251
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Ge J, Schäfer A, Ertl G, Nordbeck P. Thrombus Aspiration for ST-Segment-Elevation Myocardial Infarction in Modern Era: Still an Issue of Debate? Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005739. [PMID: 29042400 DOI: 10.1161/circinterventions.117.005739] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The role of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for acute ST-segment-elevation myocardial infarction has been a matter of intense research and debate now. Although recent randomized controlled clinical trials (notably TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia] and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) do not supply evidence supporting the routine use of TA in patients with ST-segment-elevation myocardial infarction, manual TA remains a therapeutic option for interventional cardiologists when treating patients with substantial thrombus burden during PPCI. It remains unknown whether patients might actually benefit from TA applied in a more selective manner depending on the thrombus burden during PPCI, instead of routine application. In this review, we summarize current knowledge on the instruments used in the TA procedure, positive as well as negative clinical effects of TA during PPCI, and analyze the potential reasons for observed effects, in an effort to help the clinical decision making by physicians for the use of TA in individual ST-segment-elevation myocardial infarction patients during PPCI.
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Affiliation(s)
- Junhua Ge
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Andreas Schäfer
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Georg Ertl
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Peter Nordbeck
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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252
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Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia. Case Rep Cardiol 2018; 2018:6148470. [PMID: 29854473 PMCID: PMC5821975 DOI: 10.1155/2018/6148470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/04/2017] [Accepted: 11/26/2017] [Indexed: 11/17/2022] Open
Abstract
We here report a case of ST-elevation myocardial infarction (STEMI) due to simultaneous acute coronary artery occlusions of two major coronary arteries in a patient with coronary ectasia. The patient had been previously submitted to percutaneous coronary angioplasty with bare metal stent implantation in both culprit vessels. Very late stent thrombosis could be the cause of the first occlusion, triggering the event in the other vessel. In addition, concomitant embolic sources were not identified. Although routine aspiration thrombectomy in STEMI was not proven to be beneficial in randomized clinical trials, it was of great value in this case. We also discuss the relation between coronary ectasia, chronic inflammatory status, and increased platelet activity which may have caused plaque disruption in another already vulnerable vessel.
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253
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Sulzgruber P, Schnaubelt S, Koller L, Goliasch G, Niederdöckl J, Simon A, El-Hamid F, Rothgerber DJ, Wojta J, Niessner A. Cardiac arrest as an age-dependent prognosticator for long-term mortality after acute myocardial infarction: the potential impact of infarction size. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:153-160. [PMID: 29856229 DOI: 10.1177/2048872618781370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: The development of cardiac arrhythmias resulting in cardiac arrest represents a severe complication in patients with acute myocardial infarction. While the worsening of the prognosis in this vulnerable patient collective is well known, less attention has been paid to its age-specific relevance from a long-term perspective. METHODS: Based on a clinical acute myocardial infarction registry we analysed 832 patients with acute myocardial infarction within the current analysis. Patients were stratified into equal groups ( n=208 per group) according to age in less than 45 years, 45-64 years, 65-84 years and 85 years and older via propensity score matching. Multivariate Cox regression analysis was used to assess the age-dependent influence of cardiac arrest on mortality. RESULTS: The total number of cardiac arrests differed significantly between age groups, demonstrating the highest incidence in the youngest population with 18.8% ( n=39), and a significantly lower incidence by increasing age (-11.6%; P=0.01). After a mean follow-up time of 8 years, a total of 264 patients (31.7%) died due to cardiovascular causes. While cardiac arrest was a strong and independent predictor for mortality within the total study population with an adjusted hazard ratio of 3.21 (95% confidence interval 2.23-4.61; P<0.001), there was no significant association with mortality independently in very young patients (<45 years; adjusted hazard ratio of 1.73, 95% confidence interval 0.55-5.53; P=0.35). CONCLUSION: We found that arrhythmias resulting in cardiac arrest are more common in very young acute myocardial infarction patients (<45 years) compared to their older counterparts, and were able to demonstrate that the prognostic value of cardiac arrest on long-term mortality in patients with acute myocardial infarction is clearly age dependent.
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Affiliation(s)
- Patrick Sulzgruber
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria.,2 Ludwig Boltzmann Institute, Cluster for Cardiovascular Research, Austria
| | | | - Lorenz Koller
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Georg Goliasch
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Jan Niederdöckl
- 3 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Alexander Simon
- 3 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Feras El-Hamid
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
| | | | - Johann Wojta
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria.,2 Ludwig Boltzmann Institute, Cluster for Cardiovascular Research, Austria
| | - Alexander Niessner
- 1 Department of Internal Medicine II, Medical University of Vienna, Austria
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254
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Long-term Follow-up of the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI). Can J Cardiol 2018; 34:736-743. [DOI: 10.1016/j.cjca.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/20/2022] Open
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255
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Patterson T, Perkins GD, Hassan Y, Moschonas K, Gray H, Curzen N, de Belder M, Nolan JP, Ludman P, Redwood SR. Temporal Trends in Identification, Management, and Clinical Outcomes After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2018; 11:e005346. [DOI: 10.1161/circinterventions.117.005346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Tiffany Patterson
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, United Kingdom (G.D.P.)
| | - Yahma Hassan
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| | | | - Huon Gray
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, United Kingdom (H.G., N.C.)
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, United Kingdom (H.G., N.C.)
| | - Mark de Belder
- Cardiology Department, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.)
| | - Jerry P. Nolan
- School of Clinical Sciences, University of Bristol and Department of Anaesthesia, Royal United Hospital, Bath, United Kingdom (J.P.N.)
| | - Peter Ludman
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (P.L.)
| | - Simon R. Redwood
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
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256
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Dai S, Huang B, Zou Y, Guo J, Liu Z, Pi D, Qiu Y, Xiao C. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain. Medicine (Baltimore) 2018; 97:e10844. [PMID: 29851795 PMCID: PMC6392761 DOI: 10.1097/md.0000000000010844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score < 2 were enrolled in the emergency department. Baseline data were collected and a HEART score was determined in each participant during the indexed emergency visit. Participants were follow-up for 30 days after discharge and the studied endpoints included acute myocardial infarction, cardiovascular mortality and all-cause mortality.A total of 244 patients were enrolled and 2 was loss of follow-up. The mean age was 50.4 years old and male patients accounted for 64.5%. Substernal pain and featured as pressure of the pain accounted for 34.3% and 39.3%, respectively. After 30 days' follow-up, no patient in the low-risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.
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Affiliation(s)
- Siping Dai
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Bo Huang
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Yunliang Zou
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Jianbin Guo
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Ziyong Liu
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Dangyu Pi
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Yunhong Qiu
- Emergency Department, The Third People's Hospital of Huizhou, Huizhou
| | - Chun Xiao
- Department of Cardiology, the Third People's Hospital of Huizhou, Guangdong Province, China
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257
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Kebernik J, Borlich M, Tölg R, El-Mawardy M, Abdel-Wahab M, Richardt G. Dual Antithrombotic Therapy with Clopidogrel and Novel Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Real-world Study. Cardiol Ther 2018; 7:79-87. [PMID: 29633088 PMCID: PMC5986673 DOI: 10.1007/s40119-018-0108-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION For patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), proper antithrombotic therapy is equivocal. Current guidelines recommend triple therapy, which carries a high risk of bleeding. Recent large trials suggest that dual therapy (DT) with novel oral anticoagulant (NOAC) plus P2Y12 inhibitor can be an appropriate alternative, but real-world data for this alternative are scarce and the optimal duration of DT has not yet been established. METHODS This analysis was performed in a single-center prospective cohort. We investigated 216 PCI patients with indication for anticoagulation due to AF. After PCI patients received DT with reduced doses NOAC plus P2Y12 inhibitor for 6 months, which was followed by standard dose NOAC monotherapy. Efficacy endpoints were defined as cardiac death, myocardial infarction (MI), stent thrombosis (ST), and stroke. Safety endpoints were bleeding events as defined by Bleeding Academic Consortium (BARC). RESULTS Baseline characteristics of our study population were described by a CHA2DS2-VASc score of greater than 4 and a HAS-BLED score of greater than 3. After a mean follow-up of 18.7 months, efficacy events occurred in 12 patients (5.6%). We observed three (1.4%) cardiac deaths, two (0.9%) MIs, six (2.8%) strokes, and one (0.5%) definite ST. After switching from DT to NOAC monotherapy after 6.3 ± 1.7 months, there was no rebound of ischemic events. Bleeding events occurred in 34 patients (15.7%) mainly under DT, while bleeding was less during NOAC monotherapy. CONCLUSIONS In this long-term study of high-risk and real-world AF-patients with PCI, DT with NOAC and P2Y12 inhibitor (6 months) followed by NOAC monotherapy was safe and effective.
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Affiliation(s)
- Julia Kebernik
- Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | | | - Ralph Tölg
- Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | | | | | - Gert Richardt
- Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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258
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Dillinger JG, Ducrocq G, Elbez Y, Cohen M, Bode C, Pollack C, Nicolau JC, Henry P, Kedev S, Wiviott SD, Sabatine MS, Mehta SR, Steg PG. Activated Clotting Time to Guide Heparin Dosing in Non–ST-Segment–Elevation Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention and Treated With IIb/IIIa Inhibitors. Circ Cardiovasc Interv 2018; 11:e006084. [DOI: 10.1161/circinterventions.118.006084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Jean-Guillaume Dillinger
- From the Department of Cardiology, CREATIF, Hôpital Lariboisière, AP-HP, Université Paris Diderot-Sorbonne Paris Cité, Inserm U-942, France (J.-G.D., P.H.)
| | - Gregory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), an F-CRIN network, DHU FIRE, Hôpital Bichat, AP-HP, Université Paris Diderot-Sorbonne Paris Cité, Inserm U-1148, France (G.D., Y.E., P.G.S.)
| | - Yedid Elbez
- FACT (French Alliance for Cardiovascular Trials), an F-CRIN network, DHU FIRE, Hôpital Bichat, AP-HP, Université Paris Diderot-Sorbonne Paris Cité, Inserm U-1148, France (G.D., Y.E., P.G.S.)
| | - Marc Cohen
- Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.)
| | - Christoph Bode
- Medizinische Universitatsklinik, Freiburg, Germany (C.B.)
| | - Charles Pollack
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA (C.P.)
| | - José C. Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (J.C.N.)
| | - Patrick Henry
- From the Department of Cardiology, CREATIF, Hôpital Lariboisière, AP-HP, Université Paris Diderot-Sorbonne Paris Cité, Inserm U-942, France (J.-G.D., P.H.)
