1
|
Rodriguez-Granillo AM, Solórzano L, Pérez-Omaña GV, Ascarrunz D, Pavlovsky H, Gomez-Valerio R, Bertrán I, Flores F, Parra J, Guiroy J, Mieres J, Carvajal F, Fernández-Pereira C, Rodriguez AE. Trends in primary percutaneous coronary intervention for the treatment of acute coronary ST-elevation myocardial infarction in Latin American countries: insights from the CECI consortium. Front Cardiovasc Med 2024; 11:1275907. [PMID: 38826814 PMCID: PMC11140057 DOI: 10.3389/fcvm.2024.1275907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/16/2024] [Indexed: 06/04/2024] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) requires revascularization treatment, preferably via primary percutaneous coronary interventions (pPCI). There is a lack of data about contemporary management of STEMI in Latin America. Methods This was a multicenter, multinational, prospective, and dynamic registry of patients undergoing pPCI in Latin America for STEMI (STEMI/LATAMI Registry) that was carried out in nine centers from five countries (Argentina, Ecuador, Venezuela, Bolivia, and the Dominican Republic) between June 2021 and June 2023. All interventionalists involved in the study were originally trained at the same institution (Centro de Estudios en Cardiología Intervencionista, Buenos Aires, Argentina). The primary objective was to evaluate procedural and in-hospital outcomes of pPCI in STEMI and in-hospital outcome in the Latin America (LATAM) region; as secondary endpoints, we analyzed the following subgroups: differences between pPCI vs. pharmaco-invasive or late presenters, gender, elderly and very elderly patients, cardiogenic shock outcomes, and causes of STEMI. Results In total, 744 STEMI patients who underwent PCI between June 2021 and June 2023 in five countries (nine centers) in our continent were included; 76.3% had a pPCI, 8.1% pharmaco-invasive PCI, and 15.6% had late STEMI PCI. There were no differences in region or center when we evaluated in-hospital and 30 days of death. The rate of procedural success was 96.2%, and the overall in-hospital mortality rate was 2.2%. In the subgroup of pPCI, mean symptom onset-to-balloon time was 295.3 ± 246 min, and mean door-to-balloon time was 55.8 ± 49.9 min. The femoral approach was chosen in 60.5%. In 3.0% of patients, the left main disease was the culprit artery, with 1.63 ± 1.00 stents per patient (564 drug-eluting stents and 652 bare metal stents), with 34 patients receiving only plain optimal balloon angioplasty. Definitive stent thrombosis was related to the infarct artery as the primary cause of STEMI in 7.5% of patients. The use of assistant mechanical devices was low, at 2.1% in the pPCI group. Women were older, with large numbers in very elderly age (≥90 years), greater mortality, and incidence of spontaneous coronary dissection as a cause of STEMI (p < 0.001, p < 0.001, p < 0.001, and p < 0.003, respectively). Conclusion In suitable LATAM Centers from low/medium-income countries, this prospective registry in patients with STEMI, PCI performed by well-trained operators has comparable results to those reported in well-developed countries.
