler. Circulating levels of miRNA146, miRNA21, and MMP1 were significantly increased in patients with STEMI vs. SIHD (p = 0.0001, p = 0.0001, p = 0.04, respectively). MiRNA126 negatively correlated with LVEF (r = -0.33, p = 0.01) and LV deformation parameters (r = -0.31, p = 0.03) in patients with STEMI and negatively correlated with ABI parameters (r = -0.39, p = 0.03, r = -0.40, p = 0.03, respectively) in patients with SIHD. MiRNA146 did not have any significant correlations, while higher values of miRNA21 were associated with lower values of GLS in STEMI patients and with higher values of GLS in SIHD patients. Both MMP1 and MMP9 correlated negatively with LVEF (r = -0.27, p = 0.04, r = -0.40, p = 0.001, respectively) and GLS in patients with STEMI, and positively with arterial stiffness in patients with SIHD (r = 0.40 and r = 0.32, respectively; both p < 0.05). MiRNA126, miRNA21, and both MMP1 and MMP9 are associated with LV and arterial function parameters in patients with acute coronary syndrome. Meanwhile, they inversely correlate with arterial function in patients with chronic atherosclerotic disease. However, further studies are needed to establish whether these novel biomarkers have diagnosis and prognosis significance.
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Affiliation(s)
- Loredana Iacobescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Dionisie Lupu Street, 126900 Bucharest, Romania
- University and Emergency Hospital, Splaiul Independentei 169, 050098 Bucharest, Romania
| | - Andrea Olivia Ciobanu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Dionisie Lupu Street, 126900 Bucharest, Romania
- University and Emergency Hospital, Splaiul Independentei 169, 050098 Bucharest, Romania
| | - Razvan Macarie
- Institute of Cellular Biology and Pathology Nicolae Simionescu, 050568 Bucharest, Romania
| | - Mihaela Vadana
- Institute of Cellular Biology and Pathology Nicolae Simionescu, 050568 Bucharest, Romania
| | - Letitia Ciortan
- Institute of Cellular Biology and Pathology Nicolae Simionescu, 050568 Bucharest, Romania
| | | | - Elena Butoi
- Institute of Cellular Biology and Pathology Nicolae Simionescu, 050568 Bucharest, Romania
| | - Maya Simionescu
- Institute of Cellular Biology and Pathology Nicolae Simionescu, 050568 Bucharest, Romania
| | - Dragos Vinereanu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Dionisie Lupu Street, 126900 Bucharest, Romania
- University and Emergency Hospital, Splaiul Independentei 169, 050098 Bucharest, Romania
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Cheng J, Wang Y, Sheng J, Ya W, Xia Z. Accuracy of death risk prediction models for acute coronary syndrome patients: a systematic review and meta-analysis. Minerva Cardiol Angiol 2024; 72:405-415. [PMID: 38436608 DOI: 10.23736/s2724-5683.23.06415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
INTRODUCTION This study systematically evaluates the accuracy of several death risk prediction models for patients with acute coronary syndrome (ACS) through evidence-based methods. We identify the most accurate and effective ACS death risk prediction model and provide an evidence-based basis for clinical healthcare personnel to evaluate their choice of death risk prediction model for ACS patients. EVIDENCE ACQUISITION An evidence-based approach was used to study the current death risk prediction model for ACS. First, a literature search was carried out using computer-based and manual searching. The literature databases searched include Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, WanFang Data, CNKI, VPCS, and SinoMed. The search period was limited to 2009 to 2022. Screening, quality evaluation and data extraction were carried out for the included articles. The PROBAST was used to conduct a migration risk assessment. RevMan 5.3 and Meta-DiSc 1.4 were used in combination to determine the model effect sizes. A descriptive analysis was conducted for the data that could not be meta-analyzed. EVIDENCE SYNTHESIS A total of 8277 articles were initially included in this study. After screening, 25 articles were finally included, involving 11 different risk prediction models. A total of 306,390 patients with ACS were included of which 158,080 (51.6%) were male and 147,793 (48.4%) were female. The patients stemmed from 11 different countries (e.g., China, the USA, Spain, the UK, etc.). The total number of deaths was 23,601. The sensitivity of the GRACE risk prediction model was 0.78, with a specificity of 0.76 and an AUC value of 0.86. The sensitivity of the CAMI risk prediction model was 0.78, with a specificity of 0.70 and an AUC value of 0.85. The sensitivity of the TIMI risk prediction model was 0.51, with a specificity of 0.81, and an AUC value of 0.64. The sensitivity of the REMS risk prediction model was 0.78, with a specificity of 0.46 and an AUC value of 0.41. Eight different risk prediction models (EPICOR, CRUSADE, SAMI, GWTG, LNS, SYNTAX II, APACHE II) that could not be combined with the effect size were also included, with sensitivities ranging from 0.77-0.95, specificities ranging from 0.22-0.99, and AUC values ranging from 0.71-0.92. CONCLUSIONS The GRACE and CAMI risk prediction models demonstrate good accuracy for evaluating the death risk of ACS patients. The accuracy of the TIMI risk prediction model is similar to that of the REMS risk prediction model. The APACHE II, SYNTAX II, EPICOR, and CAMI risk prediction models also show good accuracy for estimating the risk of death in ACS patients, although further validation is needed due to limited evidence. For improved predictive accuracy and to help advance medical interventions, the author recommends that clinical medical staff use the GRACE model to predict the death risk of ACS patients.
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Affiliation(s)
- Jifang Cheng
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yike Wang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China -
| | - Jiantong Sheng
- Huzhou University, Huzhou, Zhejiang, China
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, China
| | - Wang Ya
- Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Zhu Xia
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Wester A, Jepsen P, Hagström H. Statin initiation after myocardial infarction in patients with alcohol-related liver disease: A nationwide population-based study. Liver Int 2024; 44:2002-2010. [PMID: 38651770 DOI: 10.1111/liv.15912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIMS Secondary prevention with statins improves clinical outcomes after myocardial infarction (MI). We aimed to compare odds of statin initiation after MI in patients with co-existing alcohol-related liver disease (ALD) to the general population, and the association between statin initiation and mortality in the patients with ALD. METHODS All statin-naïve patients with ALD and a first-time MI between 2006 and 2020 were identified from Swedish healthcare registers and matched for age, sex, and year of MI with up to ten ALD-free general population controls with a first-time MI. Logistic regression was used to estimate adjusted odds ratios (OR) for statin initiation within 30 days after MI for ALD patients versus controls. Cox regression was used in patients with ALD to compare mortality between statin initiators and non-initiators. RESULTS Of the 276 patients with a first-time MI and ALD, 206 (74.6%) were male, the median age was 67 (interquartile range 62-72), 151 (54.7%) had cirrhosis, and 62 (22.5%) had decompensated cirrhosis. 1769 matched controls were included. Initiation of statins was less common in ALD patients (50.0%) than controls (89.2%, adjusted OR = .15, 95% confidence interval [CI] = .10-.20). Among patients with ALD, statin initiators and non-initiators were followed for a median of 3.9 (interquartile range = 1.8-7.7) and 1.9 years (interquartile range = .5-4.4), respectively. Statin initiators had lower mortality than non-initiators (adjusted hazard ratio = .41, 95%CI = .28-.59). CONCLUSIONS Patients with ALD less often initiated statins after MI than the general population. Statin initiation was associated with improved survival, suggesting that patients with ALD might be undertreated following MI.