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University of St. Cyril and Methodius, Skopje, Macedonia (S.K.)
| | - Stephen D. Wiviott
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W., M.S.S.)
| | - Marc S. Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W., M.S.S.)
| | - Shamir R. Mehta
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, ON, Canada (S.R.M.)
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), an F-CRIN network, DHU FIRE, Hôpital Bichat, AP-HP, Université Paris Diderot-Sorbonne Paris Cité, Inserm U-1148, France (G.D., Y.E., P.G.S.)
- Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.)
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259
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Clinical outcomes of complete revascularization using either angiography-guided or fractional flow reserve-guided drug-eluting stent implantation in non-culprit vessels in ST elevation myocardial infarction patients: insights from a study based on a systematic review and meta-analysis. Int J Cardiovasc Imaging 2018; 34:1349-1364. [DOI: 10.1007/s10554-018-1362-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/20/2018] [Indexed: 12/31/2022]
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260
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Deharo P, Johnson TW, Rahbi H, Kandan R, Bowles R, Mozid A, Dorman S, Strange JW, Baumbach A. Bivalirudin versus heparin in primary PCI: clinical outcomes and cost analysis. Open Heart 2018; 5:e000767. [PMID: 29765614 PMCID: PMC5950626 DOI: 10.1136/openhrt-2017-000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/07/2018] [Accepted: 02/14/2018] [Indexed: 01/30/2023] Open
Abstract
Background The evidence for benefits of bivalirudin over heparin has recently been challenged. We aimed to analyse the safety and cost-effectiveness following reintroduction of heparin instead of bivalirudin as the standard anticoagulation for primary percutaneous coronary intervention (PPCI) in a high-volume centre. Methods and results This analysis was an open-label, prospective registry including all patients admitted to our centre for PPCI from April 2014 to April 2016. Heparin was reintroduced as standard anticoagulant in April 2015. During the 2 years, 1291 patients underwent a PPCI, 662 in the Bivalirudin protocol period (Cohort B) and 629 in the Heparin protocol period (Cohort H). Baseline and procedural characteristics were not significantly different, except for a higher use of thromboaspiration and femoral access in the earlier Cohort B. Glycoprotein 2b3a (Gp2b3a) antagonists were used in 24% of the patients in Cohort B versus 28% in Cohort H (P<0.01). We did not observe any differences in death at 180 days (11.03% in Cohort B vs 11.29% in Cohort H)(HR 95% CI 0.98 (0.72 to 1.33), P=0.88). The incidence of any bleeding complications at 30 days did not differ between the two periods (21.9% vs 21.9%, P=0.99). The cost related to the anticoagulants amounted to £246 236 in Cohort B versus £4483 in Cohort H (£324 406 vs £102 347 when adding Gp2b3a antagonists). Conclusion We did not find clinically relevant changes in patient outcomes, including bleeding complications with reintroduction of heparin in our PPCI protocol. However, the use of heparin was associated with a major reduction in treatment costs.
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Affiliation(s)
- Pierre Deharo
- Cardiology, Bristol Heart Institute, Bristol, UK.,Hopital la Timone, Marseille, France
| | | | - Hazim Rahbi
- Cardiology, Bristol Heart Institute, Bristol, UK
| | | | - Ruth Bowles
- Cardiology, Bristol Heart Institute, Bristol, UK
| | - Abdul Mozid
- Cardiology, Bristol Heart Institute, Bristol, UK
| | | | | | - Andreas Baumbach
- Cardiology, Bristol Heart Institute, Bristol, UK.,Barts Health NHS Trust, London, UK
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261
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Kang MG, Hahm JR, Kim KH, Park HW, Koh JS, Hwang SJ, Hwang JY, Ahn JH, Park Y, Jeong YH, Park JR, Kwak CH. Prognostic value of total triiodothyronine and free thyroxine levels for the heart failure in patients with acute myocardial infarction. Korean J Intern Med 2018; 33:512-521. [PMID: 28073241 PMCID: PMC5943658 DOI: 10.3904/kjim.2016.292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/AIMS Although a low triiodothyronine (T3) state is closely associated with heart failure (HF), it is uncertain whether total T3 levels on admission is correlated with the clinical outcomes of acute myocardial infarction (AMI). The aim of this study is to investigate the prognostic value of total T3 levels for major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with AMI undergone percutaneous coronary intervention (PCI). METHODS A total of 765 PCI-treated AMI patients (65.4 ± 12.6 years old, 215 women) between January 2012 and July 2014 were included and 1-year MACCEs were analyzed. We assessed the correlation of total T3 and free thyroxine (fT4) with prevalence of 1-year MACCEs and the predictive values of total T3, fT4, and the ratio of total T3 to fT4 (T3/fT4), especially for HF requiring re-hospitalization. RESULTS Thirty patients (3.9%) were re-hospitalized within 12 months to control HF symptoms. Total T3 levels were lower in the HF group than in the non-HF group (84.32 ± 21.04 ng/dL vs. 101.20 ± 20.30 ng/dL, p < 0.001). Receiver operating characteristic curve analysis showed the cut-offs of total T3 levels (≤ 85 ng/dL) and T3/fT4 (≤ 60) for HF (area under curve [AUC] = 0.734, p < 0.001; AUC = 0.774, p < 0.001, respectively). In multivariate analysis, lower T3/fT4 was an independent predictor for 1-year HF in PCI-treated AMI patients (odds ratio, 1.035; 95% confidential interval, 1.007 to 1.064; p = 0.015). CONCLUSIONS Lower levels of total T3 were well correlated with 1-year HF in PCI-treated AMI patients. The T3/fT4 levels can be an additional marker to predict HF.
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Affiliation(s)
- Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Ryeal Hahm
- Division of Endocrinology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kye-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun-Woong Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seok-Jae Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Hwa Ahn
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Yongwhi Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Young-Hoon Jeong
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Choong Hwan Kwak
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
- Correspondence to Choong Hwan Kwak, M.D. Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea Tel: +82-55-214-3720 Fax: +82-55-214-3250 E-mail:
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262
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Lee DJH, Loh JKK, Jafary FH, Ho HH, Watson T, Stoll HP, Ong PJL. Polymer-free biolimus-A9-coated stent for primary percutaneous coronary intervention. Herz 2018; 44:750-755. [PMID: 29666900 DOI: 10.1007/s00059-018-4701-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/28/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The polymer-free biolimus-A9 drug-coated stent (DCS) was reported to have superior safety and efficacy outcomes compared with a bare metal stent in the LEADERS FREE trial of high-bleeding-risk patients with acute coronary syndrome and on dual antiplatelet treatment (DAPT) for 1 month. The aim of this investigation was to evaluate the DCS in a consecutive cohort of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). METHODS We analyzed data from 164 consecutive STEMI patients who underwent PPCI using the DCS at our institution. The primary efficacy endpoint was clinically indicated target lesion revascularization (ciTLR); the primary safety endpoint was a composite of cardiac death, myocardial infarction, and definite/probable stent thrombosis. Clinical outcomes at 1 year are presented here. RESULTS The mean age of the patients was 61.5 ± 15.5 years, and 86.6% were male. The median symptom-to-balloon-time was 55 min. In 57.9% of patients (n = 95), the infarct had an anterior location. PPCI achieved Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in 163 of 164 patients (99.4%). All patients were prescribed DAPT for 1 year. At 1 year, ciTLR occurred in 1.2% of patients, the primary safety endpoint was reached in 4.3% of patients, and definite stent thrombosis was noted in 0.6% of patients. CONCLUSION In this consecutive real-world cohort of patients, the DCS was safe and efficacious when used for PPCI in patients with STEMI.
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Affiliation(s)
- D J H Lee
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore, Singapore
| | - J K K Loh
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore, Singapore
| | - F H Jafary
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore, Singapore
| | - H H Ho
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore, Singapore
| | - T Watson
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore, Singapore. .,Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand.
| | - H-P Stoll
- Department for Clinical Research, Biosensors Europe, Morges, Switzerland
| | - P J L Ong
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore, Singapore
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Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El‐Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev 2018; 4:CD012318. [PMID: 29665617 PMCID: PMC6494633 DOI: 10.1002/14651858.cd012318.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the major cause of mortality worldwide. Coronary artery disease (CAD) contributes to half of mortalities caused by CVD. The mainstay of management of CAD is medical therapy and revascularisation. Revascularisation can be achieved via coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Peripheral arteries, such as the femoral or radial artery, provide the access to the coronary arteries to perform diagnostic or therapeutic (or both) procedures. OBJECTIVES To assess the benefits and harms of the transradial compared to the transfemoral approach in people with CAD undergoing diagnostic coronary angiography (CA) or PCI (or both). SEARCH METHODS We searched the following databases for randomised controlled trials on 10 October 2017: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science Core Collection. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform in August 2017. There were no language restrictions. Reference lists were also checked and we contacted authors of included studies for further information. SELECTION CRITERIA We included randomised controlled trials that compared transradial and transfemoral approaches in adults (18 years of age or older) undergoing diagnostic CA or PCI (or both) for CAD. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. At least two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We contacted trial authors for missing information. We used risk ratio (RR) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). All analyses were checked by another author. MAIN RESULTS We identified 31 studies (44 reports) including 27,071 participants and two ongoing studies. The risk of bias in the studies was low or unclear for several domains. Compared to the transfemoral approach, the transradial approach reduced short-term net adverse clinical events (NACE) (i.e. assessed during hospitalisation and up to 30 days of follow-up) (RR 0.76, 95% CI 0.61 to 0.94; 17,133 participants; 4 studies; moderate quality evidence), cardiac death (RR 0.69, 95% CI 0.54 to 0.88; 11,170 participants; 11 studies; moderate quality evidence). However, short-term myocardial infarction was similar between both groups (RR 0.91, 95% CI 0.81 to 1.02; 19,430 participants; 11 studies; high quality evidence). The transradial approach had a lower procedural success rate (RR 0.97, 95% CI 0.96 to 0.98; 25,920 participants; 28 studies; moderate quality evidence), but was associated with a lower risk of all-cause mortality (RR 0.77, 95% CI 0.62 to 0.95; 18,955 participants; 10 studies; high quality evidence), bleeding (RR 0.54, 95% CI 0.40 to 0.74; 23,043 participants; 20 studies; low quality evidence), and access site complications (RR 0.36, 95% CI 0.22 to 0.59; 16,112 participants; 24 studies; low quality evidence). AUTHORS' CONCLUSIONS Transradial approach for diagnostic CA or PCI (or both) in CAD may reduce short-term NACE, cardiac death, all-cause mortality, bleeding, and access site complications. There is insufficient evidence regarding the long-term clinical outcomes (i.e. beyond 30 days of follow-up).
