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Alexandre A, Campinas A, Brochado B, Braga M, Sá‐Couto D, Santos M, Ribeiro D, Brandão M, Silva MP, de Morais GP, Calvão J, Silva JC, Baggen‐Santos R, Luz A, Silveira J, Torres S. Twelve-year trends in unprotected left main coronary artery occlusion: insights from a real-world multicentre study. ESC Heart Fail 2024; 11:1981-1994. [PMID: 38549183 PMCID: PMC11287319 DOI: 10.1002/ehf2.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 07/31/2024] Open
Abstract
AIMS Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12 year period. METHODS AND RESULTS This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%. CONCLUSIONS In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.
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Affiliation(s)
- André Alexandre
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Andreia Campinas
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Bruno Brochado
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Marta Braga
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - David Sá‐Couto
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Mariana Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Diana Ribeiro
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Mariana Brandão
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Marisa Passos Silva
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Gustavo Pires de Morais
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - João Calvão
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - João Carlos Silva
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - Raquel Baggen‐Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - André Luz
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- Cardiovascular Research Group, UMIB – Unit for Multidisciplinary Research in Biomedicine, ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - João Silveira
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Severo Torres
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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3
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Pan HH, Yuan N, He LY, Sheng JL, Hu HL, Zhai CL. Machine learning-based mRNA signature in early acute myocardial infarction patients: the perspective toward immunological, predictive, and personalized. Funct Integr Genomics 2023; 23:160. [PMID: 37178159 DOI: 10.1007/s10142-023-01081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Patients diagnosed with stable coronary artery disease (CAD) are at continued risk of experiencing acute myocardial infarction (AMI). This study aims to unravel the pivotal biomarkers and dynamic immune cell changes, from an immunological, predictive, and personalized viewpoint, by implementing a machine-learning approach and a composite bioinformatics strategy. Peripheral blood mRNA data from different datasets were analyzed, and CIBERSORT was used for deconvoluting human immune cell subtype expression matrices. Weighted gene co-expression network analysis (WGCNA) in single-cell and bulk transcriptome levels was conducted to explore possible biomarkers for AMI, with a particular emphasis on examining monocytes and their involvement in cell-cell communication. Unsupervised cluster analysis was performed to categorize AMI patients into different subtypes, and machine learning methods were employed to construct a comprehensive diagnostic model to predict the occurrence of early AMI. Finally, RT-qPCR on peripheral blood samples collected from patients validated the clinical utility of the machine learning-based mRNA signature and hub biomarkers. The study identified potential biomarkers for early AMI, including CLEC2D, TCN2, and CCR1, and found that monocytes may play a vital role in AMI samples. Differential analysis revealed that CCR1 and TCN2 exhibited elevated expression levels in early AMI compared to stable CAD. Machine learning methods showed that the glmBoost+Enet [alpha=0.9] model achieved high predictive accuracy in the training set, external validation sets, and clinical samples in our hospital. The study provided comprehensive insights into potential biomarkers and immune cell populations involved in the pathogenesis of early AMI. The identified biomarkers and the constructed comprehensive diagnostic model hold great promise for predicting the occurrence of early AMI and can serve as auxiliary diagnostic or predictive biomarkers.
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Affiliation(s)
- Hai-Hua Pan
- The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, 314001, People's Republic of China
| | - Na Yuan
- The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, 314001, People's Republic of China
| | - Ling-Yan He
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People's Republic of China
| | - Jia-Lin Sheng
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People's Republic of China
| | - Hui-Lin Hu
- The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, 314001, People's Republic of China.
| | - Chang-Lin Zhai
- The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, 314001, People's Republic of China.