Collapse
Affiliation(s)
- Alfredo Matías Rodriguez-Granillo
- Interventional Cardiology Department, Centro de Estudios en Cardiología Intervencionista (CECI), Ciudad de Buenos Aires, Argentina
- Interventional Cardiology Department, Sanatorio Las Lomas, San Isidro, Provincia de Buenos Aires, Argentina
| | - Leonardo Solórzano
- Interventional Cardiology Department, CardioCentro, Manta, Manabí, Ecuador
| | | | - Diego Ascarrunz
- Interventional Cardiology Department, Sanatorio Las Lomas, San Isidro, Provincia de Buenos Aires, Argentina
- Interventional Cardiology Department, Clínica IMA, Adrogué, Provincia de Buenos Aires, Argentina
| | - Hernán Pavlovsky
- Interventional Cardiology Department, Sanatorio Las Lomas, San Isidro, Provincia de Buenos Aires, Argentina
- Interventional Cardiology Department, Clínica IMA, Adrogué, Provincia de Buenos Aires, Argentina
| | - Reynaldo Gomez-Valerio
- Interventional Cardiology Department, Centro de Intervenciones Cardiovasculares, Santo Domingo, Dominican Republic
| | - Ignacio Bertrán
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - Federico Flores
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - Julio Parra
- Interventional Cardiology Department, InCorazón, Quito, Ecuador
| | - Juan Guiroy
- Interventional Cardiology Department, Instituto Cardiovascular del Chaco, Resistencia, Provincia de Chaco, Argentina
| | - Juan Mieres
- Interventional Cardiology Department, Centro de Estudios en Cardiología Intervencionista (CECI), Ciudad de Buenos Aires, Argentina
- Interventional Cardiology Department, Sanatorio Las Lomas, San Isidro, Provincia de Buenos Aires, Argentina
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - Francisco Carvajal
- Interventional Cardiology Department, Sanatorio Las Lomas, San Isidro, Provincia de Buenos Aires, Argentina
- Interventional Cardiology Department, InCorazón, Quito, Ecuador
| | - Carlos Fernández-Pereira
- Interventional Cardiology Department, Centro de Estudios en Cardiología Intervencionista (CECI), Ciudad de Buenos Aires, Argentina
- Interventional Cardiology Department, Clínica IMA, Adrogué, Provincia de Buenos Aires, Argentina
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - Alfredo E. Rodriguez
- Interventional Cardiology Department, Centro de Estudios en Cardiología Intervencionista (CECI), Ciudad de Buenos Aires, Argentina
- Interventional Cardiology Department, Sanatorio Las Lomas, San Isidro, Provincia de Buenos Aires, Argentina
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| |
Collapse
|
2
|
Iyer M, Shah R, Zheng W, Ziada KM, Khot U, Krishnaswamy A, Kapadia SR, Reed GW. Aetiology and predictors of major bleeding events in patients with heart failure with reduced ejection fraction undergoing percutaneous coronary intervention. Open Heart 2024; 11:e002572. [PMID: 38663889 PMCID: PMC11043724 DOI: 10.1136/openhrt-2023-002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES We sought to determine the relationship between the degree of left ventricular ejection fraction (LVEF) impairment and the frequency and type of bleeding events after percutaneous coronary intervention (PCI). DESIGN This was an observational retrospective cohort analysis. Patients who underwent PCI from 2009 to 2017 were identified from our institutional National Cardiovascular Disease Registry (NCDR) CathPCI database. Patients were stratified by pre-PCI LVEF: preserved (≥50%), mildly reduced (41%-49%) and reduced (≤40%) LVEF. PRIMARY OUTCOME MEASURES The outcome was major bleeding, defined by NCDR criteria. Events were classified based on bleeding aetiology and analysed by multivariable logistic regression. RESULTS Among 13 537 PCIs, there were 817 bleeding events (6%). The rate of bleeding due to any cause, blood transfusion, gastrointestinal bleeding and coronary artery perforation or tamponade each increased in a stepwise fashion comparing preserved, mildly reduced and reduced LVEF reduction (p<0.05 for all comparisons). However, there were no differences in bleeding due to asymptomatic drops in haemoglobin, access site haematoma or retroperitoneal bleeding. After multivariable adjustment, mildly reduced and reduced LVEF remained independent predictors of bleeding events (OR 1.36, 95% CI 1.06 to 1.74, p<0.05 and OR 1.73, 95% CI 1.45 to 2.06, p<0.0001). CONCLUSIONS The degree of LV dysfunction is an independent predictor of post-PCI major bleeding events. Patients with mildly reduced or reduced LVEF are at greatest risk of post-PCI bleeding, driven by an increased need for blood transfusion, major GI bleeding events and coronary artery perforation or tamponade. Pre-PCI LV dysfunction does not predict asymptomatic declines in haemoglobin, access site haematoma or retroperitoneal bleeding.