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Affiliation(s)
- Axel Wester
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden
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Alexandre A, Campinas A, Brochado B, Braga M, Sá‐Couto D, Santos M, Ribeiro D, Brandão M, Silva MP, de Morais GP, Calvão J, Silva JC, Baggen‐Santos R, Luz A, Silveira J, Torres S. Twelve-year trends in unprotected left main coronary artery occlusion: insights from a real-world multicentre study. ESC Heart Fail 2024; 11:1981-1994. [PMID: 38549183 PMCID: PMC11287319 DOI: 10.1002/ehf2.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 07/31/2024] Open
Abstract
AIMS Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12 year period. METHODS AND RESULTS This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%. CONCLUSIONS In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.
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Affiliation(s)
- André Alexandre
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Andreia Campinas
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Bruno Brochado
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Marta Braga
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - David Sá‐Couto
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Mariana Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Diana Ribeiro
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Mariana Brandão
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Marisa Passos Silva
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Gustavo Pires de Morais
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - João Calvão
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - João Carlos Silva
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - Raquel Baggen‐Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - André Luz
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- Cardiovascular Research Group, UMIB – Unit for Multidisciplinary Research in Biomedicine, ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - João Silveira
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Severo Torres
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
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Roy B, Cho JG, Baker L, Thomas L, Curnow J, Harvey JJ, Geenty P, Banerjee A, Lai K, Vicaretti M, Erksine O, Li J, Alasady R, Wong V, Tai JE, Thirunavukarasu C, Haque I, Chien J. Pulmonary embolism response teams. A description of the first 36-month Australian experience. Intern Med J 2024; 54:1283-1291. [PMID: 38497689 DOI: 10.1111/imj.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND High/intermediate-risk pulmonary embolism (PE) confers increased risk of cardiovascular morbidity and mortality. International guidelines recommend the formation of a PE response team (PERT) for PE management because of the complexity of risk stratification and emerging treatment options. However, there are currently no available Australian data regarding outcomes of PE managed through a PERT. AIMS To analyse the clinical and outcome data of patients from an Australian centre with high/intermediate-risk PE requiring PERT-guided management. METHODS We performed a retrospective observational study of 75 consecutive patients with high/intermediate-risk PE who had PERT involvement, between August 2018 and July 2021. We recorded clinical and interventional data at the time of PERT and assessed patient outcomes up to 30 days from PERT initiation. We used unpaired t tests to compare right to left ventricular (RV/LV) ratios by computed tomography criteria or transthoracic echocardiogram (TTE) at baseline and after interventions. RESULTS Data were available for 74 patients. Initial computed tomography pulmonary angiography RV/LV ratio was increased at 1.65 ± 0.5 and decreased to 1.30 ± 0.29 following PERT-guided interventions (P < 0.001). TTE RV/LV ratio also decreased following PERT-guided management (1.09 ± 0.19 vs 0.93 ± 0.17; P < 0.001). 20% of patients had any bleeding complication, but two-thirds were mild, not requiring intervention. All-cause mortality was 6.8%, and all occurred within the first 7 days of admission. CONCLUSION The PERT model is feasible in a large Australian centre in managing complex and time-critical PE. Our data demonstrate outcomes comparable with existing published international PERT data. However, successful implementation at other Australian institutions may require adequate centre-specific resource availability and the presence of multispeciality input.
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Affiliation(s)
- Bapti Roy
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- School of Medical & Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Jin-Gun Cho
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Luke Baker
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Liza Thomas
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Curnow
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - John J Harvey
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul Geenty
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ashoke Banerjee
- Department of Intensive Care Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kevin Lai
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Mauro Vicaretti
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Odette Erksine
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Li
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rafid Alasady
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vanessa Wong
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jian E Tai
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - Imran Haque
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Algül E, Özbeyaz NB, Şahan HF, Aydınyılmaz F, Sunman H, Tulmaç M. Stress Hyperglycemia Ratio Is Associated With High Thrombus Burden in Patients With Acute Coronary Syndrome. Angiology 2024; 75:645-650. [PMID: 37005730 DOI: 10.1177/00033197231167054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
The blood glucose level at admission indicates (with some limitations) poor prognosis and thrombus burden in patients with the acute coronary syndrome (ACS). Our study aimed to measure the predictive value of the stress hyperglycemia ratio (SHR), an indicator of stress hyperglycemia, showing increased thrombus burden in patients with ACS. Patients (n = 1222) with ACS were enrolled in this cross-sectional study. Coronary thrombus burden was classified as high and low. SHR was calculated by dividing the admission serum glucose by the estimated average glucose derived from HbA1c. Low thrombus burden was detected in 771 patients, while high thrombus burden (HTB) was detected in 451 patients. SHR was found to be significantly higher in patients with HTB (1.1 ± .3 vs 1.06 ± .4; P = .002). SHR was determined as a predictor of HTB (odds ratio (OR) 1.547 95% CI (1.139-2.100), P < .001) as a result of univariate analysis. According to multivariate analysis, SHR was determined as an independent risk factor for HTB (OR 1.328 CI (1.082-1.752), P = .001). We found that SHR predicted thrombus burden with higher sensitivity than admission glucose level in patients with ACS.
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Affiliation(s)
- Engin Algül
- Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Nail Burak Özbeyaz
- Department of Cardiology Clinic, Pursaklar State Hospital, Ankara, Turkey
| | - Haluk Furkan Şahan
- Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Faruk Aydınyılmaz
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Hamza Sunman
- Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Murat Tulmaç
- Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Shibasaki I, Saito S, Kanazawa Y, Takei Y, Tsuchiya G, Fukuda H. Preoperative Impella therapy in patients with ventricular septal rupture and cardiogenic shock: haemodynamic and organ function outcomes. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae137. [PMID: 39041629 PMCID: PMC11315651 DOI: 10.1093/icvts/ivae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/28/2024] [Accepted: 07/22/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES We examined the effects of preoperative Impella treatment on haemodynamic stability, organ recovery and postoperative outcomes in patients with postinfarction ventricular septal rupture (PIVSR) and cardiogenic shock (CS). METHODS Between April 2018 and February 2024, the data of 10 of 15 patients with PIVSR and CS who underwent Impella therapy were analysed. Emergency surgery was contingent on haemodynamic stability with the Impella/ECpella, except in the presence of organ failure. We utilized a generalized linear mixed model to evaluate organ ischaemia through changes in blood parameters upon admission and at subsequent intervals post-Impella insertion. RESULTS Preoperative Impella or combined Impella and ECpella (5 patients each) support was provided, with diagnoses and operations occurring at an average of 4 days (interquartile range: 2-5) and 8 days (interquartile range: 2-14) after myocardial infarction, respectively. Treatment significantly reduced lactate, alanine aminotransferase, creatine kinase-MB and troponin I levels (P ≤ 0.05 for all). Conversely, no significant change was noted in the aspartate aminotransferase level or the estimated glomerular filtration rate. Haemoglobin and platelet counts decreased despite transfusions (P < 0.001). No surgical deaths occurred; however, 70% of the patients required prolonged mechanical ventilation, and 80% were transferred to other facilities for rehabilitation. CONCLUSIONS Impella or ECpella treatment can improve haemodynamic and organ failure outcomes in patients with PIVSR and CS. However, the risks of prolonged support, including haemorrhagic events and the need for extended rehabilitation, point to a need for comparative studies to optimize support duration.