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Affiliation(s)
- Ahmed A Kolkailah
- John H. Stroger, Jr. Hospital of Cook CountyDepartment of MedicineChicagoILUSA
| | | | - Ahmed M Muhammed
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Mohamed E Zahran
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Marwah Anas El‐Wegoud
- Egyptian Center for Evidence Based Medicine (ECEBM)8 Masaken Hayet El Tadrees Ain Shams University, El Khalifa El Maamoun St.CairoEgypt11646
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine16 Ali Fahmi Kamel StreetHeliopolisCairoEgypt11351
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Cavallari LH, Franchi F, Rollini F, Been L, Rivas A, Agarwal M, Smith DM, Newsom K, Gong Y, Elsey AR, Starostik P, Johnson JA, Angiolillo DJ. Clinical implementation of rapid CYP2C19 genotyping to guide antiplatelet therapy after percutaneous coronary intervention. J Transl Med 2018; 16:92. [PMID: 29642909 PMCID: PMC5896099 DOI: 10.1186/s12967-018-1469-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/31/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The CYP2C19 nonfunctional genotype reduces clopidogrel effectiveness after percutaneous coronary intervention (PCI). Following clinical implementation of CYP2C19 genotyping at University Florida (UF) Health Shands Hospital in 2012, where genotype results are available approximately 3 days after PCI, testing was expanded to UF Health Jacksonville in 2016 utilizing a rapid genotyping approach. We describe metrics with this latter implementation. METHODS Patients at UF Health Jacksonville undergoing left heart catheterization with intent to undergo PCI were targeted for genotyping using the Spartan RX™ system. Testing metrics and provider acceptance of testing and response to genotype results were examined, as was antiplatelet therapy over the 6 months following genotyping. RESULTS In the first year, 931 patients, including 392/505 (78%) total patients undergoing PCI, were genotyped. The median genotype test turnaround time was 96 min. Genotype results were available for 388 (99%) PCI patients prior to discharge. Of 336 genotyped PCI patients alive at discharge and not enrolled in an antiplatelet therapy trial, 1/6 (17%) poor metabolizers (PMs, with two nonfunctional alleles), 38/93 (41%) intermediate metabolizers (IMs, with one nonfunctional allele), and 119/237 (50%) patients without a nonfunctional allele were prescribed clopidogrel (p = 0.110). Clopidogrel use was higher among non-ACS versus ACS patients (78.6% vs. 42.2%, p < 0.001). Six months later, among patients with follow-up data, clopidogrel was prescribed in 0/4 (0%) PMs, 33/65 (51%) IMs, and 115/182 (63%) patients without a nonfunctional allele (p = 0.008 across groups; p = 0.020 for PMs versus those without a nonfunctional allele). CONCLUSION These data demonstrate that rapid genotyping is clinically feasible at a high volume cardiac catheterization facility and allows informed chronic antiplatelet prescribing, with lower clopidogrel use in PMs at 6 months. Trial registration ClinicalTrials.gov Identifier: NCT02724319; registered March 31, 2016; https://www.clinicaltrials.gov/ct2/show/NCT02724319?term=angiolillo&rank=7.
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Affiliation(s)
- Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL USA
- Center for Pharmacogenomics, University of Florida, Gainesville, FL USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL USA
| | - Francesco Franchi
- Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL USA
| | - Fabiana Rollini
- Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL USA
| | - Latonya Been
- Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL USA
| | - Andrea Rivas
- Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL USA
| | - Malhar Agarwal
- Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL USA
| | - D. Max Smith
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL USA
- Center for Pharmacogenomics, University of Florida, Gainesville, FL USA
| | - Kimberly Newsom
- University of Florida Health Pathology Laboratories, Gainesville, FL USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL USA
- Center for Pharmacogenomics, University of Florida, Gainesville, FL USA
| | - Amanda R. Elsey
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL USA
| | - Petr Starostik
- University of Florida Health Pathology Laboratories, Gainesville, FL USA
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL USA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL USA
- Center for Pharmacogenomics, University of Florida, Gainesville, FL USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL USA
| | - Dominick J. Angiolillo
- Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL USA
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265
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Huang J, Li N, Li Z, Hou XJ, Li ZZ. Low-Dose Unfractionated Heparin with Sequential Enoxaparin in Patients with Diabetes Mellitus and Complex Coronary Artery Disease during Elective Percutaneous Coronary Intervention. Chin Med J (Engl) 2018; 131:764-769. [PMID: 29578118 PMCID: PMC5887733 DOI: 10.4103/0366-6999.228251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Despite its limitations, unfractionated heparin (UFH) has been the standard anticoagulant used during percutaneous coronary intervention (PCI). This study compared the safety of low-dose UFH with sequential enoxaparin with that of UFH in patients with diabetes mellitus (DM) and complex coronary artery disease receiving elective PCI. Methods: In this retrospective study, 514 consecutive patients with atherosclerotic cardiovascular diseases and type 2 DM were admitted to the hospital and received selective PCI, from January 2013 to December 2015. All patients with PCI received low-dose UFH with enoxaparin (intraductal 50 U/kg UFH and 0.75 mg/kg enoxaparin, n = 254; UFH-Enox group) or UFH only (intraductal 100 U/kg UFH, n = 260; UFH group). The study endpoints were major adverse cardiac events (MACEs), namely death, myocardial infarction (MI), stroke, target-vessel immediate revascularization (TVR), and thrombolysis in MI (TIMI) major bleeding, within 30 days and 1 year after PCI. Any catheter thrombosis during the procedure was recorded. Results: Only one patient had an intraductal thrombus in the UFH group. At the 30-day follow-up, no MACE occurred in any group; seven and five cases of recurrent angina and/or rehospitalization were reported in the UFH-Enox and UFH groups, respectively; there was no significant difference between the two groups (χ2 = 0.11, P = 0.77). There was no TIMI major bleeding in the groups. With respect to the 1-year endpoint, two cases of recurrent MI and two of TVRs were reported in the UFH-Enox group, whereas in the UFH group, one case of recurrent MI and three of TVRs were reported; no significant difference existed between the two groups (χ2 = 0, P = 0.99). There were 30 and 25 recurrent angina and/or rehospitalizations in the UFH-Enox and UFH groups, respectively; there was no significant difference between the two groups (χ2 = 0.37, P = 0.57). Conclusion: In elective PCI, low-dose UFH with sequential enoxaparin has similar effects and safety to the UFH-only method.
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Affiliation(s)
- Ji Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhao Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xue-Jian Hou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhi-Zhong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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266
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Olie RH, van der Meijden PE, ten Cate H. The coagulation system in atherothrombosis: Implications for new therapeutic strategies. Res Pract Thromb Haemost 2018; 2:188-198. [PMID: 30046721 PMCID: PMC6055505 DOI: 10.1002/rth2.12080] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/05/2018] [Indexed: 12/13/2022] Open
Abstract
Clinical manifestations of atherosclerotic disease include coronary artery disease (CAD), peripheral artery disease (PAD), and stroke. Although the role of platelets is well established, evidence is now accumulating on the contribution of coagulation proteins to the processes of atherosclerosis and atherothrombosis. Coagulation proteins not only play a role in fibrin formation and platelet activation, but also mediate various biological and pathophysiologic processes through activation of protease-activated-receptors (PARs). Thus far, secondary prevention in patients with CAD/PAD has been the domain of antiplatelet therapy, however, residual atherothrombotic risks remain substantial. Therefore, combining antiplatelet and anticoagulant therapy has gained more attention. Recently, net clinical benefit of combining aspirin with low-dose rivaroxaban in patients with stable atherosclerotic disease has been demonstrated. In this review, based on the State of the Art lecture "Clotting factors and atherothrombosis" presented at the ISTH Congress 2017, we highlight the role of coagulation proteins in the pathophysiology of atherothrombosis, and specifically focus on therapeutic strategies to decrease atherothrombotic events by optimization of vascular protection.
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Affiliation(s)
- Renske H. Olie
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Thrombosis Expertise CenterMUMC+MaastrichtThe Netherlands
- Laboratory for Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
| | - Paola E.J. van der Meijden
- Thrombosis Expertise CenterMUMC+MaastrichtThe Netherlands
- Laboratory for Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
| | - Hugo ten Cate
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Thrombosis Expertise CenterMUMC+MaastrichtThe Netherlands
- Laboratory for Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
- Center for Thrombosis and HaemostasisGutenberg UniversityMainzGermany
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267
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Thomas RJ, Balady G, Banka G, Beckie TM, Chiu J, Gokak S, Ho PM, Keteyian SJ, King M, Lui K, Pack Q, Sanderson BK, Wang TY. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2018; 11:e000037. [DOI: 10.1161/hcq.0000000000000037] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | | | | | | | - P. Michael Ho
- ACC/AHA Task Force on Performance Measures Liaison. American Association of Cardiovascular and Pulmonary Rehabilitation Representative
| | - Steven J. Keteyian
- ACC/AHA Task Force on Performance Measures Liaison. American Association of Cardiovascular and Pulmonary Rehabilitation Representative
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Mackman N, Spronk HMH, Stouffer GA, Ten Cate H. Dual Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease and Peripheral Artery Disease Patients. Arterioscler Thromb Vasc Biol 2018; 38:726-732. [PMID: 29449336 PMCID: PMC5978740 DOI: 10.1161/atvbaha.117.310048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/31/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Nigel Mackman
- From the Thrombosis and Hemostasis Program, Division of Hematology and Oncology (N.M.) and Division of Cardiology (G.A.S.), Department of Medicine, McAllister Heart Institute, University of North Carolina at Chapel Hill; and Laboratory for Clinical Thrombosis and Haemostasis, Thrombosis Expert Centre, Department of Internal Medicine (H.M.H.S., H.t.C.) and Department of Biochemistry (H.M.H.S., H.t.C.), Cardiovascular School of Medicine (Cardiovascular Research Institute Maastricht), Maastricht University Medical Centre, the Netherlands.