Collapse
Affiliation(s)
- Meghana Iyer
- Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, Ohio, USA
| | - Rohan Shah
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Weili Zheng
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Umesh Khot
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Zhao X, Liu C, Zhou P, Sheng Z, Li J, Zhou J, Chen R, Wang Y, Chen Y, Song L, Zhao H, Yan H. Development and Validation of a Prediction Rule for Major Adverse Cardiac and Cerebrovascular Events in High-Risk Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention. Clin Interv Aging 2022; 17:1099-1111. [PMID: 35880211 PMCID: PMC9307870 DOI: 10.2147/cia.s358761] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims We aimed to develop a clinical prediction tool to improve the prognosis of major adverse cardiac and cerebrovascular events (MACCE) among high-risk myocardial infarction (MI) patients undergoing primary percutaneous coronary intervention (PCI). Methods The present study was a prospective and observational study. A total of 4151 consecutive MI patients who underwent primary PCI at Fuwai Hospital in Beijing, China (January 2010 and June 2017) were enrolled. Forty-eight patients without follow-up data were excluded from the study. The pre-specified criteria (Supplementary Information 1) were chosen to enroll MI patients at high risk for MACCE complications after PCI. Results The full model included seven variables, with a risk score of 160 points. Derivation and validation cohort models predicting MACCE had C-statistics of 0.695 and 0.673. The area under the curve (AUC) of the survival receiver operating characteristic curve (ROC) for predicting MACCE was 0.991 and 0.883 in the derivation and validation cohorts, respectively. Conclusion The predicted model was internally validated and calibrated in large cohorts of patients with high-risk MI receiving primary PCI to predict MACCE and showed modest accuracy in the derivation and validation cohorts.
Collapse
Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| |
Collapse
|
4
|
Matysek M, Wójcicki K, Tokarek T, Dziewierz A, Rakowski T, Bartuś S, Dudek D. Knowledge and Prevalence of Risk Factors for Coronary Artery Disease in Patients after Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting. Healthcare (Basel) 2022; 10:1142. [PMID: 35742193 PMCID: PMC9223287 DOI: 10.3390/healthcare10061142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is associated with a short hospital stay and fast recovery. However, it might be related to insufficient implementation of lifestyle changes after the procedure. Conversely, coronary artery bypass grafting (CABG) is a highly invasive technique that requires a prolonged hospital stay and long rehabilitation with more opportunities for education. This study aimed to evaluate the impact of CABG on adherence to lifestyle modifications and knowledge about coronary artery disease (CAD) in comparison with PCI. We also evaluated the level of education and tried to define groups of patients that might require targeted education. METHODS Data was collected using a self-designed 56-item questionnaire. Questions assessed the knowledge of CAD risk factors and the level of their control. RESULTS The study group consisted of 155 consecutive patients admitted to the Cardiology Department. Patients with a history of PCI (68%) (at least 8 weeks before) were included in the prior-PCI group, and patients with previous surgical revascularization (also at least 8 weeks before) were assigned to the prior-CABG group (32%). The knowledge score was higher in the prior-CABG group. The median (IQR) results in the prior-PCI vs. prior-CABG group were, respectively: 20 (12-24) vs. 22 (19-25) [points, per 31 max.]; p = 0.01. Similar results were obtained in the level of risk control (prior-PCI vs. prior-CABG, respectively: 6 (4-7) vs. 7 (6-8) [points, per 15 max.]; p = 0.002). CONCLUSIONS The method of treatment of CAD might impact the implementation of lifestyle modifications after the procedure. More effort is required to improve secondary prevention, especially in PCI patients.
Collapse
Affiliation(s)
- Mikołaj Matysek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 31-501 Kraków, Poland; (K.W.); (A.D.); (S.B.)
| | - Krzysztof Wójcicki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 31-501 Kraków, Poland; (K.W.); (A.D.); (S.B.)
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland;
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 31-501 Kraków, Poland; (K.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-501 Kraków, Poland; (T.R.); (D.D.)
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-501 Kraków, Poland; (T.R.); (D.D.)