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Affiliation(s)
- Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
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Masi P, Gendreau S, Moyon Q, Leguyader M, Lebreton G, Ropers J, Dangers L, Sitruk S, Bréchot N, Pineton de Chambrun M, Chommeloux J, Schmidt M, Luyt CE, Leprince P, Combes A, Frere C, Hékimian G. Bleeding complications, coagulation disorders, and their management in acute myocardial infarction-related cardiogenic shock rescued by veno-arterial ECMO: A retrospective cohort study. J Crit Care 2024; 82:154771. [PMID: 38471248 DOI: 10.1016/j.jcrc.2024.154771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Management of dual antiplatelet therapy (DAPT) in patients on venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging. Our objective was to describe the frequency, management and outcomes of severe bleeding complications and determine their occurrence risk factors. MATERIAL AND METHODS We conducted a retrospective observational cohort study including post-AMI cardiogenic shock patients requiring VA-ECMO. Severe bleeding was defined based on the Bleeding Academic Research Consortium classification. We calculated multivariable Fine-Gray models to assess factors associated with risk of severe bleeding. RESULTS From January 2015 to July 2019, 176 patients received VA-ECMO after AMI and 132 patients were included. Sixty-five (49%) patients died. Severe bleeding occurred in 39% of cases. Severe thrombocytopenia (< 50 G/L) and hypofibrinogenemia (<1,5 g/L) occurred in respectively 31% and 19% of patients. DAPT was stopped in 32% of patients with a 6% rate of stent thrombosis. Anticoagulation was stopped in 39% of patients. Using a multivariate competing risk model, female sex, time on ECMO, troponin at admission and Impella® implantation were independently associated with severe bleeding. CONCLUSIONS Bleeding complications and coagulation disorders were frequent and severe in patients on VA-ECMO after AMI, leading of antiplatelet therapy withdrawal in one third of patients.
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Affiliation(s)
- Paul Masi
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, France.
| | - Ségolène Gendreau
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, France
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Maxence Leguyader
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Cardiothoracic surgery department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Jacques Ropers
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière -Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Laurence Dangers
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Samuel Sitruk
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière -Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Nicolas Bréchot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Juliette Chommeloux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Matthieu Schmidt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Charles Edouard Luyt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Pascal Leprince
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Cardiothoracic surgery department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Alain Combes
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Corinne Frere
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Department of Hematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Guillaume Hékimian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
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Li J, Wang Y, Yang X, Zhu H, Jiang Z. Drug-induced hypoglycemia: a disproportionality analysis of the FAERS database. Expert Opin Drug Saf 2024; 23:1061-1067. [PMID: 37909653 DOI: 10.1080/14740338.2023.2278700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Hypoglycemia is an adverse event (AE) that cannot be ignored in clinical practice. This study aimed to identify the most common and top drugs associated with the risk of hypoglycemia based on the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. RESEARCH DESIGN AND METHODS We used OpenVigil 2.1 pharmacovigilance analytics platform to query FAERS database and data from 2004 to 2023 were retrieved. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify hypoglycemia cases, and DrugBank database was used to determine drug generic names. RESULTS A total of 11,155,106 AEs reports were identified, of which 28,443 (0.25%) were related to hypoglycemia. Metformin (6926 cases) was associated with most cases of hypoglycemia. According to the disproportionality analysis, the top five drugs with the highest ROR and PRR were penamecillin, nikethamide, sotagliflozin, norethandrolone, glimepiride/pioglitazone. Nineteen of the top 50 drugs did not have hypoglycemia indicated in the package insert. CONCLUSIONS By analyzing the FAERS database, we listed drugs with a strong hypoglycemic signal for which the label does not provide a reminder. Notably, the potential hypoglycemia risks are of great importance and should be closely monitored in medical practice.
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Affiliation(s)
- Jie Li
- Department of Pharmacy, Zhangjiagang TCM Hospital, Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Yilei Wang
- Department of Pharmacy, Taicang TCM Hospital, Affiliated to Nanjing University of Chinese Medicine, Taicang, Jiangsu, China
| | - Xiang Yang
- Department of Pharmacy, Zhangjiagang TCM Hospital, Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Haohao Zhu
- Department of Pharmacy, Wuxi Central Rehabilitation Hospital, Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Zhitao Jiang
- Department of Pharmacy, Zhangjiagang TCM Hospital, Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
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Chen X, Zhang X, Yang Y, Sun Y, Si J, Jiang S, Hu Y, Ding Z, Xia Y, Chen Y, Liu Y. Left ventricular reverse remodelling as a promising strategy for resolving left ventricular thrombus. ESC Heart Fail 2024; 11:2214-2222. [PMID: 38628024 PMCID: PMC11287347 DOI: 10.1002/ehf2.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/27/2023] [Accepted: 03/15/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Recent years, several studies have suggested that abnormal baseline left ventricular (LV) function and structure are associated with left ventricular thrombus (LVT) formation. Despite this, most studies have given less attention to the potential role of left ventricular reverse remodelling (LVRR), that is, the improvement of LV function and structure, in resolving LVT. In this study, we aim to investigate the clinical characteristics, prognosis, and LVT resolution in patients with LVRR. METHODS AND RESULTS This is a retrospective study conducted at The First Affiliated Hospital of Dalian Medical University. Our cohort consists of patients diagnosed with LVT between 1 November 2015 and 31 May 2020. Enrolled patients were categorized into two groups: LVRR and Failure of LVRR. The primary endpoints included LVT resolution and embolic events. A total of 84 patients were included in the study, with 59 patients in the LVRR group and 25 patients in the Failure of LVRR group. In our study, patients in the LVRR group experienced higher incidence of LVT resolution and a lower risk of embolic events. Multivariate logistic analysis revealed that Failure of LVRR was the only independent negative predictor for LVT resolution and positive predictor for embolic events. CONCLUSIONS Patients with LVRR experience higher incidence of LVT resolution and have lower risk of embolic events, highlighting the significance of identifying and mitigating risk factors that contribute to abnormal LV function and structure in management of patients with LVT.