| | - Henri M H Spronk
- From the Thrombosis and Hemostasis Program, Division of Hematology and Oncology (N.M.) and Division of Cardiology (G.A.S.), Department of Medicine, McAllister Heart Institute, University of North Carolina at Chapel Hill; and Laboratory for Clinical Thrombosis and Haemostasis, Thrombosis Expert Centre, Department of Internal Medicine (H.M.H.S., H.t.C.) and Department of Biochemistry (H.M.H.S., H.t.C.), Cardiovascular School of Medicine (Cardiovascular Research Institute Maastricht), Maastricht University Medical Centre, the Netherlands
| | - George A Stouffer
- From the Thrombosis and Hemostasis Program, Division of Hematology and Oncology (N.M.) and Division of Cardiology (G.A.S.), Department of Medicine, McAllister Heart Institute, University of North Carolina at Chapel Hill; and Laboratory for Clinical Thrombosis and Haemostasis, Thrombosis Expert Centre, Department of Internal Medicine (H.M.H.S., H.t.C.) and Department of Biochemistry (H.M.H.S., H.t.C.), Cardiovascular School of Medicine (Cardiovascular Research Institute Maastricht), Maastricht University Medical Centre, the Netherlands
| | - Hugo Ten Cate
- From the Thrombosis and Hemostasis Program, Division of Hematology and Oncology (N.M.) and Division of Cardiology (G.A.S.), Department of Medicine, McAllister Heart Institute, University of North Carolina at Chapel Hill; and Laboratory for Clinical Thrombosis and Haemostasis, Thrombosis Expert Centre, Department of Internal Medicine (H.M.H.S., H.t.C.) and Department of Biochemistry (H.M.H.S., H.t.C.), Cardiovascular School of Medicine (Cardiovascular Research Institute Maastricht), Maastricht University Medical Centre, the Netherlands
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269
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Kim DH, Park CB, Jin ES, Hwang HJ, Sohn IS, Cho JM, Kim CJ. Predictors of decreased left ventricular function subsequent to follow-up echocardiography after percutaneous coronary intervention following acute ST-elevation myocardial infarction. Exp Ther Med 2018; 15:4089-4096. [PMID: 29725361 PMCID: PMC5920495 DOI: 10.3892/etm.2018.5962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 02/24/2017] [Indexed: 11/25/2022] Open
Abstract
The preferred treatment for patients with ST elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PCI). However, not all patients improve or maintain heart function following primary PCI, and certain patients may experience decreased heart function. The present study investigated factors associated with left ventricular (LV) dysfunction, and improvement or deterioration of LV ejection fraction (LVEF) at follow-up echocardiography following successful primary PCI. The clinical outcomes following primary PCI were also investigated. The present study assessed 4,044 patients who underwent primary PCI following a diagnosis of STEMI between January 2008 and March 2012. A total of 1,736 patients who underwent echocardiography between 30 days and 1 year after STEMI and PCI, and who had completed clinical follow-up, were included in the present study. A total of 243 patients (14.0%) demonstrated LV dysfunction at follow-up echocardiography. Multivariate analysis revealed that LV dysfunction (≤40%) at index STEMI, LVEF at index admission, renal insufficiency (creatinine ≥1.4 mg/dl), peak creatine kinase (CK) and peak CK MB isoenzyme (CKMB) were independent predictors of LV dysfunction at follow-up. Independent predictors for the deterioration of LVEF at follow-up were dyslipidemia, LVEF at index admission, LVEF ≤40% at index admission, peak CK and peak troponin-I. Furthermore, being male, having no history of coronary artery disease, pre-thrombolysis in myocardial infarction (TIMI) flow, LVEF at index admission, LVEF ≤40% at index admission, peak CKMB and peak troponin I were independent predictors of LVEF improvement at follow-up. One-year major adverse cardiac events were significantly increased in the LV dysfunction group compared with patients who did not exhibit LV dysfunction according to Cox regression analysis (13.6 vs. 20.4%; P=0.017). Therefore, the present study may provide valuable prognostic information for clinicians to advise patients who experience LV dysfunction despite having undergone successful primary PCI. Additional management is required in patients with these high-risk features following STEMI.
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Affiliation(s)
- Dong-Hee Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Chang-Bum Park
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Eun-Sun Jin
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Hui-Jeong Hwang
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Jin-Man Cho
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea
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Absence of a correlation between the ABO blood group and thrombus burden in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2018; 29:145-150. [PMID: 28938239 DOI: 10.1097/mca.0000000000000564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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271
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Foraker RE, Guha A, Chang H, O'Brien EC, Bower JK, Crouser ED, Rosamond WD, Raman SV. Survival After MI in a Community Cohort Study: Contribution of Comorbidities in NSTEMI. Glob Heart 2018; 13:13-18. [PMID: 29409724 PMCID: PMC5963709 DOI: 10.1016/j.gheart.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/24/2017] [Accepted: 01/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) comprises the majority of MI worldwide, yet mortality remains high. Management of NSTEMI is relatively delayed and heterogeneous compared with the "time is muscle" approach to ST-segment elevation MI, though it is unknown to what extent comorbid conditions drive NSTEMI mortality. OBJECTIVES We sought to quantify mortality due to MI versus comorbid conditions in patients with NSTEMI. METHODS Participants of the ARIC (Atherosclerosis Risk in Communities) study cohort ages 45 to 64 years, who developed incident NSTEMI were identified and incidence-density matched to participants who did not experience an MI by age group, sex, race, and study community. We estimated hazard ratios for all-cause mortality, comparing those who developed NSTEMI to those who did not experience an MI. RESULTS ARIC participants with incident NSTEMI were more likely at baseline to be smokers, have diabetes and renal dysfunction, and take blood pressure or cholesterol-lowering medications than were participants who did not have an MI. Over one-half of participants experiencing NSTEMI died over a median follow-up of 8.4 years; incident NSTEMI was associated with 30% higher risk of mortality after adjusting for comorbid conditions (hazard ratio: 1.30; 95% confidence interval: 1.11 to 1.53). CONCLUSIONS NSTEMI confers a significantly higher mortality hazard beyond what can be attributed to comorbid conditions. More consistent and effective strategies are needed to reduce mortality in NSTEMI amid comorbid conditions.
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Affiliation(s)
- Randi E Foraker
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | - Avirup Guha
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA
| | - Henry Chang
- Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | | | - Julie K Bower
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Elliott D Crouser
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University, Columbus, OH, USA
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Subha V Raman
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA.
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Clinical Significance of Reciprocal ST-segment Changes in Patients With STEMI: A Cardiac Magnetic Resonance Imaging Study. ACTA ACUST UNITED AC 2018; 72:120-129. [PMID: 29478870 DOI: 10.1016/j.rec.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/09/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES We sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS We performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index. RESULTS Patients with reciprocal change (n=133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5±169.8 vs 289.7±337.3min, P=.042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P=.002) and a greater myocardial salvage index (P=.04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P=.14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P=.92). CONCLUSIONS Reciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI.
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Bravo CA, Hirji SA, Bhatt DL, Gluud C, Faxon DP, Ohman EM, Kaneko T, Engstrøm T, Høfsten DE, Brennan JM. Cochrane corner: complete versus culprit-only revascularisation in ST segment elevation myocardial infarction with multivessel disease. Heart 2018; 104:1144-1147. [DOI: 10.1136/heartjnl-2017-312857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/03/2022] Open
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Chang XW, Zhang SY, Wang H, Zhang MM, Zheng WF, Ma HF, Gu YF, Wei JH, Qiu CG. Combined value of red blood cell distribution width and global registry of acute coronary events risk score on predicting long-term major adverse cardiac events in STEMI patients undergoing primary PCI. Oncotarget 2018; 9:13971-13980. [PMID: 29568409 PMCID: PMC5862630 DOI: 10.18632/oncotarget.24128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/03/2017] [Indexed: 12/22/2022] Open
Abstract
The combined value of RDW and GRACE risk score for cardiovascular prognosis in ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been fully investigated. This study was designed to explore the combined value of RDW and GRACE risk score on predicting long-term major adverse cardiac event (Mace) in STEMI patients undergoing primary PCI. This study included 390 STEMI patients. The primary endpoint at the (33.5 ± 7.1) months follow-up was composed of cardiac death and nonfatal myocardial infarction. The relationship between clinical parameters and clinical outcomes was evaluated using Cox regression model and receiver operating characteristic (ROC) analysis. Mace occurred in 126 (32.3%) patients including 54 (13.8%) cardiac deaths and 72 (18.5%) nonfatal myocardial infarctions. Patients in Mace group had significantly higher RDW and GRACE score than the patients in non-Mace group. According to the Cox model, RDW and GRACE score were the most important independent predictors of Mace and cardiac death. The best cut-off value for RDW to predict the occurrence of primary events was 13.25% (AUC = 0.694, 95% CI:0.639–0.750, P < 0.001) and that for GRACE score was 119.5 (AUC = 0.721, 95% CI:0.666–0.777, P < 0.001). The combination of RDW and GRACE score were more valuable (AUC = 0.775, 95% CI: 0.727–0.824, P < 0.001). Kaplan–Meier analysis provided significant prognostic information with the highest risk for cardiac death (Log-Rank χ2 = 24.684, P < 0.001) in group with both high RDW (> 13.25%) and high GRACE score (> 119.5). The combination of RDW level and GRACE score may be valuable and simple independent predictors of Mace and cardiac death in STEMI patients undergoing primary PCI. They may be useful tools for risk stratification and may indicate long-term clinical outcomes.