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 31-501 Kraków, Poland; (K.W.); (A.D.); (S.B.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-501 Kraków, Poland; (T.R.); (D.D.)
| |
Collapse
|
5
|
Oh S, Jeong MH, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Outcomes of Nonagenarians with Acute Myocardial Infarction with or without Coronary Intervention. J Clin Med 2022; 11:jcm11061593. [PMID: 35329920 PMCID: PMC8955178 DOI: 10.3390/jcm11061593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Percutaneous coronary intervention (PCI) is the mainstay treatment of acute myocardial infarction (AMI); however, many clinicians are reluctant to perform PCI in the elderly population. This study aimed to compare the clinical outcomes of PCI versus medical therapy in nonagenarian Korean patients with AMI. We compared the clinical outcomes of nonagenarian patients with AMI with or without PCI. From the pooled data, based on a series of Korean AMI registries during 2005−2020, 467 consecutive patients were selected and categorized into two groups: the PCI and no-PCI groups. The primary endpoint was 1-year major adverse cardiac event (MACE), a composite of all-cause death, non-fatal myocardial infarction, and any revascularization. Among the 467 participants, 68.5% received PCI. The PCI group had lower proportions of Killip classes III-IV, previous heart failure, and left ventricular ejection fraction <40%, but had higher proportions of all prescribed medications and STEMI diagnosis. The 1-year MACE and all-cause death were higher in the no-PCI group, although partially attenuated post-IPTW. Our study showed that nonagenarian patients with AMI undergoing PCI had better clinical outcomes than those without PCI. Nonetheless, further investigation is needed in the future to elucidate whether PCI is beneficial for this population.
Collapse
Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
- Correspondence: ; Tel.: +82-10-2665-6243
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| |
Collapse
|
6
|
Hu MJ, Tan JS, Jiang WY, Gao XJ, Yang YJ. The optimal percutaneous coronary intervention strategy for patients with ST-segment elevation myocardial infarction and multivessel disease: a pairwise and network meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221078088. [PMID: 35295615 PMCID: PMC8918769 DOI: 10.1177/20406223221078088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the optimal percutaneous coronary intervention (PCI) strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. Methods: Trials that randomized patients with STEMI and multivessel coronary artery disease to immediate multivessel PCI, staged multivessel PCI, or culprit-only PCI and prospective observational studies that investigated all-cause death were included. Random effect risk ratio (RR) and 95% confidence interval (CI) were calculated. Results: A total of 13 randomized trials with 7627 patients and 21 prospective observational studies with 60311 patients were included. In the pairwise and network meta-analysis based on randomized trials, immediate or staged multivessel PCI was associated with a lower risk of long-term major adverse cardiac events (MACE; RR: 0.58; 95% CI: 0.45 to 0.74) than culprit-only PCI, which was mainly due to lower risks of myocardial infarction (RR: 0.67; 95% CI: 0.51 to 0.88) and revascularization (RR: 0.38; 95% CI: 0.28 to 0.51), without any significant difference in all-cause death (RR: 0.85; 95% CI: 0.69 to 1.04; I2 = 0.0%). However, short-term outcomes were deficient in randomized trials. The results from real-world prospective observational studies suggested that staged multivessel PCI reduced long-term all-cause death (RR: 0.53; 95% CI: 0.39 to 0.71; I2 = 15.6%), whereas immediate multivessel PCI increased short-term all-cause death (RR: 1.58; 95% CI: 1.22 to 2.05; I2 = 43.8%) relative to culprit-only PCI. Conclusion: For patients in randomized trials, multivessel PCI in an immediate or staged procedure was preferred due to improvements in long-term outcomes. As a supplement, the results in real-world patients derived from prospective observational studies suggested that staged multivessel PCI was superior to immediate multivessel PCI. Therefore, staged multivessel PCI may be the optimal PCI strategy for patients with STEMI and multivessel coronary artery disease.
Collapse
Affiliation(s)
- Meng-Jin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang-Shan Tan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Yang Jiang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Jin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| |
Collapse
|
7
|
Wongthida T, Lumkul L, Patumanond J, Wongtheptian W, Piyayotai D, Phinyo P. Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041997. [PMID: 35206186 PMCID: PMC8872110 DOI: 10.3390/ijerph19041997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022]
Abstract
ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin < 12 gm/dL, pre- and intra-procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration > 60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.