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Affiliation(s)
- Xuefu Chen
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Xinxin Zhang
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yahui Yang
- College of PharmacyDalian Medical UniversityDalianChina
- School of Pharmaceutical SciencesShandong UniversityJinanChina
| | - Yuxi Sun
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
- Department of Cardiology, West China HospitalSichuan UniversityChenduChina
| | - Jinping Si
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Shufen Jiang
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yuze Hu
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Zijie Ding
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yunlong Xia
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yanwei Chen
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Ying Liu
- Department of CardiologyThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
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133
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Naveen V, Rajesh Lenin R, Stanley LM, Kumar JS. Serum Magnesium Levels and QTc Interval Prolongation As Prognostic Markers in Acute Myocardial Infarction: A Randomized Controlled Study. Cureus 2024; 16:e66051. [PMID: 39224744 PMCID: PMC11367062 DOI: 10.7759/cureus.66051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Acute myocardial infarction (AMI) is frequently preceded by arrhythmias, which continue to be a prominent cause of abrupt fatality in AMI. Abnormal magnesium levels have been linked to the emergence of arrhythmia because it enhances myocardial metabolism and cardiac output and prevents calcium buildup and myocardial cell death by lowering arrhythmias. The objectives of this study were to evaluate serum magnesium levels and QTc interval as prognostic indicators in AMI patients during the initial 48 hours of hospital stay and to correlate these parameters with the Global Registry of Acute Coronary Events (GRACE) scoring. We studied AMI patients by dividing them into two groups: those with abnormal and those with normal serum magnesium levels. Methods After obtaining ethical approvals, patients were subjected to detailed history, which included sociodemographic details, drug history, clinical examination, and investigations such as creatine kinase myocardial band (CK-MB), CK-total, troponin-T, ECG (QTc interval), two-dimensional echocardiogram (2D-ECHO), serum creatinine and magnesium levels, heart rate, and blood pressure. We also calculated the GRACE score for all patients. Results We found that patients in the age group of 51-60 years were more prone to developing arrhythmias, and while AMI was more prevalent in males, the occurrence of arrhythmias was slightly higher in females with AMI. Anterior wall motion abnormality (AWMA) was the most predominant abnormality, and 12.3% of AWMA patients had arrhythmias. QTc interval was significantly longer in patients who developed arrhythmias. Interestingly, among patients with QTc prolongation, 35% patients had abnormal magnesium levels, while 65% had normal magnesium levels. In our study, of the 25 patients with hypermagnesemia, nine (36%) developed arrhythmias, while of the 75 patients with hypomagnesemia, 15 (20%) patients developed arrhythmias. Interestingly, we found that there was a positive correlation between GRACE score and serum magnesium as well as QTc interval prolongation. Lastly, among the six deaths reported, three (50%) patients had arrhythmias. Conclusion Overall, we conclude that serum magnesium levels play a pivotal role as a prognostic tool for arrhythmias and are a useful investigation during the initial 48 hours of admission in AMI patients.
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Affiliation(s)
- Venkat Naveen
- General Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chengalpattu, IND
| | - Raji Rajesh Lenin
- Medical Research, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chengalpattu, IND
| | - Lanord M Stanley
- General Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chengalpattu, IND
| | - J S Kumar
- General Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chengalpattu, IND
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134
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Sumi K, Iwakura T, Yoon R, Nakahara Y, Kuwabara M, Marui A. Effect of Delayed Surgery for Ventricular Septal Rupture on Postoperative Outcomes. Cureus 2024; 16:e66655. [PMID: 39262563 PMCID: PMC11387514 DOI: 10.7759/cureus.66655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVES The prognosis of ventricular septal rupture (VSR) after acute myocardial infarction remains poor; hence, surgical repair is essential. However, the appropriate timing for surgical intervention remains unclear. We aimed to compare the prognosis between early (<96 hours) and delayed (≥96 hours) surgery for VSR. METHODS This single-center, retrospective cohort study used data from 49 patients who underwent VSR repair after acute myocardial infarction (AMI) between 2007 and 2022 at our institution. In-hospital and one-, three-, and 10-year mortality and major adverse cardiac and cerebrovascular events were compared between the early (group A) and delayed (group B) surgery after AMI. RESULTS No significant differences were found between the patients' backgrounds of the two groups. The in-hospital mortality rates were 37.5 and 16.0% for groups A and B, respectively (P = 0.114). The overall survival rates estimated using Kaplan-Meier analysis were 66.5 ± 6.9, 58.2 ± 7.5, and 28.8 ± 10.6% after one, three, and 10 years, respectively. The mortality rates in group B at three (hazard risk ratio: 2.691; 95% confidence interval: 1.02-7.097) and 10 (hazard risk ratio: 2.575; 95% confidence interval: 1.125-5.891) years were significantly better than those in group A. Major adverse cardiac and cerebrovascular events were significantly different between the two groups at all time points. CONCLUSIONS These results showed that patients who underwent surgery for VSR 96 hours after AMI had better long-term survival than those who underwent surgery within 96 hours.
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Affiliation(s)
- Kohei Sumi
- Department of Cardiothoracic Surgery, Sakakibara Heart Institute, Tokyo, JPN
| | - Tomohiro Iwakura
- Department of Cardiothoracic Surgery, Sakakibara Heart Institute, Tokyo, JPN
| | - Ryangwon Yoon
- Department of Cardiothoracic Surgery, Sakakibara Heart Institute, Tokyo, JPN
| | - Yoshinori Nakahara
- Department of Cardiothoracic Surgery, Sakakibara Heart Institute, Tokyo, JPN
| | | | - Akira Marui
- Department of Cardiothoracic Surgery, Sakakibara Heart Institute, Tokyo, JPN
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135
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Liu L, Zeng B, Zhang J, Li G, Zong W. Impact of subclinical hypothyroidism on in-hospital outcomes and long-term mortality among acute myocardial infarction patients with diabetic mellitus. Acta Cardiol 2024; 79:650-658. [PMID: 37961871 DOI: 10.1080/00015385.2023.2279421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) has been regarded as a predictor of poor outcomes in patients with acute myocardial infarction (AMI). AMI complicated by diabetes mellitus (DM) tends to have a high prevalence and a worse prognosis. We aim to evaluate the association between thyroid dysfunction and in-hospital outcomes and short- and medium-term mortality in diabetic patients with AMI. METHODS From January 2017 to November 2020, a total of 432 patients with AMI were included in this study, including 209 DM patients and 223 non-DM patients. Baseline characteristics, medical history, and laboratory parameters of patients were recorded after admission. In-hospital outcomes and 30-day mortality were recorded, and long-term mortality was recorded with a median follow-up of 34.2 ± 5.6 months. RESULTS Subclinical hypothyroidism (SCH) was defined as an elevated TSH level of more than with a normal range of circulating thyroid hormones. In AMI with DM group, 26/209 (12.4%) patients were complicated with SCH, these patients tend to be older and experienced worse in-hospital outcomes compared to patients without SCH, including higher rates of acute heart failure, acute kidney injury, and atrial fibrillation. Moreover, patients with SCH had a higher prevalence of 30-day mortality and long-term mortality, compared with patients without SCH. CONCLUSIONS Diabetic AMI patients with SCH had worse in-hospital outcomes and higher 30-day and long-term mortality. Patients with diabetic AMI should pay attention to thyroid function, and SCH is an independent risk factor for short-term and long-term mortality in diabetic AMI patients.