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Affiliation(s)
- Xue-Wei Chang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.,Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Shou-Yan Zhang
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Hao Wang
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Ming-Ming Zhang
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Wei-Feng Zheng
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Hui-Fang Ma
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Yun-Fei Gu
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, China
| | - Jing-Han Wei
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chun-Guang Qiu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
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275
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Veno-arterial extracorporeal membrane oxygenation in addition to primary PCI in patients presenting with ST-elevation myocardial infarction. Neth Heart J 2017; 26:76-84. [PMID: 29260464 PMCID: PMC5783893 DOI: 10.1007/s12471-017-1068-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI) can cause great haemodynamic instability. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide haemodynamic support in patients with STEMI but data on outcome and complications are scarce. Methods An in-hospital registry was conducted enrolling all patients receiving VA-ECMO. Patients were analysed for medical history, mortality, neurological outcome, complications and coronary artery disease. Results Between 2011 and 2016, 12 patients underwent pPCI for STEMI and received VA-ECMO for haemodynamic support. The majority of the patients were male (10/12) with a median age of 63 (47–75) years and 4 of the 12 patients had a history of coronary artery disease. A cardiac arrest was witnessed in 11 patients. The left coronary artery was compromised in 8 patients and 4 had right coronary artery disease. All patients were in Killip class IV. Survival to discharge was 67% (8/12), 1‑year survival was 42% (5/12), 2 patients have not yet reached the 1‑year survival point but are still alive and 1 patient died within a year after discharge. All-cause mortality was 42% (5/12) of which mortality on ECMO was 33% (4/12). Patient-related complications occurred in 6 of the 12 patients: 1 patient suffered major neurological impairment, 2 patients suffered haemorrhage at the cannula site, 2 patients had limb ischaemia and 1 patient had a haemorrhage elsewhere. There were no VA-ECMO hardware malfunctions. Conclusion VA-ECMO in pPCI for STEMI has a high survival rate and neurological outcome is good, even when the patient is admitted with a cardiac arrest.
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276
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Li MN, Wang HJ, Zhang NR, Xuan L, Shi XJ, Zhou T, Chen B, Zhang J, Li H. MTHFR C677T gene polymorphism and the severity of coronary lesions in acute coronary syndrome. Medicine (Baltimore) 2017; 96:e9044. [PMID: 29245302 PMCID: PMC5728917 DOI: 10.1097/md.0000000000009044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, circulating levels of homocysteine (Hcy), and the severity of coronary lesion in patients with acute coronary syndrome (ACS) remains unknown.Consecutive ACS patients were included. MTHFR C677T polymorphisms were determined via amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Gensini scores were used to evaluate the severity of coronary lesions.Three hundred ten ACS patients were included, and grouped according to the MTHFR C677T polymorphism variant: CC (n = 78, 25.2%), CT (n = 137, 44.2%), and TT (n = 95, 30.6%) groups. No significant differences were detected with respect to baseline characteristics. Patients in TT group had significantly higher Hcy, and significantly lower folic acid (FA) levels as compared with those in the other 2 groups (P < .05 for both). More importantly, patients with TT had more severe coronary lesions as compared with those from the other 2 groups, as evidenced by higher Gensini scores (P < .05 for both); however, no significant differences were observed with respect to the numbers of affected coronary arteries, or the number, length, and diameter of stents implanted in each group (P > .05 for all). On multivariate logistic regression analysis, presence of a T allele in MTHFR C677T was found to be independently associated with higher circulating Hcy (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.01-1.12, P = .024), and higher Gensini scores (OR: 1.01, 95% CI: 1.00-1.02, P = .046).MTHFR C677T TT polymorphism was associated with higher Hcy levels and more severe coronary lesions in patients with ACS.
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277
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Combined assessment of left ventricular end-diastolic pressure and ejection fraction by left ventriculography predicts long-term outcomes of patients with ST-segment elevation myocardial infarction. Heart Vessels 2017; 33:453-461. [DOI: 10.1007/s00380-017-1080-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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278
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Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, Green LA, Heidenreich PA, Ho PM, Jurgens CY, King ML, Kumbhani DJ, Pancholy S. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2017; 10:HCQ.0000000000000032. [DOI: 10.1161/hcq.0000000000000032] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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279
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 981] [Impact Index Per Article: 140.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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280
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Determinants of slow flow following stent implantation in intravascular ultrasound-guided primary percutaneous coronary intervention. Heart Vessels 2017; 33:226-238. [PMID: 28887713 DOI: 10.1007/s00380-017-1050-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/06/2017] [Indexed: 12/13/2022]
Abstract
Slow flow is a serious complication in primary percutaneous coronary intervention (PCI) and is associated with poor clinical outcomes. Intravascular ultrasound (IVUS)-guided PCI may improve clinical outcomes after drug-eluting stent implantation. The purpose of this study was to seek the factors of slow flow following stent implantation, including factors related to IVUS-guided primary PCI. The study population consisted of 339 ST-elevation myocardial infarction patients, who underwent stent deployment with IVUS. During PCI, 56 patients (16.5%) had transient or permanent slow flow. Multivariate logistic regression analysis showed age (OR 1.04, 95% CI 1.01-1.07, P = 0.01), low attenuation plaque on IVUS (OR 3.38, 95% CI 1.70-6.72, P = 0.001), initial Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 (vs. TIMI 0: OR 0.44, 95% CI 0.20-0.99, P = 0.046), and the ratio of stent diameter to vessel diameter (per 0.1 increase: OR 2.63, 95% CI 1.84-3.77, P < 0.001) were significantly associated with slow flow. A ratio of stent diameter to vessel diameter of 0.71 had an 80.4% sensitivity and 56.9% specificity to predict slow flow. There was no significant difference in ischemic-driven target vessel revascularization between the modest stent expansion (ratio of stent diameter to vessel diameter <0.71) and aggressive stent expansion (ratio of stent diameter to vessel diameter ≥0.71) strategies. Unlike other variables, the ratio of stent diameter to vessel diameter was the only modifiable factor. The modest stent expansion strategy should be considered to prevent slow flow following stent implantation in IVUS-guided primary PCI.
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281
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Giustino G, Redfors B, Brener SJ, Kirtane AJ, Généreux P, Maehara A, Dudek D, Neunteufl T, Metzger DC, Crowley A, Mehran R, Gibson CM, Stone GW. Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: insights from the INFUSE-AMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:339-347. [DOI: 10.1177/2048872617719649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The determinants and significance of early (30-day) heart failure symptoms after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge heart failure in patients with STEMI, and evaluated its impact on clinical outcomes. Methods: Patients from the INFUSE-AMI trial were categorized according to New York Heart Association (NYHA) functional classification at their 30-day visit (NYHA class ≥2 versus 1). Independent correlates of NYHA class ≥2 were determined by multivariable logistic regression. A landmark analysis beyond 30 days was performed to assess the impact of 30-day NYHA class ≥2 on 1-year risk of death or hospitalization for heart failure. Results: Among 402 patients enrolled in the INFUSE-AMI trial with data on NYHA class at 30 days, 76 (18.9%) had NYHA class ≥2. Independent correlates of 30-day NYHA class ≥2 were age, Killip class ≥2 at presentation, heart rate at presentation, intraprocedural no-reflow, and 30-day infarct size (% total ventricular mass). After adjustment for infarct size, patients with NYHA class ≥2 remained at higher risk of death or hospitalization for heart failure at 1-year follow-up compared to those in NYHA class 1 (11.8% vs. 2.8%, adjusted hazard ratio 3.78, 95% confidence interval 1.16–12.22, P=0.03). Conclusions: Clinical, procedural, and imaging variables predict the development of clinical heart failure after primary percutaneous coronary intervention in patients with STEMI. Early post-discharge heart failure symptoms identify a high-risk patient cohort for subsequent heart failure hospitalization and death, independent of infarct size. Trial Registration: ClinicalTrials.gov ; NCT00976521
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Affiliation(s)
- Gennaro Giustino
- Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, USA
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | - Sorin J Brener
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Medicine, New York Methodist Hospital, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Canada
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA
| | - Dariusz Dudek
- Department of Medicine, Department of Interventional Cardiology, Jagiellonian University Medical College, Poland
| | | | | | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | - Roxana Mehran
- Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, USA
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA
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282
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Bugiardini R, Ricci B, Cenko E, Vasiljevic Z, Kedev S, Davidovic G, Zdravkovic M, Miličić D, Dilic M, Manfrini O, Koller A, Badimon L. Delayed Care and Mortality Among Women and Men With Myocardial Infarction. J Am Heart Assoc 2017; 6:e005968. [PMID: 28862963 PMCID: PMC5586439 DOI: 10.1161/jaha.117.005968] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/07/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Women with ST-segment-elevation myocardial infarction (STEMI) have higher mortality rates than men. We investigated whether sex-related differences in timely access to care among STEMI patients may be a factor associated with excess risk of early mortality in women. METHODS AND RESULTS We identified 6022 STEMI patients who had information on time of symptom onset to time of hospital presentation at 41 hospitals participating in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776) from October 2010 through April 2016. Patients were stratified into time-delay cohorts. We estimated the 30-day risk of all-cause mortality in each cohort. Despite similar delays in seeking care, the overall time from symptom onset to hospital presentation was longer for women than men (median: 270 minutes [range: 130-776] versus 240 minutes [range: 120-600]). After adjustment for baseline variables, female sex was independently associated with greater risk of 30-day mortality (odds ratio: 1.58; 95% confidence interval, 1.27-1.97). Sex differences in mortality following STEMI were no longer observed for patients having delays from symptom onset to hospital presentation of ≤1 hour (odds ratio: 0.77; 95% confidence interval, 0.29-2.02). CONCLUSIONS Sex difference in mortality following STEMI persists and appears to be driven by prehospital delays in hospital presentation. Women appear to be more vulnerable to prolonged untreated ischemia. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01218776.