Collapse
Affiliation(s)
- Thanutorn Wongthida
- Office of Research and Knowledge Management, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
| | - Wattana Wongtheptian
- Cardiology Unit, Department of Medicine, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Dilok Piyayotai
- Cardiology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Department of Family Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
| |
Collapse
|
8
|
Lv J, Zhao Q, Yang J, Gao X, Zhang X, Ye Y, Dong Q, Fu R, Sun H, Yan X, Li W, Yang Y, Xu H. Length of Stay and Short-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention: Insights from the China Acute Myocardial Infarction Registry. Int J Gen Med 2021; 14:5981-5991. [PMID: 34588802 PMCID: PMC8473847 DOI: 10.2147/ijgm.s330379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Length of stay (LOS) in patients with ST-segment elevation myocardial infarction (STEMI) is directly associated with financial pressure and medical efficiency. This study aimed to determine impact of LOS on short-term outcomes and associated factors of LOS in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). METHODS A total of 3615 patients with STEMI after PPCI in the China Acute Myocardial Infarction registry were included in the analysis. Predictors of prolonged LOS were analyzed by multivariate logistic regression model with generalized estimating equation. The impact of LOS on 30-day clinical outcomes was assessed. RESULTS The median LOS was 9 (7, 12) days. Patients with a longer LOS (>7 days) were older, more often in lower-level hospitals, had more periprocedural complications and hospitalization expense. Fourteen variables, such as weekend admission and lower-level hospitals, were identified as independent associated factors of prolonged LOS. There were no significant difference in 30-day major adverse cardiac and cerebrovascular events (MACCE), readmission, and functional status between patients with LOS≤7d and LOS>7d after multivariate adjustment and propensity score matching. However, patients who discharged over one week had better medication adherence (adjusted odds ratio: 0.817, 95% confidence interval: 0.687-0.971, P=0.022). Significant interaction was observed in medication use between gender and LOS (Pinteraction=0.038). CONCLUSION Patients with STEMI undergoing PPCI experienced a relatively long LOS in China, which resulted in more medical expenses but no improvement on 30-day MACCE, readmission, and functional recovery. Poor 30-day medication adherence with short LOS reflects unsatisfying transition of management from hospital to community. More efforts are needed to reduce LOS safely and improve the efficiency of medical care.
Collapse
Affiliation(s)
- Junxing Lv
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Qinghao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Jingang Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Xiaojin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Xuan Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Yunqing Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Qiuting Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Rui Fu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Hui Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Xinxin Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Wei Li
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - On behalf of the China Acute Myocardial Infarction Registry Study Group
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| |
Collapse
|
9
|
The risk for subsequent coronary interventions in a local Polish population. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:429-435. [PMID: 33598016 PMCID: PMC7863820 DOI: 10.5114/aic.2020.101768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Paradoxically, the literature lacks an assessment of the impact of various factors on subsequent coronary interventions in patients with coronary artery disease (CAD). Aim To assess the impact of various factors on subsequent percutaneous transluminal coronary angioplasty (PTCA), as well as to characterize the clinical profile of people undergoing repeated diagnostic coronary angiography without significant coronary artery changes. Material and methods We investigated retrospective data from 4041 subjects according to the clinical factors which may affect the occurrence of unplanned future PTCA. Results The strongest risk factors for subsequent PTCA were significant stenosis of left descending artery (OR = 2.17, 95% CI: 1.09–4.32) during baseline coronary angiography, the atherosclerotic burden (number of critically narrowed vessels) (OR for narrowing lesions in 3 epicardial arteries 12.13, 95% CI: 5.40–27.27), and restenosis in a previously implanted stent (OR = 4.34, 95% CI: 1.96–9.62). A strong positive relationship between total mortality and the number of critically narrowed coronary arteries (during baseline hospitalization) was observed. Patients without significant coronary artery stenosis in two diagnostic angiographies (control group) differed from subjects with hemodynamic relevant CAD in: higher creatinine levels, more frequent presence of chronic obstructive pulmonary disease and more frequent symptoms of intermittent claudication. Conclusions The results of the study are in accord with real clinical practice. The arteriosclerotic burden is a major cause of recurrent PTCA, but an important clinical issue is the qualification for recurrent coronary-angiography in those patients whose previous coronary angiography did not show significant stenosis, because other clinical causes may explain their symptoms.
