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Sakellariou XM, Katsouras CS, Papafaklis MI, Floros C, Michalis LK, Karmpaliotis D. Absolute zero-contrast percutaneous coronary interventions: An intravascular ultrasound-guided case series and literature review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:95-104. [PMID: 38135569 DOI: 10.1016/j.carrev.2023.12.008] [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: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Contrast media (CM)-associated adverse effects including mainly acute kidney injury and hypersensitivity reactions still remain a significant treatment burden to vulnerable patients requiring percutaneous coronary intervention (PCI). The complete omission of CM administration accompanied by intravascular ultrasound (IVUS) guidance may offer an appropriate revascularization treatment. METHODS We hereby present a case series of four patients with challenging coronary lesions and relative/absolute contraindications to CM use [(hypersensitivity reaction owning to CM, history of contrast-induced acute kidney injury, solitary kidney, or advanced chronic kidney disease (CKD)] who underwent absolute zero-contrast IVUS-guided PCI following a predetermined protocol. RESULTS The initial diagnostic angiography was reviewed for landmark identification, and multiple guidewires created a metallic road map providing additional landmarks and protected side branches. IVUS imaging was performed to determine lesion length, reference segments and landing zones, assess stent expansion/apposition and identify major complications. All procedures were successfully completed without any CM administration, renal function deterioration, pericardial effusion, or stent edge dissection. CONCLUSIONS We demonstrated the feasibility of absolute zero-contrast IVUS-guided PCI in patients with complex coronary lesions susceptible to CM-associated adverse effects. Since the safety of this strategy is well-documented in patients with CKD and challenging lesions morphology even in acute settings, evidence-based validation of this approach is capable of changing the otherwise conservative treatment of vulnerable patients where even minimum doses of CM may have detrimental effects. SUMMARY FOR THE ANNOTATED TABLE OF CONTENTS Patients with vulnerable renal function as well as former hypersensitivity reaction to contrast media encounter a significant treatment burden regarding coronary artery disease. Zero-contrast IVUS-guided strategy based on a predetermined protocol provides a feasible alternative approach in patients susceptible to contrast media-associated adverse effects even in the presence of complex coronary lesions.
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Affiliation(s)
| | - Christos S Katsouras
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | | | - Christos Floros
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
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Yuan Y, Qiu H, Hu X, Zhang J, Wu Y, Qiao S, Yang Y, Gao R. A risk score model of contrast-induced acute kidney injury in patients with emergency percutaneous coronary interventions. Front Cardiovasc Med 2022; 9:989243. [PMID: 36312242 PMCID: PMC9606750 DOI: 10.3389/fcvm.2022.989243] [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: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background The previously built score models of contrast-induced acute kidney injury (CI-AKI) were principally founded on selective percutaneous coronary intervention (PCI) cases. Our study was to form a risk score model of CI-AKI and make a temporal validation in a population who underwent emergency PCIs. Methods We included patients who underwent emergency PCIs from 2013 to 2018 and divided them into the derivation and validation cohorts. Logistic regression analysis was harnessed to create the risk model. In this research, we defined CI-AKI as an increase in serum creatinine (SCr) ≥0.5 mg/dL (44.2 μmol/L) above baseline within seven days following exposure to contrast medium. Results A total of 3564 patients who underwent emergency PCIs were enrolled and divided into the derivation (2376 cases) and validation cohorts (1188 cases), with CI-AKI incidence of 6.61 and 5.39%, respectively. By logistic analysis, the CI-AKI risk score model was constituted by 8 variables: female (1 point), history of transient ischemic attack (TIA)/stroke (1 point), left ventricular ejection fraction (LVEF) classification (1 point per class), big endothelin-1 (ET-1) classification (1 point per class), estimated glomerular filtration rate (eGFR) classification (1 point per class), intra-aortic balloon pump (IABP) application (1 point), left anterior descending (LAD) stented (1 point), and administration of diuretic (2 points). The patients could be further divided into three groups: low-risk, moderate-risk, and high-risk groups, in accordance with the risk scores of 3–6, 7–10, and ≥11 points, and to the CI-AKI rates of 1.4, 11.9, and 42.6%. The CI-AKI risk score model performed well in discrimination (C statistic = 0.787, 95% CI: 0.731–0.844) and calibration ability, and showed a superior clinical utility. Conclusion We developed a simple CI-AKI risk score model which performs well as a tool for CI-AKI prediction in patients who underwent emergency PCIs.