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Affiliation(s)
- Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Serbia
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Goran Davidovic
- Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- Faculty of Medical Sciences, University in Kragujevac, Serbia
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Serbia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Croatia
| | - Mirza Dilic
- Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest, Hungary
- Department of Physiology, New York Medical College, Valhalla, NY
| | - Lina Badimon
- Cardiovascular Research Institute (ICCC), CiberCV-Institute Carlos III, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau Autonomous University of Barcelona, Spain
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283
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Ferreira JP, Rossignol P, Demissei B, Sharma A, Girerd N, Anker SD, Cleland JG, Dickstein K, Filippatos G, Hillege HL, Lang CC, Metra M, Ng LL, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zwinderman AH, Voors A, Zannad F. Coronary angiography in worsening heart failure: determinants, findings and prognostic implications. Heart 2017; 104:606-613. [DOI: 10.1136/heartjnl-2017-311750] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 12/15/2022] Open
Abstract
ObjectivesCoronary angiography is regularly performed in patients with worsening signs and/or symptoms of heart failure (HF). However, little is known on the determinants, findings and associated clinical outcomes of coronary angiography performed in patients with worsening HF.MethodsThe BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) programme enrolled 2516 patients with worsening symptoms and/or signs of HF, either hospitalised or in the outpatient setting. All patients were included in the present analysis.ResultsOf the 2516 patients included, 315 (12.5%) underwent coronary angiography within the 30 days after the onset of worsening symptoms and/or signs of HF. Subjects who underwent angiography were more often observed as inpatients, had more often an overt acute coronary syndrome, had higher troponin I levels, were younger and had better renal function (all p≤0.01). Patients who underwent coronary angiography had a lower risk of the primary outcome of death and/or HF hospitalisation (adjusted HR=0.71, 95% CI 0.57 to 0.89, p=0.003) and death (adjusted HR=0.59, 95% CI 0.43 to 0.80, p=0.001). Among the patients who underwent coronary angiography, those with a coronary stenosis (39%) had a worse prognosis than those without stenosis (adjusted HR for the primary outcome=1.71, 95% CI 1.10 to 2.64, p=0.016).ConclusionsCoronary angiography was performed in <13% of patients with symptoms and/or signs of worsening HF. These patients were remarkably different from those who did not undergo coronary angiography and had a lower risk of subsequent events. The presence of coronary stenosis on coronary angiography was associated with a worse prognosis.
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284
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Aetesam-Ur-Rahman M, Berry C. Cardiovascular Diagnosis and Therapy ( CDT) Editorial: the Minimalist Immediate Mechanical Intervention study. Cardiovasc Diagn Ther 2017; 7:S73-S76. [PMID: 28748152 DOI: 10.21037/cdt.2017.01.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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285
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Lønborg J, Engstrøm T, Kelbæk H, Helqvist S, Kløvgaard L, Holmvang L, Pedersen F, Jørgensen E, Saunamäki K, Clemmensen P, De Backer O, Ravkilde J, Tilsted HH, Villadsen AB, Aarøe J, Jensen SE, Raungaard B, Køber L, Høfsten DE. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization). Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004460. [PMID: 28404623 DOI: 10.1161/circinterventions.116.004460] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization. CONCLUSIONS The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.
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Affiliation(s)
- Jacob Lønborg
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.).
| | - Thomas Engstrøm
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Henning Kelbæk
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Steffen Helqvist
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Lene Kløvgaard
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Lene Holmvang
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Frants Pedersen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Erik Jørgensen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Kari Saunamäki
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Peter Clemmensen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Ole De Backer
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Jan Ravkilde
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Hans-Henrik Tilsted
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Anton Boel Villadsen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Jens Aarøe
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Svend Eggert Jensen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Bent Raungaard
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Lars Køber
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Dan Eik Høfsten
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
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Matsuyama T, Kitamura T, Katayama Y, Kiyohara K, Hayashida S, Kawamura T, Iwami T, Ohta B. Factors associated with the difficulty in hospital acceptance among elderly emergency patients: A population-based study in Osaka City, Japan. Geriatr Gerontol Int 2017. [PMID: 28626877 DOI: 10.1111/ggi.13098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM We aimed to investigate prehospital factors associated with difficulty in hospital acceptance among elderly emergency patients. METHODS We reviewed ambulance records in Osaka City from January 2013 through December 2014, and enrolled all elderly emergency patients aged ≥65 years who were transported by on-scene emergency medical service personnel to a hospital that the personnel had selected. The definition of difficulty in hospital acceptance was to the requirement for ≥4 phone calls to hospitals by emergency medical service personnel before receiving a decision from the destination hospitals. Prehospital factors associated with difficulty in hospital acceptance were examined through logistic regression analysis. RESULTS During the study period, 72 105 elderly patients were included, and 13 332 patients (18.5%) experienced difficulty in hospital acceptance. In the simple linear regression model, hospital selection time increased significantly with an increasing number of phone calls (R2 = 0.774). In the multivariable analysis, older age (P for trend <0.001), calls from a healthcare facility (adjusted odds ratio [AOR] 1.23, 95% confidence interval [CI] 1.15-1.32), night-time (AOR 2.17, 95% CI 2.08-2.26) and weekend/holidays (AOR 1.43, 95% CI 1.38-1.49) were significantly associated with difficulty in hospital acceptance. A positive association was observed between gastrointestinal emergency-related symptoms and difficulty in hospital acceptance among elderly patients with symptoms of internal disease (AOR 1.71, 95% CI 1.53-1.91). CONCLUSIONS In Japan, which has a rapidly aging population, a comprehensive strategy for elderly emergency patients, especially for advanced age groups or nursing home residents, is required. Geriatr Gerontol Int 2017; 17: 2441-2448.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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287
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Non-infarct related artery revascularization in ST-segment elevation myocardial infarction patients with multivessel disease. Curr Opin Cardiol 2017; 32:600-607. [PMID: 28617684 DOI: 10.1097/hco.0000000000000427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Multivessel disease (MVD) is common in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) and is associated with significant risk of future cardiovascular (CV) events including short and longer-term mortality. In this review, we examine the pathophysiologic construct contributing to adverse prognosis of MVD in STEMI, relevant available evidence that currently guides the management of the noninfarct-related artery (IRA) stenosis and define the remaining knowledge gaps for future studies. RECENT FINDINGS Results of recent small sized randomized trials, when pooled, suggest improvement in CV outcomes including CV mortality and repeat revascularization with revascularization of the non-IRA stenosis compared with medical management alone. In addition, there does not appear to be an increase in bleeding, contrast-induced nephropathy or stroke, as suggested by earlier observational data. SUMMARY These recent data have led to a Class IIb recommendation in the American College of Cardiology/American Heart Association guidelines stating that non-IRA revascularization may be considered in selected patients with STEMI and MVD who are hemodynamically stable, either at the time of primary PCI or as a planned staged procedure. The ongoing COMPLETE and CULPRIT-SHOCK studies will provide additional data to further inform the role of non-IRA revascularization and its timing in the management of these patients.
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288
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Petretta M, Cuocolo A. Comparison of ESC and ACC/AHA guidelines for myocardial revascularization: are the differences clinically relevant? The European perspective. J Nucl Cardiol 2017; 24:1057-1061. [PMID: 28432668 DOI: 10.1007/s12350-017-0885-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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289
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Ismail S, Wong C, Rajan P, Vidovich M. ST-elevation acute myocardial infarction in pregnancy: 2016 update. Clin Cardiol 2017; 40:399-406. [PMID: 28191905 PMCID: PMC6490392 DOI: 10.1002/clc.22655] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 12/26/2022] Open
Abstract
Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST-elevation myocardial infarction (STEMI) in this unique population. From a cardiologist, maternal-fetal medicine specialist, and anesthesiologist's perspective, we provide recommendations for the diagnosis and management of STEMI occurring during pregnancy.
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Affiliation(s)
- Sahar Ismail
- Division of CardiologyEmory UniversityAtlantaGeorgia
| | - Cynthia Wong
- Department of AnesthesiaUniversity of Iowa Carver College of MedicineIowa CityIowa
| | - Priya Rajan
- Department of Obstetrics and Gynecology, Maternal–Fetal MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
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Kim K, Lee TA, Touchette DR, DiDomenico RJ, Ardati AK, Walton SM. Contemporary Trends in Oral Antiplatelet Agent Use in Patients Treated with Percutaneous Coronary Intervention for Acute Coronary Syndrome. J Manag Care Spec Pharm 2017; 23:57-63. [PMID: 28025925 PMCID: PMC10398038 DOI: 10.18553/jmcp.2017.23.1.57] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent trials demonstrated the efficacy of prasugrel and ticagrelor compared with clopidogrel in the reduction of cardiovascular complications in patients with acute coronary syndrome (ACS). However, it is unclear how use of the 3 antiplatelet medications has changed in commercially insured patients since the advent of the new agents. OBJECTIVES To (a) describe the adoption of prasugrel and ticagrelor in patients who received percutaneous coronary intervention (PCI) for the onset of ACS and (b) explore patient factors associated with the selection of the drug to provide insight into utilization patterns of these antiplatelet agents. METHODS Patients who received a new dispensing of an antiplatelet agent following a hospitalization for a PCI administered for ACS were identified from insurance claims between 2009 and 2013. Demographics and comorbid conditions were determined based on a 6-month period before the ACS event. Longitudinal trends in antiplatelet agent selection were illustrated using descriptive statistics segmented by month and quarter. Using logistic regressions with stepwise model selection, factors associated with use of the newer medications, as well as with the selection between ticagrelor and prasugrel, were identified. RESULTS The analysis included 66,335 subjects. The use of clopidogrel decreased from 100% to roughly 65% of total antiplatelet agent use by the end of 2011 and leveled off thereafter. The introduction of ticagrelor in 2011 coincided with a drop in prasugrel initiation from 35%-18% by December 2013. The use of new agents as opposed to use of clopidogrel was associated with younger age (< 65 years), male gender, and a diagnosis of ST-elevation myocardial infarction. In addition, conditions increasing mortality and risk of cardiovascular complication were associated with higher odds of using clopidogrel. The odds of using ticagrelor over prasugrel increased with older age and history of a cerebrovascular event. CONCLUSIONS In 2013, clopidogrel remained the most prescribed agent. Meanwhile, ticagrelor had gradually replaced a substantial portion of prasugrel initiation. Further investigation into outcomes associated with the newer agents, as well as reasons behind the conservative use of the antiplatelet agents, is warranted. DISCLOSURES No funding was received for the conduct of this study. DiDomenico received an honorarium from Amgen for the preparation of a heart failure drug monograph for Pharmacy Practice News and was a co-investigator on funded research for the Patient-Centered Outcomes Research Institute. DiDomenico also serves as an advisory board member for a heart failure program at Otsuka America Pharmaceuticals and as an advisory board member at Novartis Pharmaceuticals. Touchette has received unrestricted grant funding from Cardinal Health and Sunovion Pharmaceuticals and has also served as a consultant to and director of the American College of Clinical Pharmacy Practice-Based Research Network on a study funded by Pfizer. None of the authors of this study are involved in financial or personal relationships with agencies, institutions, or organizations that inappropriately influenced the statistical analysis plan or interpretation of the results. Study concept and design were contributed by Kim, Lee, Touchette, and Walton, with assistance from DiDomenico and Ardati. Kim and Lee collected the data, and data interpretation was performed by Lee, DiDomenico, and Ardati, along with Kim and Walton and assisted by Touchette. The manuscript was written by Kim and Walton, with assistance from the other authors, and revised by Kim, Walton, and Lee, with assistance from the other authors.