Collapse
|
10
|
No clinical benefit from manual thrombus aspiration in patients with non-ST-elevation myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:32-40. [PMID: 26966447 PMCID: PMC4777704 DOI: 10.5114/pwki.2016.56947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There are scarce data on the usefulness of manual thrombectomy among patients with non-ST-elevation myocardial infarction (NSTEMI). Early positive reports were not supported by the clinical outcome in the recent TATORT-NSTEMI (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non-ST-Elevation Myocardial Infarction) study. AIM To analyze the long-term outcome of NSTEMI patients treated with manual thrombectomy during percutaneous coronary intervention (PCI) in the Polish multicenter National Registry of Drug Eluting Stents (NRDES) study. MATERIAL AND METHODS There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry in 2010-2011. Patients with a diagnosis of NSTEMI were divided into two groups: those that were treated with manual thrombectomy for their primary PCI (T) and those who were not (NT). RESULTS There were 923 patients diagnosed with NSTEMI in NRDES. Aspiration thrombectomy was used in 71 (7.7%) patients and the remaining 852 (92.3%) NSTEMI cases were treated without thrombectomy during the index PCI. Thrombectomy was more often used in patients with TIMI less than 1, thrombus grades 4 and 5 and older male patients. Percutaneous coronary interventions complications such as distal embolization and slow flow were more often observed in the thrombectomy subgroup. Overall mortality at 1 year was 1.69% in the T and 5.92% in the NT group (p = 0.24 and p = 0.32 after propensity score matching adjustment with p = 0.11 in the multivariate logistic regression model). CONCLUSIONS There was no mortality benefit from thrombus aspiration in NSTEMI patients at 1-year follow-up.
Collapse
|
11
|
Dudek D, Dziewierz A, Brener SJ, Abizaid A, Merkely B, Costa RA, Bar E, Rakowski T, Kornowski R, Dressler O, Abizaid A, Silber S, Stone GW. Mesh-covered embolic protection stent implantation in ST-segment-elevation myocardial infarction: final 1-year clinical and angiographic results from the MGUARD for acute ST elevation reperfusion trial. Circ Cardiovasc Interv 2015; 8:e001484. [PMID: 25603802 DOI: 10.1161/circinterventions.114.001484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The MGuard, a bare metal stent covered with a polymer mesh, was designed to reduce distal embolization during percutaneous coronary intervention in ST-segment-elevation myocardial infarction. In the MGUARD for Acute ST Elevation Reperfusion trial, the primary end point of complete ST-segment resolution was significantly improved with the MGuard compared with control. We evaluated 1-year clinical and angiographic results. METHODS AND RESULTS Patients with ST-segment-elevation myocardial infarction ≤12 hours undergoing primary percutaneous coronary intervention of a single de novo native lesion were randomized to the MGuard versus any commercially available metallic stent (39.8% drug-eluting). Clinical follow-up was performed through 1 year, and angiography at 13 months was planned in 50 MGuard patients. There was no difference in major adverse cardiac events (1.8% versus 2.3%; P=0.75) at 30 days between the groups. Major adverse cardiac events at 1 year were higher with the MGuard, driven by greater ischemia-driven target lesion revascularization (8.6% versus 0.9%; P=0.0003). Conversely, mortality tended to be lower with the MGuard at 30 days (0% versus 1.9%; P=0.04) and at 1 year (1.0% versus 3.3%; P=0.09). Late lumen loss at 13 months in the MGuard was 0.99±0.80 mm, and binary restenosis was 31.6%. CONCLUSIONS In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, a trend toward reduced 1-year mortality was present in patients treated with the MGuard stent. Target lesion revascularization and major adverse cardiac events rates during follow-up were higher in the MGuard group than in the control stent group, and angiographic late loss of the MGuard was consistent with that expected from bare metal stents. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01368471.