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Affiliation(s)
- Lei Liu
- Department of Cardiology, Hubei No.3 People's Hospital of Jianghan University, Wuhan, China
| | - Bin Zeng
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Zhang
- Department of Cardiology, Hubei No.3 People's Hospital of Jianghan University, Wuhan, China
| | - Geng Li
- Department of Cardiology, Hubei No.3 People's Hospital of Jianghan University, Wuhan, China
| | - Wenxia Zong
- Department of Cardiology, The Third People's Hospital of Hubei Province Affiliated to Jianghan University, Wuhan, China
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Borkowski P, Maliha M, Borkowski M, Borkowska N, Singh N, Chauhan A, Chowdhury I, Yakkali S, Satish V, Choi H. Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA): A Case Report and Comprehensive Discussion of Pathophysiology and Risk Factors. Cureus 2024; 16:e67144. [PMID: 39161551 PMCID: PMC11332960 DOI: 10.7759/cureus.67144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 08/21/2024] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) refers to the occurrence of myocardial infarction symptoms and signs despite angiographic findings showing normal or near-normal coronary arteries. Unlike the more commonly recognized myocardial infarction with coronary artery disease (MICAD), MINOCA often has a better prognosis; however, it is not without risk, as it is associated with increased mortality. We present a 72-year-old female who presented to the hospital with acute chest pain. Following a thorough diagnostic workup, including laboratory tests, left heart catheterization, and cardiac imaging, she was diagnosed with MINOCA. This case report provides a comprehensive review of the pathophysiological mechanisms underlying MINOCA, such as plaque disruption without significant stenosis, microvascular dysfunction, coronary artery spasm, coronary thrombosis or embolism, and spontaneous coronary artery dissection. Additionally, we explore the associated risk factors, highlighting the unconventional risk factors. MINOCA represents a diverse clinical condition with various causes and complex pathophysiology. The variability underscores the necessity for further research to deepen our understanding of this condition. Enhanced knowledge will lead to better diagnostic and treatment strategies, ultimately improving patient outcomes.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Maisha Maliha
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | | | - Natalia Borkowska
- Pediatrics, Samodzielny Publiczny Zakład Opieki Zdrowotnej (SPZOZ), Krotoszyn, POL
| | - Nikita Singh
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Abhyuday Chauhan
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Ishmum Chowdhury
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Shreyas Yakkali
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Vikyath Satish
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Hansol Choi
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
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Bigot M, Guy JM, Monpere C, Cohen-Solal A, Pavy B, Iliou MC, Bosser G, Corone S, Douard H, Farrokhi T, Guerder A, Guillo P, Houppe JP, Pezel T, Pierre B, Roueff S, Thomas D, Verges B, Blanchard JC, Ghannem M, Marcadet D. Cardiac rehabilitation recommendations of the Group Exercise Rehabilitation Sports - Prevention (GERS-P) of the French Society of Cardiology: 2023 update. Arch Cardiovasc Dis 2024; 117:521-541. [PMID: 39174436 DOI: 10.1016/j.acvd.2024.05.119] [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: 02/04/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Muriel Bigot
- Centre de réadaptation cardiaque, Cardiocéan, 17138 Puilboreau, France.
| | - Jean Michel Guy
- Le Clos Champirol rééducation, 42270 Saint-Priest-en-Jarez, France
| | | | - Alain Cohen-Solal
- Service de cardiologie, centre de réadaptation cardiaque, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Inserm UMRS-942, université Paris Cité, 75010 Paris, France
| | - Bruno Pavy
- Service de réadaptation cardiovasculaire, CH Loire Vendée Océan, 44270 Machecoul, France
| | - Marie Christine Iliou
- Centre de réadaptation cardiaque, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Gilles Bosser
- Service de cardiologie pédiatrique et congénitale, CHU Nancy, 54600 Vandœuvre-Lès-Nancy, France
| | - Sonia Corone
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | | | - Titi Farrokhi
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | - Antoine Guerder
- Service de pneumologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Pascal Guillo
- Centre de réadaptation Saint-Yves, 35000 Rennes, France
| | | | - Theo Pezel
- Service de cardiologie, hôpital Lariboisière, AP-HP, université Paris Est Créteil, 75010 Paris, France
| | | | - Stephane Roueff
- Service de néphrologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - Daniel Thomas
- Institut de cardiologie Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | | | - Mohamed Ghannem
- Service de cardiologie, hôpital de Gonesse, faculté de médecine, Sousse, Tunisia; Université Picardie Jules-Verne, 80000 Amiens, France
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138
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Lee OH, Heo SJ, Johnson TW, Kim Y, Cho DK, Kim JS, Kim BK, Choi D, Hong MK, Jang Y, Jeong MH. Optical coherence tomography-guided versus intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:607-617. [PMID: 38110116 DOI: 10.1016/j.rec.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) yields clinical outcomes comparable to intravascular ultrasound (IVUS)-guided PCI in patients with stable ischemic heart disease. However, there is a scarcity of data comparing the clinical outcomes of OCT-guided and IVUS-guided PCI in the setting of acute myocardial infarction (AMI). We sought to compare the clinical outcomes of OCT-guided vs IVUS-guided PCI for patients with AMI in the era of second-generation drug-eluting stent (DES). METHODS We identified 5260 consecutive patients who underwent PCI with a second-generation DES for AMI under IVUS or OCT guidance from pooled data derived from a series of Korean AMI registries between 2011 and 2020. The primary endpoint was the 1-year rate of target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. RESULTS A total of 535 (10.2%) and 4725 (89.8%) patients were treated under OCT and IVUS guidance, respectively. The 1-year target lesion failure rates were comparable between the OCT and IVUS groups before and after propensity score matching (hazard ratio, 0.92; 95%CI, 0.42-2.05, P=.84). The OCT utilization rate did not exceed 5% of total patients treated with second-generation DES implantation during the study period. The primary factors for the selection of OCT over IVUS were the absence of chronic kidney disease, non-left main vessel disease, single-vessel disease, stent diameter <3mm, and stent length ≤ 25mm. CONCLUSIONS OCT-guided PCI in patients with AMI treated with a second-generation DES provided comparable clinical outcomes for 1-year target lesion failure compared with IVUS-guided PCI.
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Affiliation(s)
- Oh-Hyun Lee
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Yongcheol Kim
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.
| | - Deok-Kyu Cho
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
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Sun B, Wang CY, Chen RR. Clinical Efficacy and Safety of Early Intravenous Administration of Beta-Blockers in Patients Suffering from Acute ST-Segment Elevation Myocardial Infarction Without Heart Failure Undergoing Primary Percutaneous Coronary Intervention: A Study-Level Meta-Analysis of Randomized Clinical Trials. Cardiovasc Drugs Ther 2024; 38:833-846. [PMID: 37002468 PMCID: PMC11266243 DOI: 10.1007/s10557-023-07448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Several clinical studies have produced diverse results regarding the efficacy and safety of early intravenous beta-blockers in patients with acute ST-segment elevation myocardial infarction (STEMI). A study-level meta-analysis of randomized clinical trials (RCTs) comparing early intravenous beta-blockers versus placebo or routine care in STEMI patients undergoing primary percutaneous coronary intervention (PCI) was performed. METHODS A database search was conducted using PubMed, EMBASE, the Cochrane Library, and Clinicaltrials.gov for randomized clinical trials (RCTs) that compared intravenous beta-blockers versus placebo or routine care in STEMI patients who underwent primary PCI. The efficacy outcomes were infarct size (IS, % of LV) and the myocardial salvage index (MSI) based on magnetic resonance imaging, electrocardiographic findings, heart rate, ST-segment reduction percent (STR%), and complete STR. Safety outcomes included arrhythmias in the first 24 h (ventricular tachycardia and fibrillation [VT/VF], atrial fibrillation [AF], bradycardia, and advanced atrioventricular [AV] block), cardiogenic shock and hypotension during hospitalization, left ventricular ejection fraction (LVEF), and major adverse cardiovascular events (cardiac death, stroke, reinfarction, and heart failure readmission) at follow-up. RESULTS Seven RCTs with 1428 patients were included in this study, with 709 patients in the intravenous beta-blockers and 719 in the control group. Intravenous beta-blockers improved MSI compared to the control group (weighted mean difference [WMD] 8.46, 95% confidence interval [CI] 3.12-13.80, P = 0.002, I2 = 0%), but no differences were observed in IS (% of LV) between groups. Compared to the control group, the intravenous beta-blockers group had a lower risk of VT/VF (relative risk [RR] 0.65, 95% CI 0.45-0.94, P = 0.02, I2 = 35%) without an increase of AF, bradycardia, and AV-block and significantly decreased HR, hypotension. LVEF at 1 week ± 7 days (WMD 2.06, 95% CI 0.25-3.88, P = 0.03, I2 = 12%) and 6 months ± 7 days (WMD 3.24, 95% CI 1.54-4.95, P = 0.0002, I2 = 0%) was improved in the intravenous beta-blockers group compared to the control group. Subgroup analysis showed that intravenous beta-blockers before PCI decreased the risk of VT/VF and improved LVEF compared to the control group. Furthermore, sensitivity analysis showed that patients with a left anterior descending (LAD) artery lesion had a smaller IS (% of LV) in the intravenous beta-blockers group compared to the control group. CONCLUSION Intravenous beta-blockers improved the MSI, decreased the risk of VT/VF in the first 24 h, and were associated with increased LVEF at 1 week and 6 months following PCI. In particular, intravenous beta-blockers started before PCI is beneficial for patients with LAD lesions.