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Affiliation(s)
- Ying Yuan
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong Qiu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,*Correspondence: Hong Qiu
| | - Xiaoying Hu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuan Wu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Higuchi S, Kabeya Y, Nishina Y, Miura Y, Shibata S, Hata N, Suda T, Hirabuki K, Hasegawa H, Yoshino H, Matsuda T. Clinical impact of noncontrast percutaneous coronary intervention in patients with acute coronary syndrome. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:57-64. [PMID: 35466147 DOI: 10.2152/jmi.69.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE Contrast-induced acute kidney injury (CI-AKI) is one of the common serious complications of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This study aimed to assess the significance of noncontrast strategy in the setting of ACS. METHODS CI-AKI was defined as an increase in serum creatinine of ?0.5 mg/dL or ?1.25 times from the baseline. One-year worsening renal function (WRF) was defined as an increase of ?0.3mg/dL in serum creatinine from the baseline after PCI. RESULTS Of 250 ACS patients, 81 were treated with noncontrast PCI. The average doses of contrast medium in the noncontrast and conventional groups were 17 (9?22) ml and 150 (120?200) ml, respectively. CI-AKI was observed in 4 patients (5%) in the noncontrast group and 29 patients (17%) in the conventional group. Noncontrast PCI was associated with a lower incidence of CI-AKI (adjusted odds ratio, 0.26;95% confidence interval [CI], 0.08?0.82). The bootstrap method and inverse probability weighting led to similar results. CI-AKI was associated with a higher incidence of 1-year WRF (adjusted hazard ratio, 2.30;95% CI, 1.12?4.69), while noncontrast PCI was not. CONCLUSIONS Noncontrast PCI was associated with the lower incidence of CI-AKI in ACS patients. J. Med. Invest. 69 : 57-64, February, 2022.
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Affiliation(s)
- Satoshi Higuchi
- Department of Cardiology, Kyorin University Faculty of Medicine.,Department of Emergency and General Medicine, Kyorin University Faculty of Medicine
| | - Yusuke Kabeya
- Division of General Internal Medicine, Department of Internal Medicine, Tokai University.,Department of Home Care Medicine, Sowa Clinic
| | - Yoshio Nishina
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Yusuke Miura
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Shigeki Shibata
- Department of Emergency and General Medicine, Kyorin University Faculty of Medicine
| | - Noritaka Hata
- Department of Emergency and General Medicine, Kyorin University Faculty of Medicine
| | - Tomoya Suda
- Department of Emergency and General Medicine, Kyorin University Faculty of Medicine
| | - Kazukuni Hirabuki
- Department of Emergency and General Medicine, Kyorin University Faculty of Medicine
| | - Hiroshi Hasegawa
- Department of Emergency and General Medicine, Kyorin University Faculty of Medicine
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Takeaki Matsuda
- Department of Traumatology and Critical Care Medicine, Kyorin University Faculty of Medicine
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Shibata K, Wakabayashi K, Ishinaga T, Morimura M, Aizawa N, Suzuki T, Furuya T, Sato C, Nishikura T, Ikeda N, Kikuchi M, Tanno K, Shinke T, Izumizaki M. Feasibility, Safety, and Long-Term Outcomes of Zero-Contrast Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease. Circ J 2022; 86:787-796. [DOI: 10.1253/circj.cj-21-0905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keita Shibata
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Kohei Wakabayashi
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Tomoyuki Ishinaga
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Mitsuyuki Morimura
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Naoki Aizawa
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Toshiaki Suzuki
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Takahiro Furuya
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Chisato Sato
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Tenjin Nishikura
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Naoko Ikeda
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Miwa Kikuchi
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Kaoru Tanno
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital
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Asker-Hagelberg C, Boran T, Bouygues C, Eskola SM, Helmle L, Hernández C, Houýez F, Lee H, Lingri DD, Louette L, Meheus L, Penninckx W, Stepniewska B. Repurposing of Medicines in the EU: Launch of a Pilot Framework. Front Med (Lausanne) 2022; 8:817663. [PMID: 35083258 PMCID: PMC8784735 DOI: 10.3389/fmed.2021.817663] [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: 11/18/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
Repurposing of authorised medicines has been under discussion for a long time. Drug repurposing is the process of identifying a new use for an existing medicine in an indication outside the scope of the original approved indication. Indeed, the COVID-19 health crisis has brought the concept to the frontline by proving the usefulness of this practise in favour of patients for an early access to treatment. Under the umbrella of the Pharmaceutical Committee and as a result of the discussions at the European Commission Expert Group on Safe and Timely Access to Medicines for Patients (STAMP) a virtual Repurposing Observatory Group (RepOG) was set up in 2019 to define and test the practical aspects of a pilot project thought to provide support to “not-for-profit” stakeholders generating or gathering data for a new therapeutic use for an authorised medicine. The group's initial plan was impacted by the outbreak of the SARS-CoV-2 pandemic and the launch of the pilot needed to be postponed. This article describes the progress and the activities conducted by the group during this past and yet extraordinary 2020–2021 to keep the project alive and explores on the background of this topic together with the obvious opportunities this health crisis has brought up in terms of repurposing of medicines.