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4
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Li B, Feng Q, Yu C, Yang J, Qin X, Li X, Cao J, Xu X, Yang C, Jin Y. Predictive value of serum HIF-1α and VEGF for arrhythmia in acute coronary syndrome patients. Exp Biol Med (Maywood) 2023; 248:685-690. [PMID: 37350444 PMCID: PMC10291207 DOI: 10.1177/15353702231171902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/22/2023] [Indexed: 06/24/2023] Open
Abstract
Percutaneous coronary intervention (PCI) has been widely used in the alleviation of myocardial ischemia in patients with acute coronary syndrome (ACS). However, the incidence of reperfusion arrhythmia (RA) after PCI is high, which seriously affects the prognosis of ACS patients. Therefore, this study aimed to study the predictive value of serum HIF-1α and VEGF levels before PCI for RA in ACS patients post PCI. A total of 200 ACS patients who underwent PCI were selected and divided into those with RA after PCI (RA, n = 93) and those without RA after PCI (non-RA, n = 107) according to Lown grade. Spearman correlation analysis was applied for the relationship between serum hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) levels and Lown grade. Patients with RA after PCI tended to have higher levels of creatine kinase muscle and brain isoenzyme (CK-MB), serum HIF-1α and VEGF before surgery. Low left ventricular ejection fraction (LVEF), high CK-MB, high serum VEGF and HIF-1α were risk factors for RA in ACS patients within 24 h after PCI. Receiver operating characteristic (ROC) analysis revealed that serum HIF-1α and VEGF levels could predict RA in ACS patients after PCI, and the combined detection could increase the sensitivity of single HIF-1α detection and the specificity of single VEGF detection. Lown grade was positively correlated with the serum HIF-1α and VEGF concentrations. In conclusion, serum HIF-1α and VEGF levels before PCI are risk factors for the occurrence of RA in ACS patients after PCI, and have certain predictive values for the occurrence of RA in ACS patients after PCI.
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Affiliation(s)
- Bin Li
- Wuxi No.2 People’s Hospital, The Affiliated Wuxi Clinical College of Nantong University, Wuxi 214002, China
| | - Qiuting Feng
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Cheng Yu
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Jun Yang
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Xian Qin
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Xing Li
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Jianing Cao
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Xin Xu
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Chenjian Yang
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
| | - Yan Jin
- Wuxi No.2 People’s Hospital, The Affiliated Wuxi Clinical College of Nantong University, Wuxi 214002, China
- Department of Cardiology, Jiangnan University Medical Center (JUMC), Wuxi 214002, China
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5
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Nishihira K, Kojima S, Takegami M, Honda S, Nakao YM, Takahashi J, Itoh T, Watanabe T, Takayama M, Shimokawa H, Sumiyoshi T, Kimura K, Yasuda S. Clinical Characteristics and In-Hospital Mortality According to Left Main and Non-Left Main Culprit Lesions - Report From the Japan Acute Myocardial Infarction Registry (JAMIR). Circ Rep 2019; 1:601-609. [PMID: 33693106 PMCID: PMC7897686 DOI: 10.1253/circrep.cr-19-0056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/06/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Acute coronary syndrome (ACS) due to an unprotected left main coronary artery (LMCA) lesion is a critical condition, but there are limited data available on in-hospital outcomes of percutaneous coronary intervention (PCI). Methods and Results: The Japan Acute Myocardial Infarction Registry is a nationwide, real-world database. The clinical data on 13,548 ACS patients hospitalized between January 2011 and December 2013 were retrospectively collected from 10 representative regional ACS registry groups. We compared the 404 patients (3.0%) with LMCA ACS with the remaining 13,144 patients with non-LMCA ACS. The LMCA group was characterized by older age, lower rate of ST-segment elevation myocardial infarction, and higher rate of advanced Killip class. In-hospital mortality was significantly higher in patients with LMCA ACS than in those with non-LMCA ACS (23.3% vs. 5.5%, respectively; P<0.001). Primary PCI for non-LMCA lesions was associated with lower in-hospital mortality (OR, 0.48; 95% CI: 0.34-0.66), but that for LMCA lesions was not (OR, 2.89; 95% CI: 1.13-7.40). Longer door-to-balloon time was associated with Killip class ≥2 and higher in-hospital mortality in the non-LMCA group but not in the LMCA group. Conclusions: Primary PCI in patients with LMCA ACS is still challenging; therefore, effective strategies are needed.
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Affiliation(s)
- Kensaku Nishihira
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School Kurashiki Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center Suita Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Yoko M Nakao
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center Suita Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai Japan
| | - Tomonori Itoh
- Division of Cardiology, Iwate Medical University Morioka Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine Yamagata Japan
| | | | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai Japan
| | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
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Doucet S, Jolicœur EM, Serruys PW, Ragosta M, Kron IL, Scholtz W, Börgermann J, Zhang Y, McAndrew T, Sabik JF, Kappetein AP, Stone GW. Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease: Analysis from the EXCEL trial. Am Heart J 2019; 214:9-17. [PMID: 31150791 DOI: 10.1016/j.ahj.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial. METHODS We used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL. RESULTS At baseline, 1151 patients (60.7%) presented with SIHD and 746 patients (39.3%) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70-1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI 0.73-1.48]) or with ACS (HR 0.82; 95% CI 0.54-1.26) (Pinteraction = .34). CONCLUSIONS The acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.