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Affiliation(s)
- Bing Sun
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
| | - Chi Yao Wang
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
| | - Rui Rui Chen
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China.
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140
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Wu Q, Wu M, Zhang K, Sun R, Li H, Tong J, Guo Y. Regulatory T cells as a therapeutic target in acute myocardial infarction. Mol Immunol 2024; 172:17-22. [PMID: 38865800 DOI: 10.1016/j.molimm.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
Acute myocardial infarction (AMI), mainly triggered by vascular occlusion or thrombosis, is the most prevalent cause of morbidity and mortality among all cardiovascular diseases. The devastating consequences of AMI are further aggravated by the intricate cellular processes involved in inflammation. In the past two decades, many studies have reported that regulatory T cells (Tregs), as the main immunoregulatory cells, play a crucial role in AMI progression. This review offers a comprehensive insight into the intricate relationship between Tregs and AMI development. Moreover, it explores emerging therapeutic strategies that focus on Tregs and their exosomes. Furthermore, we underscore the importance of employing noninvasive in vivo imaging techniques to advance the clinical applications of Tregs-based treatments in AMI. Although further research is essential to fully elucidate the molecular mechanisms underlying the effects of Tregs, therapies tailored to these cells hold immense potential for the treatment of patients with AMI.
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Affiliation(s)
- QiHong Wu
- Sichuan University, West China Second University Hospital, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, Sichuan, 610041, PR China
| | - Mengyue Wu
- Sichuan University, West China School of Basic Medical Sciences & Forensic Medicine, No. 17 People's South Road, Chengdu 610041, PR China
| | - Kun Zhang
- Sichuan University, West China Second University Hospital, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, Sichuan, 610041, PR China
| | - Ran Sun
- Sichuan University, West China Second University Hospital, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, Sichuan, 610041, PR China
| | - Hong Li
- Sichuan University, West China Second University Hospital, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, Sichuan, 610041, PR China
| | - Jiyu Tong
- Sichuan University, West China Second University Hospital, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, Sichuan, 610041, PR China; Sichuan University, West China School of Basic Medical Sciences & Forensic Medicine, No. 17 People's South Road, Chengdu 610041, PR China.
| | - Yingkun Guo
- Sichuan University, West China Second University Hospital, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, Sichuan, 610041, PR China; Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China.
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Akyuz S, Calik AN, Onuk T, Yaylak B, Kolak Z, Eren S, Mollaalioglu F, Durak F, Cetin M, Tanboga IH. The predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock. Herz 2024; 49:302-308. [PMID: 38172314 DOI: 10.1007/s00059-023-05231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/25/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS. METHODS The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno's C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R2] and likelihood ratio χ2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death. RESULTS All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59-3.68], R2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased. CONCLUSION The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.
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Affiliation(s)
- Sukru Akyuz
- Department of Cardiology, Faculty of Medicine, Okan University, Acibadem Mahallesi, Elysium Elit Kosuyolu A Blok D.1, Kadikoy, Istanbul, Turkey.
| | - Ali Nazmi Calik
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tolga Onuk
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Baris Yaylak
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Kolak
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Feyza Mollaalioglu
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Furkan Durak
- Department of Cardiology, Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Ibrahim Halil Tanboga
- Department of Biostatistics, Nisantasi University Medical School, Istanbul, Turkey
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
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142
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Kemp BJ, Thompson DR, Coates V, Bond S, Ski CF, Monaghan M, McGuigan K. International guideline comparison of lifestyle management for acute coronary syndrome and type 2 diabetes mellitus: A rapid review. Health Policy 2024; 146:105116. [PMID: 38943831 DOI: 10.1016/j.healthpol.2024.105116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/07/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.
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Affiliation(s)
- Bridie J Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Vivien Coates
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Sarah Bond
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; Australian Centre for Heart Health, Deakin University, Melbourne, Australia
| | | | - Karen McGuigan
- Queen's Communities and Place, Queen's University Belfast, Belfast, UK.
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143
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Triska J, Maitra N, Deshotels MR, Haddadin F, Angiolillo DJ, Vilahur G, Jneid H, Atar D, Birnbaum Y. A Comprehensive Review of the Pleiotropic Effects of Ticagrelor. Cardiovasc Drugs Ther 2024; 38:775-797. [PMID: 36001200 DOI: 10.1007/s10557-022-07373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
AIMS This review summarizes the findings of preclinical studies evaluating the pleiotropic effects of ticagrelor. These include attenuation of ischemia-reperfusion injury (IRI), inflammation, adverse cardiac remodeling, and atherosclerosis. In doing so, it aims to provide novel insights into ticagrelor's mechanisms and benefits over other P2Y12 inhibitors. It also generates viable hypotheses for the results of seminal clinical trials assessing ticagrelor use in acute and chronic coronary syndromes. METHODS AND RESULTS A comprehensive review of the preclinical literature demonstrates that ticagrelor protects against IRI in the setting of both an acute myocardial infarction (MI), and when MI occurs while on chronic treatment. Maintenance therapy with ticagrelor also likely mitigates adverse inflammation, cardiac remodeling, and atherosclerosis, while improving stem cell recruitment. These effects are probably mediated by ticagrelor's ability to increase local interstitial adenosine levels which activate downstream cardio-protective molecules. Attenuation and augmentation of these pleiotropic effects by high-dose aspirin and caffeine, and statins respectively may help explain variable outcomes in PLATO and subsequent randomized controlled trials (RCTs). CONCLUSION Most RCTs and meta-analyses have not evaluated the pleiotropic effects of ticagrelor. We need further studies comparing cardiovascular outcomes in patients treated with ticagrelor versus other P2Y12 inhibitors that are mindful of the unique pleiotropic advantages afforded by ticagrelor, as well as possible interactions with other therapies (e.g., aspirin, statins, caffeine).