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Affiliation(s)
| | - Tomas Boran
- Director of the Marketing Authorisation Section, State Institute for Drug Control (SUKL), Prague, Czechia
| | - Christelle Bouygues
- Regulatory Affairs Office, Human Medicines Division, European Medicines Agency (EMA), Amsterdam, Netherlands
| | - Sini Marika Eskola
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Brussels, Belgium
| | - Laszlo Helmle
- European Commission Directorate-General Research and Innovation, Brussels, Belgium
| | - César Hernández
- Alternate Representative of Spain in EMA Management Board, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - François Houýez
- Treatment Information and Access, European Organisation for Rare Diseases (Eurordis), Paris, France
| | - Helen Lee
- European Commission Directorate-General for Health and Food Safety, Brussels, Belgium
| | - Dimitra D Lingri
- Association Internationale de la Mutualité Pharmaceutical Working Group, Brussels, Belgium
| | - Laurent Louette
- European Confederation of Pharmaceutical Entrepreneurs, Brussels, Belgium
| | - Lydie Meheus
- Anticancer Fund, Appointed Alternate of the Committee for Advanced Therapies of the European Medicines Agency (CAT/EMA) to Represent Patients, Strombeek-Bever, Belgium
| | - Wim Penninckx
- Federal Agency of Medicines and Health Products (FAMHP), Brussels, Belgium
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Li M, Li L, Qin Y, Luo E, Wang D, Qiao Y, Tang C, Yan G. Elevated TyG Index Predicts Incidence of Contrast-Induced Nephropathy: A Retrospective Cohort Study in NSTE-ACS Patients Implanted With DESs. Front Endocrinol (Lausanne) 2022; 13:817176. [PMID: 35273567 PMCID: PMC8901499 DOI: 10.3389/fendo.2022.817176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index is a reliable and specific biomarker for insulin resistance and is associated with renal dysfunction. The present study sought to explore the relationship between TyG index and the incidence of contrast-induced nephropathy (CIN) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients implanted with drug-eluting stents (DESs). METHODS A total of 1108 participants were recruited to the study and assigned to two groups based on occurrence of CIN. TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Baseline characteristics and incidence of CIN were compared between the two groups. Logistic regression analysis was performed to evaluate the relationship between TyG index and CIN. RESULTS The results showed that 167 participants (15.1%) developed CIN. Subjects in the CIN group had a significantly higher TyG index compared with subjects in the non-CIN group (8.9 ± 0.7 vs. 9.3 ± 0.7, P<0.001). TyG index was significantly correlated with increased risk of CIN after adjusting for confounding factors irrespective of diabetes mellitus status and exhibited a J-shaped non-linear association. Subgroup analysis showed a significant gender difference in the relationship between TyG index and CIN. Receiver operating characteristic (ROC) curve analysis indicated that the risk assessment performance of TyG index was superior compared with other single metabolic indexes. Addition of TyG index to the baseline model increased the area under the curve from 0.713 (0.672-0.754) to 0.742 (0.702-0.782) and caused a reclassification improvement of 0.120 (0.092-0.149). CONCLUSION The findings from the present study show that a high TyG index is significantly and independently associated with incidence of CIN in NSTE-ACS patients firstly implanted with DESs. Routine preoperative assessment of TyG index can alleviate CIN and TyG index provides a potential target for intervention in prevention of CIN.
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Affiliation(s)
- Mingkang Li
- School of Medicine, Southeast University, Nanjing, China
| | - Linqing Li
- School of Medicine, Southeast University, Nanjing, China
| | - Yuhan Qin
- School of Medicine, Southeast University, Nanjing, China
| | - Erfei Luo
- School of Medicine, Southeast University, Nanjing, China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yong Qiao
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- *Correspondence: Chengchun Tang, ; Gaoliang Yan,
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- *Correspondence: Chengchun Tang, ; Gaoliang Yan,
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Wasilewski M, Roy S, Patel NG, Jovin IS. Angiotensin-Converting Enzyme Inhibitors and Contrast-Associated Acute Kidney Injury After Coronary Angiography and Intervention. Am J Cardiovasc Drugs 2021; 21:487-497. [PMID: 33369717 DOI: 10.1007/s40256-020-00455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
Contrast-associated acute kidney injury has multiple definitions, but is generally described as worsening renal function after administration of iodinated contrast media. It is associated with high in-hospital mortality and poor long-term survival. Furthermore, patients undergoing coronary angiography commonly have comorbidities such as hypertension or congestive heart failure, which are often treated with renin-angiotensin-aldosterone system-blocking agents such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Trials assessing the effects of these renin-angiotensin-aldosterone system-blocking agents on the subsequent development of contrast-associated acute kidney injury have shown conflicting data, suggesting both beneficial and harmful effects. Therefore, there are no clear guidelines on whether clinicians should discontinue renin-angiotensin-aldosterone system-blocking agents peri-procedurally. In this article, we review the data from trials assessing the effects of peri-procedural renin-angiotensin system-blocking agent use in patients undergoing coronary and peripheral angiography and intervention. Future studies will likely focus on the extent of damage or potential benefit of these agents on renal function, cardiac function, as well as morbidity and mortality. Currently, there is insufficient evidence to recommend discontinuation of angiotensin-converting enzyme inhibitors prior to coronary angiography.
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Affiliation(s)
- Melissa Wasilewski
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, 1201 Broad Rock Boulevard 111J, Richmond, VA, 23249, USA
| | - Sumon Roy
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, 1201 Broad Rock Boulevard 111J, Richmond, VA, 23249, USA
| | - Nilang G Patel
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, 1201 Broad Rock Boulevard 111J, Richmond, VA, 23249, USA
- McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | - Ion S Jovin
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, 1201 Broad Rock Boulevard 111J, Richmond, VA, 23249, USA.
- McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
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