Collapse
Affiliation(s)
- Dariusz Dudek
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Artur Dziewierz
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Sorin J Brener
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Alexandre Abizaid
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Béla Merkely
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Ricardo A Costa
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Eli Bar
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Tomasz Rakowski
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Ran Kornowski
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Ovidiu Dressler
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Andrea Abizaid
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Sigmund Silber
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| | - Gregg W Stone
- From the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D., A.D., T.R.); Cardiovascular Research Foundation, New York, NY (S.J.B., O.D., G.W.S.); Department of Cardiology, New York Methodist Hospital, Brooklyn (S.J.B.); Department of Cardiology, Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (Alexandre Abizaid, R.A.C., Andrea Abizaid); Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Cardiovascular Research Center, São Paolo, Brazil (R.A.C.); InspireMD, Tel Aviv, Israel (E.B.); Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel (R.K.); Department of Cardiology, Heart Center at the Isar, Munich, Germany (S.S.); and Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital (G.W.S.)
| |
Collapse
|
12
|
Smith FGD, Brogan RA, Alabas O, Laut KG, Quinn T, Bugiardini R, Gale CP. Comparative care and outcomes for acute coronary syndromes in Central and Eastern European Transitional countries: A review of the literature. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:537-54. [DOI: 10.1177/2048872614551545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/26/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Fraser GD Smith
- Division of Epidemiology and Biostatistics, University of Leeds, UK
| | - Richard A Brogan
- Division of Epidemiology and Biostatistics, University of Leeds, UK
- York Teaching Hospital, NHS Foundation Trust, UK
| | - Oras Alabas
- Division of Epidemiology and Biostatistics, University of Leeds, UK
| | - Kristina G Laut
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Tom Quinn
- Faculty of Health and Medical Sciences, University of Surrey, UK
| | - Raffaele Bugiardini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, University of Bologna, Italy
| | - Chris P Gale
- Division of Epidemiology and Biostatistics, University of Leeds, UK
- York Teaching Hospital, NHS Foundation Trust, UK
| |
Collapse
|
13
|
Siudak Z, Mielecki W, Dziewierz A, Rakowski T, Legutko J, Bartuś S, Bryniarski KL, Partyka Ł, Dudek D. No long-term clinical benefit from manual aspiration thrombectomy in ST-elevation myocardial infarction patients. Data from NRDES registry. Catheter Cardiovasc Interv 2014; 85:E16-22. [PMID: 24909662 DOI: 10.1002/ccd.25572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/30/2014] [Accepted: 05/25/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Current STEMI guidelines recommend thrombectomy should be considered during primary PCI. Multiple data from randomized clinical trials, registries, and metanalysis have confirmed the efficacy of thrombectomy in terms of surrogate endpoints like better myocardial perfusion, less pronounced distal embolization, and conflicting results on lower all-cause mortality. Our aim was to analyze long-term outcome of STEMI patients treated with manual thrombectomy during primary PCI in a contemporary national registry. METHODS There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry. Patients were divided into two groups: those that were treated with manual thrombectomy for their primary PCI vs. those who were not. RESULTS There were altogether 2,686 patients enrolled in the NRDES Registry of whom 1,763 were diagnosed with STEMI (66%). Aspiration thrombectomy was used in 673 of these cases (38%) and 1,090 (62%) patients were treated without thrombectomy during the index primary PCI. Overall mortality at 1 year was 11.03% in thrombectomy and 7.46% in no thrombectomy group respectively (P = 0.0292 which became insignificant after propensity score matching adjustment P = 0.613). Specific subgroup analyses revealed that there was no benefit from aspiration thrombectomy in neither subgroup. CONCLUSIONS Manual aspiration thrombectomy in patients undergoing primary PCI for STEMI was not associated with improved long-term 1-year clinical outcome. Subgroup analysis did not reveal any specific setting in which thrombectomy would be clinically superior. © 2014 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Zbigniew Siudak
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | | | | | | | | | | | | | | | | |
Collapse
|