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Affiliation(s)
- Jeffrey Triska
- The Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Neil Maitra
- The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Faris Haddadin
- The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Gemma Vilahur
- Cardiovascular Program, Research Institute Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain
- CiberCV, Institute Carlos III, Madrid, Spain
| | - Hani Jneid
- Department of Medicine, Section of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Dan Atar
- The Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Yochai Birnbaum
- The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
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144
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Jung C, Bernhard M. [Monitoring of cardiovascular emergencies in the emergency department]. Dtsch Med Wochenschr 2024; 149:1034-1038. [PMID: 39146751 DOI: 10.1055/a-2105-9849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
In the emergency department, patients with potential or confirmed cardiovascular diseases constitute a significant portion of the overall patient population. Monitoring for cardiovascular surveillance of these patients, until and during the diagnostics and acute therapy often presents an interdisciplinary and interprofessional challenge. This is partly due to the limited number of monitoring spaces in emergency departments. Therefore, it is crucial to establish a differentiated indication for cardiovascular monitoring. Despite limited monitoring resources, ensuring high patient safety is paramount. The correct approach holds significant prognostic importance. For patients requiring extended monitoring, especially using invasive systems, close personnel monitoring is essential, in addition to appropriate staffing and medical equipment. The overarching goal for such patients is to ensure prompt transfer to a suitable destination unit. The provision of an intensive care bed for further care within one hour is aimed for according to the directive of the Federal Joint Committee on staged emergency care in hospitals. Often, at the beginning of the emergency department visit, a definitive diagnosis is not yet established - this is addressed accordingly with symptom-oriented considerations. The present review article focuses on the practical Implementation and modalities of monitoring, as well as its application in a selection of cardiovascular diagnoses in the emergency department.
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Affiliation(s)
- Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitatsklinikum Düsseldorf, Düsseldorf, Germany
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145
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Shaikh SA, Ismail M, Hassan M, Khurshed Shaikh J, Hashim M, Hussain Sahito S, Khan FR. Impact of Early Invasive Strategy on Left Ventricular Function Recovery in Acute Myocardial Infarction Patients in Pakistan. Cureus 2024; 16:e67778. [PMID: 39323671 PMCID: PMC11422741 DOI: 10.7759/cureus.67778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/27/2024] Open
Abstract
Background Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries like Pakistan, where healthcare resources are limited. Early Invasive Strategy (EIS), typically involving percutaneous coronary intervention (PCI), has been shown to improve outcomes in AMI patients. However, the effectiveness of EIS in resource-limited settings, such as Pakistan, remains under-explored. Objective This prospective observational cohort study aimed to assess the impact of an Early Invasive Strategy (EIS) on left ventricular (LV) function recovery in acute myocardial infarction (AMI) patients in Pakistan. The primary objective was to measure the change in left ventricular ejection fraction (LVEF) over six months. Secondary objectives included evaluating mortality, rehospitalization rates, and incidences of major adverse cardiovascular events (MACE). Multivariate regression analysis was employed to adjust for potential confounders. Methods The study was conducted from January to December 2023 at the National Institute of Cardiovascular Diseases (NICVD) satellite centers in Sukkur, Nawab Shah, and Khairpur. A total of 300 AMI patients presenting within 24 hours of symptom onset were included. Participants were divided into two groups: the EIS group (n = 150) received percutaneous coronary intervention (PCI) within 24 hours of admission, while the delayed treatment group (n = 150) received standard therapy, with invasive procedures performed after 24 hours if clinically indicated. Data were collected at baseline, during hospitalization, and at three- and six-months post-AMI. Results The EIS group demonstrated a significantly greater improvement in LVEF compared to the delayed treatment group (13.1% [95% CI, 10.8%-15.4%] vs. 7.5% [95% CI, 5.8%-9.2%], p < 0.001). Mortality was lower in the EIS group (3% [n = 4] vs. 9% [n = 13], p = 0.01), as were rehospitalizations for heart failure (7% [n = 10] vs. 14% [n = 21], p = 0.02) and incidences of MACE (8% [n = 12] vs. 16% [n = 24], p = 0.01). Multivariate regression analysis confirmed that EIS was independently associated with better LVEF improvement (coefficient = 5.78 [95% CI, 4.21-7.35], p < 0.001). Conclusion Early invasive treatments significantly enhance left ventricular function recovery and reduce mortality and rehospitalization rates in AMI patients in Pakistan. These findings advocate for the implementation of timely PCI interventions in resource-limited settings to improve clinical outcomes, particularly emphasizing cost-effectiveness and the availability of PCI.
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Affiliation(s)
- Shahbaz A Shaikh
- Cardiology, Sindh Institute of Cardiovascular Diseases, Karachi, PAK
| | - Muhammad Ismail
- Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Muhammad Hassan
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Javed Khurshed Shaikh
- Cardiology/Interventional Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Muhammad Hashim
- Cardiology/Interventional Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Sarfraz Hussain Sahito
- Cardiology/Interventional Cardiology, National Institute of Cardiovascular Diseases, Khairpur, PAK
| | - Fahad R Khan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
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146
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Nuchanat P, Methavigul K. Predictive model for left main coronary artery or triple vessel disease in patients with chronic coronary syndromes. ASIAN BIOMED 2024; 18:180-185. [PMID: 39309471 PMCID: PMC11414772 DOI: 10.2478/abm-2024-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Background Data about prediction of left main coronary artery disease (LMCAD)/three-vessel disease (TVD) in patients with chronic coronary syndromes (CCS) are lacking. Objectives This study aimed to develop a model for predicting patients at risk of LMCAD/TVD. Methods This study used retrospective data from patients with CCS scheduled for invasive coronary angiography (ICA) and who were retrospectively recruited between January 2018 and December 2020. Predictors were obtained and analyzed by using logistic regression analysis, and generated the prediction score. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The cut-off value and area under the curve (AUC) were analyzed by using the receiver operating characteristic (ROC) curve. Results We recruited 162 patients with CCS. There were 75 patients in the non-LMCAD/TVD and 87 patients in the LMCAD/TVD groups. After the multivariate analysis, new onset of heart failure (HF) or left ventricular systolic dysfunction (LVSD) and suspected CAD, ST elevation (STE) in aVR, STE in V1 and lateral ST depression (STD) were associated with increased risk of LMCAD/TVD. Based on these 4 predictors, the prediction score was created. The cut-off value of the prediction score by using ROC curve analysis was 3.0. The sensitivity, specificity, PPV, and NPV were 71.26%, 86.67%, 86.11%, and 72.22%, respectively, with an AUC of 0.855. Conclusions The CCS patients with new onset of HF or LVSD and suspected CAD, STE in aVR, and STE in V1 and lateral STD were associated with increased risk of LMCAD/TVD. The novel prediction score could predict LMCAD/TVD in those patients with acceptable sensitivity, specificity, PPV, and NPV.
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Affiliation(s)
- Piyanop Nuchanat
- Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi11000, Thailand
| | - Komsing Methavigul
- Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi11000, Thailand
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147
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Hoang TH, Maiskov VV, Merai IA, Kobalava ZD. Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. KARDIOLOGIIA 2024; 64:56-63. [PMID: 39102574 DOI: 10.18087/cardio.2024.7.n2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2024]
Abstract
AIM To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA). MATERIAL AND METHODS This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years. RESULTS MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042). CONCLUSION The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.