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Affiliation(s)
- Kibum Kim
- 1 Pharmacotherapy Outcomes Research Center, and Department of Pathology, University of Utah, Salt Lake City
| | - Todd A Lee
- 2 Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago
| | - Daniel R Touchette
- 2 Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago
| | - Robert J DiDomenico
- 3 Center for Pharmacoepidemiology and Pharmacoeconomic Research, and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago
| | - Amer K Ardati
- 4 Division of Cardiology, College of Medicine, University of Illinois at Chicago
| | - Surrey M Walton
- 2 Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago
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Ge J, Yu H, Li J. Acute Coronary Stent Thrombosis in Modern Era: Etiology, Treatment, and Prognosis. Cardiology 2017; 137:246-255. [DOI: 10.1159/000464404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/22/2017] [Indexed: 11/19/2022]
Abstract
Acute stent thrombosis (AST) is a rare but life-threatening complication of coronary artery stenting. AST remains a challenging task for cardiologists, despite the application of modern procedural techniques and dual-antiplatelet therapy strategies as well as improved understanding of the underlying pathophysiology. This review focuses on the prevalence, risk factors, prognosis, multiple potential underlying pathogenesis, knowledge gaps, and recommends diagnosis and individualized management strategies of AST.
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Bravo CA, Hirji SA, Bhatt DL, Kataria R, Faxon DP, Ohman EM, Anderson KL, Sidi AI, Sketch Jr. MH, Zarich SW, Osho AA, Gluud C, Kelbæk H, Engstrøm T, Høfsten DE, Brennan JM. Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease. Cochrane Database Syst Rev 2017; 5:CD011986. [PMID: 28470696 PMCID: PMC6481381 DOI: 10.1002/14651858.cd011986.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Multi-vessel coronary disease in people with ST elevation myocardial infarction (STEMI) is common and is associated with worse prognosis after STEMI. Based on limited evidence, international guidelines recommend intervention on only the culprit vessel during STEMI. This, in turn, leaves other significantly stenosed coronary arteries for medical therapy or revascularisation based on inducible ischaemia on provocative testing. Newer data suggest that intervention on both the culprit and non-culprit stenotic coronary arteries (complete intervention) may yield better results compared with culprit-only intervention. OBJECTIVES To assess the effects of early complete revascularisation compared with culprit vessel only intervention strategy in people with STEMI and multi-vessel coronary disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, World Health Organization International Clinical Trials Registry Platform Search Portal, and ClinicalTrials.gov. The date of the last search was 4 January 2017. We applied no language restrictions. We handsearched conference proceedings to December 2016, and contacted authors and companies related to the field. SELECTION CRITERIA We included only randomised controlled trials (RCTs), wherein complete revascularisation strategy was compared with a culprit-only percutaneous coronary intervention (PCI) for the treatment of people with STEMI and multi-vessel coronary disease. DATA COLLECTION AND ANALYSIS We assessed the methodological quality of each trial using the Cochrane 'Risk of bias' tool. We resolved the disagreements by discussion among review authors. We followed standard methodological approaches recommended by Cochrane. The primary outcomes were long-term (one year or greater after the index intervention) all-cause mortality, long-term cardiovascular mortality, long-term non-fatal myocardial infarction, and adverse events. The secondary outcomes were short-term (within the first 30 days after the index intervention) all-cause mortality, short-term cardiovascular mortality, short-term non-fatal myocardial infarction, revascularisation, health-related quality of life, and cost. We analysed data using fixed-effect models, and expressed results as risk ratios (RR) with 95% confidence intervals (CI). We used GRADE criteria to assess the quality of evidence and we conducted Trial Sequential Analysis (TSA) to control risks of random errors. MAIN RESULTS We included nine RCTs, that involved 2633 people with STEMI and multi-vessel coronary disease randomly assigned to either a complete (n = 1381) versus culprit-only (n = 1252) revascularisation strategy. The complete and the culprit-only revascularisation strategies did not differ for long-term all-cause mortality (65/1274 (5.1%) in complete group versus 72/1143 (6.3%) in culprit-only group; RR 0.80, 95% CI 0.58 to 1.11; participants = 2417; studies = 8; I2 = 0%; very low quality evidence). Compared with culprit-only intervention, the complete revascularisation strategy was associated with a lower proportion of long-term cardiovascular mortality (28/1143 (2.4%) in complete group versus 51/1086 (4.7%) in culprit-only group; RR 0.50, 95% CI 0.32 to 0.79; participants = 2229; studies = 6; I2 = 0%; very low quality evidence) and long-term non-fatal myocardial infarction (47/1095 (4.3%) in complete group versus 70/1004 (7.0%) in culprit-only group; RR 0.62, 95% CI 0.44 to 0.89; participants = 2099; studies = 6; I2 = 0%; very low quality evidence). The complete and the culprit-only revascularisation strategies did not differ in combined adverse events (51/2096 (2.4%) in complete group versus 57/1990 (2.9%) in culprit-only group; RR 0.84, 95% CI 0.58 to 1.21; participants = 4086; I2 = 0%; very low quality evidence). Complete revascularisation was associated with lower proportion of long-term revascularisation (145/1374 (10.6%) in complete group versus 258/1242 (20.8%) in culprit-only group; RR 0.47, 95% CI 0.39 to 0.57; participants = 2616; studies = 9; I2 = 31%; very low quality evidence). TSA of long-term all-cause mortality, long-term cardiovascular mortality, and long-term non-fatal myocardial infarction showed that more RCTs are needed to reach more conclusive results on these outcomes. Regarding long-term repeat revascularisation more RCTs may not change our present result. The quality of the evidence was judged to be very low for all primary and the majority of the secondary outcomes mainly due to risk of bias, imprecision, and indirectness. AUTHORS' CONCLUSIONS Compared with culprit-only intervention, the complete revascularisation strategy may be superior due to lower proportions of long-term cardiovascular mortality, long-term revascularisation, and long-term non-fatal myocardial infarction, but these findings are based on evidence of very low quality. TSA also supports the need for more RCTs in order to draw stronger conclusions regarding the effects of complete revascularisation on long-term all-cause mortality, long-term cardiovascular mortality, and long-term non-fatal myocardial infarction.
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Affiliation(s)
- Claudio A Bravo
- Albert Einstein College of Medicine, Montefiore Medical CenterMontefiore Einstein Center for Heart & Vascular Care111 East 210th StreetBronxNew YorkUSA10467
| | - Sameer A Hirji
- Brigham and Women's Hospital, Harvard Medical SchoolDepartment of Surgery75 Francis StreetBostonMAUSA02115
| | - Deepak L Bhatt
- Brigham and Women's HospitalHeart & Vascular Centre75 Francis StreetBostonMAUSA02115
| | - Rachna Kataria
- Yale New Haven Health SystemDepartment of Internal Medicine267 Grant StreetBridgeportConnecticutUSA06610
| | - David P Faxon
- Brigham and Women's HospitalCardiovascular MedicineBrigham Circle, 1620BostonMassachusettsUSA02120‐1613
| | - E Magnus Ohman
- Division of Cardiovascular Medicine, Duke Heart Center, Ambulatory CareProgramme for Advanced Coronary DiseasesBox 3126, Room 8676A HAFS BuildingDuke University Medical CenterDurhamNorth CarolinaUSA27710
| | - Kevin L Anderson
- Duke UniversitySchool of Medicine201 Trent DriveDurhamNorth CarolinaUSA27705
| | - Akil I Sidi
- University of North CarolinaDepartment of Biology201 Councilman courtMorrisvilleNorth CarolinaUSA27560
| | - Michael H Sketch Jr.
- Duke University School of MedicineDepartment of Medicine/CardiologyDUMC 3157DurhamNorth CarolinaUSA27710
| | - Stuart W Zarich
- Yale New Haven Health SystemDepartment of Cardiology267 Grant StBridgeportConnecticutUSA06610
| | - Asishana A Osho
- Massachusetts General HospitalGeneral Surgery55 Fruit StreetBostonMAUSA02114
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Henning Kelbæk
- Zealand University, Roskilde HospitalCardiac Catheterization LaboratoryKøgevej 7‐13RoskildeDenmark4000
| | - Thomas Engstrøm
- Copenhagen University Hospital, RigshospitaletDepartment of CardiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Dan Eik Høfsten
- Copenhagen University Hospital, RigshospitaletDepartment of CardiologyBlegdamsvej 9CopenhagenDenmark2100
| | - James M Brennan
- Duke University School of MedicineDepartment of Medicine/CardiologyDUMC 3157DurhamNorth CarolinaUSA27710
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Tu JV, Maclagan LC, Ko DT, Atzema CL, Booth GL, Johnston S, Tu K, Lee DS, Bierman A, Hall R, Bhatia RS, Gershon AS, Tobe SW, Sanmartin C, Liu P, Chu A. The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study. CMAJ Open 2017; 5:E315-E321. [PMID: 28446446 PMCID: PMC5498313 DOI: 10.9778/cmajo.20160139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-quality ambulatory care can reduce cardiovascular disease risk, but important gaps exist in the provision of cardiovascular preventive care. We sought to develop a set of key performance indicators that can be used to measure and improve cardiovascular care in the primary care setting. METHODS As part of the Cardiovascular Health in Ambulatory Care Research Team initiative, we established a 14-member multidisciplinary expert panel to develop a set of indicators for measuring primary prevention performance in ambulatory cardiovascular care. We used a 2-stage modified Delphi panel process to rate potential indicators, which were identified from the literature and national cardiovascular organizations. The top-rated indicators were pilot tested to determine their measurement feasibility with the use of data routinely collected in the Canadian health care system. RESULTS A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes. The indicators reflect the major cardiovascular risk factors including smoking, obesity, hypertension, diabetes, dyslipidemia and atrial fibrillation. All indicators were determined to be amenable to measurement with the use of population-based administrative (physician claims, hospital admission, laboratory, medication), survey or electronic medical record databases. INTERPRETATION The Cardiovascular Health in Ambulatory Care Research Team indicators of primary prevention performance provide a framework for the measurement of cardiovascular primary prevention efforts in Canada. The indicators may be used by clinicians, researchers and policy-makers interested in measuring and improving the prevention of cardiovascular disease in ambulatory care settings.