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Affiliation(s)
- Serge Doucet
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada
| | - E Marc Jolicœur
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada
| | - Patrick W Serruys
- Imperial College of Science, Technology and Medicine, London, United Kingdom
| | | | - Irving L Kron
- University of Virginia Health System, Charlottesville, VA
| | - Werner Scholtz
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, OH
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY.
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7
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New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion. J Interv Cardiol 2019; 2019:8238972. [PMID: 31772547 PMCID: PMC6739789 DOI: 10.1155/2019/8238972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 03/04/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). Background Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. Methods 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. Results Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). Conclusions In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up.
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8
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Liu HW, Han YL, Jin QM, Wang XZ, Ma YY, Wang G, Wang B, Xu K, Li Y, Chen SL. One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention. Chin Med J (Engl) 2018; 131:1412-1419. [PMID: 29893357 PMCID: PMC6006809 DOI: 10.4103/0366-6999.233948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. Methods From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year. Results Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ2 = 36.253, P < 0.001) and cardiac arrest (8.3% vs. 3.5%, χ2 = 5.529, P = 0.019). For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction (TIMI) flow grade<3 were significantly higher than those in the patients with a TIMI flow grade of 3 (STEMI group: 51.7% [15/29] vs. 4.1% [14/343], P < 0.001; NSTEMI group: 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEMI group were associated with higher risks of MACE (16.7% vs. 9.1%, P = 0.009) and cardiac death (5.4% vs. 1.3%, P = 0.011) compared with NSTEMI patients at 1 month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI (all P = 0.72) in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction (all P > 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients. Conclusions Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.
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Affiliation(s)
- Hai-Wei Liu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Quan-Min Jin
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Xiao-Zeng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Ying-Yan Ma
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Geng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Bin Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Yi Li
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing, Jiangsu 210006, China
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Treatment of coronary malperfusion in type A acute aortic dissection. Gen Thorac Cardiovasc Surg 2018; 66:621-625. [DOI: 10.1007/s11748-018-1014-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 11/27/2022]
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10
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Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion. J Thorac Cardiovasc Surg 2018; 156:483-489. [DOI: 10.1016/j.jtcvs.2018.02.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/03/2018] [Accepted: 02/02/2018] [Indexed: 11/19/2022]
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11
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Very low risk ST-segment elevation myocardial infarction? It exists and may be easily identified. Int J Cardiol 2016; 228:615-620. [PMID: 27880927 DOI: 10.1016/j.ijcard.2016.11.276] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early discharge protocols have been proposed for ST-segment elevation myocardial infarction (STEMI) low risk patients despite the existence of few but significant cardiovascular events during mid-term follow-up. We aimed to identify a subgroup of patients among those considered low-risk in which prognosis would be particularly good. METHODS We analyzed 30-day outcomes and long-term follow-up among 1.111 STEMI patients treated with reperfusion therapy. RESULTS Multivariate analysis identified seven variables as predictors of 30-day outcomes: Femoral approach; age>65; systolic dysfunction; postprocedural TIMI flow<3; elevated creatinine level>1.5mg/dL; stenosis of left-main coronary artery; and two or higher Killip class (FASTEST). A total of 228 patients (20.5%), defined as very low-risk (VLR), had none of these variables on admission. VLR group of patients compared to non-VLR patients had lower in-hospital (0% vs. 5.9%; p<0.001) and 30-day mortality (0% vs. 6.25%: p<0.001). They also presented fewer in-hospital complications (6.6% vs. 39.7%; p<0.001) and 30-day major adverse events (0.9% vs. 4.5%; p=0.01). Significant mortality differences during a mean follow-up of 23.8±19.4months were also observed (2.2% vs. 15.2%; p<0.001). The first VLR subject died 11months after hospital discharge. No cardiovascular deaths were identified in this subgroup of patients during follow-up. CONCLUSIONS About a fifth of STEMI patients have VLR and can be easily identified. They have an excellent prognosis suggesting that 24-48h in-hospital stay could be a feasible alternative in these patients.
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Marchese A, Paradies V, Basile M, Iorio E, Palmiotto A, Fiore F, Musumeci G, de Waha S, Thiele H, Wan S, Yaku H. How should I treat a massive left main coronary artery thrombosis in a 49-year-old woman in the context of cardiogenic shock? EUROINTERVENTION 2016; 11:e1687-90. [PMID: 27056129 DOI: 10.4244/eijv11i14a321] [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: 11/23/2022]
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