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Affiliation(s)
- T H Hoang
- Pham Ngoc Thach University of Medicine; Tam Duc Cardiology Hospital
| | - V V Maiskov
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - I A Merai
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
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148
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Luo L, Jian L, Zhou Q, Duan X, Ge L. Association of Dementia with Adverse Outcomes in Older Patients with Acute Myocardial Infarction in the ICU. Int Heart J 2024; 65:601-611. [PMID: 39010226 DOI: 10.1536/ihj.23-618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Dementia limits timely revascularization in individuals with acute myocardial infarction (AMI). However, it remains unclear whether dementia affects prognosis negatively in older individuals with AMI in the intensive care unit (ICU). This research aimed to evaluate the dementia effect on the outcomes in individuals with AMI in ICU.Data from 3,582 patients aged ≥ 65 years with AMI in ICU from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were evaluated. The independent variable was dementia at baseline, and the primary finding was death from any cause during follow-up. A 1:1 propensity score matching (PSM) showed 208 participants with and without dementia. The correlation between dementia and poor prognosis of AMI was verified using a double-robust estimation method.In the PSM cohort, the 30-day all-cause mortality was 37.50% and 33.17% in the dementia and non-dementia groups (P = 0.356), respectively, and the 1-year all-cause mortality was 61.06% and 51.44%, respectively (P = 0.048). Cox regression analysis showed no association between dementia and elevated 30-day (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84, 1.60) and 1-year (HR 1.28, 95% CI 0.99, 1.66) all-cause mortality after AMI. Similarly, dementia was not connected with in-hospital mortality, bleeding, or stroke after AMI. Interaction analysis showed that 1-year all-cause mortality was 48.00% higher in individuals with dementia and diabetic complications than in those without diabetic complications.Dementia is not an independent risk factor for adverse outcomes in AMI. Thus, it may be inappropriate to include dementia as a contraindication for invasive AMI therapy.
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Affiliation(s)
- Li Luo
- Department of the First Clinical College, Jinan University
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Linhao Jian
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Quan Zhou
- Department of Science and Education, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Xiangjie Duan
- Department of Infectious Diseases, Changde Hospital, Xiangya School of Medicine, Central South University
| | - Liangqing Ge
- Department of the First Clinical College, Jinan University
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University
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Hou X, Wu X, Chen L, Zheng X, Zheng Y, Zhang Y, Wang S, Cao T, Sun Y, Ding R, Wu J, Yu B. Effectiveness and Influencing Factors of Home-Center-Based Cardiac Rehabilitation as a Transitional Strategy for Acute Myocardial Infarction Patients. Int Heart J 2024; 65:612-620. [PMID: 39010223 DOI: 10.1536/ihj.24-030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Currently, providing patients, particularly those with acute myocardial infarction (AMI), with comprehensive cardiac rehabilitation (CR) has been challenging because of the inadequate availability of medical resources in developing countries. To ensure balance between disease instability and early rehabilitation, strategies for facilitating professional and comprehensive CR opportunities for patients with AMI must be explored.A prospective cohort study was carried out on 1,533 patients with AMI who were admitted to a tertiary hospital between July 2018 and October 2019. Following the principle of voluntarism, 286 patients with AMI participated in home-center-based CR (HCB group), whereas 1,247 patients received usual care (UC group). The primary endpoint of this study was the occurrence of cardiovascular events at 30 months after AMI. Moreover, the study analyzed factors that influence participation rate and effectiveness of the CR model.After analysis, a significant difference in the occurrence of cardiovascular endpoints between the HCB group and the UC group was observed (harzard ratio, 0.68 [95%CI, 0.51-0.91], P = 0.008), with participation in home-center-based CR being an independent influencing factor. Multivariate regression analysis revealed age, gender, smoking history, triglyceride levels, and ejection fraction as independent factors that influence participation rate. Female gender, peak oxygen uptake per kilogram body weight, and ventilation/carbon dioxide production slope were identified as factors that affect the effectiveness of the CR model.In the context of developing countries, this study demonstrates that the home-center-based CR model is efficient and analyzes factors that influence participation rate and effectiveness of the model. These findings provide practical insights for further development of CR programs.
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Affiliation(s)
- Xinyu Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
| | - Xiaojun Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Department of Cardiac Rehabilitation Center, The Second Affiliated Hospital of Harbin Medical University
| | - Liangqi Chen
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
| | - Xianghui Zheng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Department of Cardiac Rehabilitation Center, The Second Affiliated Hospital of Harbin Medical University
| | - Yang Zheng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, The Second Affiliated Hospital of Harbin Medical University
| | - Yongxiang Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
| | - Shiyu Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Department of Cardiac Rehabilitation Center, The Second Affiliated Hospital of Harbin Medical University
| | - Tianhui Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Department of Cardiac Rehabilitation Center, The Second Affiliated Hospital of Harbin Medical University
| | - Yong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, The Second Affiliated Hospital of Harbin Medical University
| | - Rongjing Ding
- Department of Rehabilitation Medicine, Peking Union Medical College Hospital
| | - Jian Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Department of Cardiac Rehabilitation Center, The Second Affiliated Hospital of Harbin Medical University
- Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, The Second Affiliated Hospital of Harbin Medical University
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, The Second Affiliated Hospital of Harbin Medical University
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Fu B, Zeng Y, Wang M, Zhao L, Sun L, Wang T, Dong J, Yang W, Hua W. The triglyceride-glucose index is a predictor of major adverse cardiovascular events in patients with coronary artery disease and psoriasis: a retrospective cohort study. Diabetol Metab Syndr 2024; 16:184. [PMID: 39085887 PMCID: PMC11290256 DOI: 10.1186/s13098-024-01423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The association between the triglyceride-glucose (TyG) index and clinical outcomes in patients with both coronary artery disease (CAD) and psoriasis is unclear. This study investigated the association between the TyG index and major adverse cardiovascular events (MACE) in patients with both CAD and psoriasis. METHODS This retrospective cohort study included patients diagnosed with both CAD and psoriasis who underwent coronary angiography at the Fuwai Hospital, Beijing, China, between January 2017 and May 2022. The study endpoint was the occurrence of MACE or end of follow-up time. Multivariate Cox proportional analysis and restricted cubic splines (RCS) were used to determine the association between the TyG index and MACE. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold value of the TyG index for predicting MACE. RESULTS This study enrolled 293 patients with both CAD and psoriasis, including 258 (88.1%) males with a mean age of 58.89 ± 9.61 years. Patients were divided into four groups based on the TyG quartiles: Q1 (N = 74), Q2 (N = 73), Q3 (N = 73), and Q4 (N = 73). After adjusting for the potential confounders, the TyG index was independently associated with MACE, both as a continuous variable (HR = 1.53, 95% CI = 1.03-2.28, P = 0.035) and as a categorical variable (Q1: reference; Q2: HR = 1.85, 95% CI = 0.88-3.87, P = 0.105; Q3: HR = 2.39, 95% CI = 1.14-5.00, P = 0.021; Q4: HR = 2.19, 95% CI = 1.001-4.81, P = 0.0497; P for trend = 0.039). RCS analysis showed an linear association between the TyG index and MACE (P-overall = 0.027, P-non-linear = 0.589). ROC curve analysis showed that the TyG index of ≥ 8.73 was the optimal threshold value (area under the ROC curve = 0.60, 95% CI 0.53-0.67). TyG index ≥ 8.73 was significantly associated with MACE (HR = 2.10, 95% CI = 1.32-3.34, P = 0.002). After adjustment for confounders, the TyG index showed independent association with MACE (HR = 2.00, 95% CI = 1.17-3.42, P = 0.011). CONCLUSIONS The TyG index showed a positive linear correlation with MACE in patients with both CAD and psoriasis. The TyG index of ≥ 8.73 might be the optimal threshold for predicting MACE.
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Affiliation(s)
- Bingqi Fu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Yan Zeng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Man Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Lin Zhao
- Department of Integrative Medicine Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lin Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Tianjie Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Junle Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China.
| | - Wei Hua
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China.
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