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Affiliation(s)
- Jack V Tu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Laura C Maclagan
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Dennis T Ko
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Clare L Atzema
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Gillian L Booth
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Sharon Johnston
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Karen Tu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Douglas S Lee
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Arlene Bierman
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Ruth Hall
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - R Sacha Bhatia
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Andrea S Gershon
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Sheldon W Tobe
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Claudia Sanmartin
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Peter Liu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Anna Chu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
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294
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Ahn HM, Kim H, Lee KS, Lee JH, Jeong HS, Chang SH, Lee KR, Kim SH, Shin EY. [Hospital Arrival Rate within Golden Time and Factors Influencing Prehospital Delays among Patients with Acute Myocardial Infarction]. J Korean Acad Nurs 2017; 46:804-812. [PMID: 28077828 DOI: 10.4040/jkan.2016.46.6.804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE This research was done to identify the hospital arrival rate and factors related to prehospital delay in arriving at an emergency medical center within the golden time after symptom onset in patients with acute myocardial infarction (AMI). METHODS Data used in the research was from the National Emergency Department Information System of the National Emergency Medical Center which reported that in 2014, 9,611 patients went to emergency medical centers for acute myocardial infarction. Prehospital time is the time from onset to arrival at an emergency medical center and is analyzed by subdividing arrival and delay based on golden time of 2 hour. RESULTS After onset of acute myocardial infarction, arrival rate to emergency medical centers within the golden time was 44.0%(4,233), and factors related to prehospital delay were gender, age, region of residence, symptoms, path to hospital visit, and method of transportation. CONCLUSION Results of this study show that in 2014 more than half of AMI patients arrive at emergency medical centers after the golden time for proper treatment of AMI. In order to reduce prehospital delay, new policy that reflects factors influencing prehospital delay should be developed. Especially, public campaigns and education to provide information on AMI initial symptoms and to enhance utilizing EMS to get to the emergency medical center driectly should be implemented for patients and/or caregivers.
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Affiliation(s)
- Hye Mi Ahn
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea.
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Jung Hyun Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hyo Seon Jeong
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Soung Hoon Chang
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Sung Hea Kim
- Department of Internal Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Eun Young Shin
- Department of Public Health Administration, Hanyang Women's University, Seoul, Korea
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295
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The mechanism of microvascular obstruction in patients with acute ST-segment elevation myocardial infarction: new light from optical coherence tomography. Coron Artery Dis 2017; 28:188-189. [PMID: 28403033 DOI: 10.1097/mca.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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296
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Elgendy AY, Elgendy IY, Mahmoud AN, Bavry AA. Long-term outcomes with aspiration thrombectomy for patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials. Clin Cardiol 2017; 40:534-541. [PMID: 28409835 DOI: 10.1002/clc.22691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 01/12/2023] Open
Abstract
Randomized clinical trials that examined long-term clinical outcomes of routine aspiration thrombectomy prior to primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction have yielded different results. We hypothesized that the routine use of manual thrombus aspiration prior to primary PCI lacks long-term clinical benefits. Electronic databases were searched for randomized trials comparing routine aspiration thrombectomy and conventional PCI. We included only trials that reported clinical outcomes beyond 6 months. The primary outcome was all-cause mortality, and the secondary outcomes included major adverse cardiovascular events, re-infarction, cardiovascular mortality, and stent thrombosis (ST). A DerSimonian-Laird model was used to construct the summary estimates risk ratio (RR). We retrieved 18 trials with 20 641 ST-segment elevation myocardial infarction patients, of whom 10 331 patients underwent routine aspiration thrombectomy prior to primary PCI. At a mean follow-up of 12 months, there was no significant decrease in the risk of all-cause mortality (RR: 0.93, 95% confidence interval [CI]: 0.82-1.05, P = 0.22), major adverse cardiac events (RR: 0.95, 95% CI: 0.87-1.03, P = 0.18), re-infarction (RR: 0.95, 95% CI: 0.80-1.13, P = 0.59), cardiovascular mortality (RR: 0.80, 95% CI: 0.47-1.36, P = 0.40), or ST (RR: 0.80, 95% CI: 0.63-1.01, P = 0.06) with routine aspiration thrombectomy. Routine aspiration thrombectomy prior to primary PCI was not associated with a reduction in long-term mortality or clinical outcomes. Future randomized trials are warranted to further evaluate the role of aspiration thrombectomy in select patients and coronary lesions.
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Affiliation(s)
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville.,North Florida/South Georgia Veterans Health System, Gainesville, Florida
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297
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Gaffar R, Habib B, Filion KB, Reynier P, Eisenberg MJ. Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.005381. [PMID: 28396570 PMCID: PMC5533029 DOI: 10.1161/jaha.116.005381] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Studies have suggested that complete revascularization is superior to culprit‐only revascularization for the treatment of enzyme‐positive acute coronary syndrome. However, the optimal timing of complete revascularization remains unclear. We conducted a systematic review and meta‐analysis of randomized controlled trials comparing single‐stage complete revascularization with multistage percutaneous coronary intervention in patients with ST‐segment elevation myocardial infarction or non–ST‐segment elevation myocardial infarction with multivessel disease. Methods and Results We systematically searched the Cochrane Central Register of Controlled Trials, Embase, PubMed, and MEDLINE for randomized controlled trials comparing single‐stage complete revascularization with multistage revascularization in patients with enzyme‐positive acute coronary syndrome. The primary outcome was the incidence of major adverse cardiovascular events at longest follow‐up. Data were pooled using DerSimonian and Laird random‐effects models. Four randomized controlled trials (n=838) were included in our meta‐analysis. The risk of unplanned repeat revascularization at longest follow‐up was significantly lower in patients randomized to single‐stage complete revascularization (risk ratio, 0.68; 95% CI, 0.47–0.99). Results also suggest a trend towards lower risks of major adverse cardiovascular events for patients randomized to single‐stage revascularization at 6 months (risk ratio, 0.67; 95% CI, 0.40–1.11) and at longest follow‐up (risk ratio, 0.79; 95% CI, 0.52–1.20). Risks of mortality and recurrent myocardial infarction at longest follow‐up were also lower with single‐stage revascularization, but 95% CIs were wide and included unity. Conclusions Our results suggest that single‐stage complete revascularization is safe. There also appears to be a trend towards lower long‐term risks of mortality and major adverse cardiovascular events; however, additional randomized controlled trials are required to confirm the potential benefits of single‐stage multivessel percutaneous coronary intervention.
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Affiliation(s)
- Rouan Gaffar
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Bettina Habib
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada .,Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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298
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Di Mario C, Sorini Dini C, Wijns W. The year in cardiology 2016: coronary interventions. Eur Heart J 2017; 38:1017-1027. [PMID: 28043975 DOI: 10.1093/eurheartj/ehw649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.,National Heart and Lung Institute, Imperial College, Sydney Street, Chelsea, London SW3 6NP, London
| | - Carlotta Sorini Dini
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - William Wijns
- Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, University Road, Galway, Ireland
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299
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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300
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Liu S, Shi X, Tian X, Zhang X, Sun Z, Miao L. Effect of CYP3A4∗1G and CYP3A5∗3 Polymorphisms on Pharmacokinetics and Pharmacodynamics of Ticagrelor in Healthy Chinese Subjects. Front Pharmacol 2017; 8:176. [PMID: 28408884 PMCID: PMC5374142 DOI: 10.3389/fphar.2017.00176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/16/2017] [Indexed: 01/01/2023] Open
Abstract
Ticagrelor is the first reversible, direct-acting, potent P2Y12 receptor antagonist in management of acute coronary syndromes. It is rapidly absorbed and extensively metabolized. AR-C124910XX, the major active metabolite, antagonizes the P2Y12 receptor at approximately equal potency. The metabolism of ticagrelor to AR-C124910XX involves CYP3A4 and CYP3A5. CYP3A polymorphisms have been well documented, and CYP3A4∗1G (g.20230G>A, rs2242480) and CYP3A5∗3 (g.6986A>G, rs776746) are the most important single nucleotide polymorphisms in Chinese. Genetic differences in CYP3A4 and CYP3A5 expression in human volunteers and patients might affect the clearance of ticagrelor or AR-C124910XX in vivo resulting in subsequent variable patient response. Thus, this study is designed to explore the effects of CYP3A4∗1G and CYP3A5∗3 polymorphisms on the pharmacokinetics and pharmcodynamics of ticagrelor in healthy Chinese subjects. The results indicated that the CYP3A4∗1G polymorphism significantly influenced the pharmacokinetics of AR-C124910XX, and it may be more important than CYP3A5∗3 with respect to influencing ticagrelor pharmacokinetics by increasing CYP3A4 activity. However, the significant effect of CYP3A4∗1G polymorphism on AR-C124910XX plasma levels did not translate into detectable effect on inhibition of platelet aggregation. Therefore, it seems not necessary to adjust the dosage of ticagrelor according to the CYP3A4 or 3A5 genotype.
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Affiliation(s)
- Shuaibing Liu
- Department of Pharmacy, The first affiliated Hospital of Zhengzhou UniversityZhengzhou, China
| | - Xiangfen Shi
- Department of Pharmacy, The first affiliated Hospital of Zhengzhou UniversityZhengzhou, China
| | - Xin Tian
- Department of Pharmacy, The first affiliated Hospital of Zhengzhou UniversityZhengzhou, China
| | - Xiaojian Zhang
- Department of Pharmacy, The first affiliated Hospital of Zhengzhou UniversityZhengzhou, China
| | - Zhiyong Sun
- Department of Pharmacy, The first affiliated Hospital of Zhengzhou UniversityZhengzhou, China
| | - Liyan Miao
- Department of Clinical Pharmacology Research Lab, The first affiliated Hospital of Soochow UniversitySuzhou, China
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