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De Filippo O, Di Franco A, Improta R, Di Pietro G, Leone A, Pecoraro M, Meynet P, Carbone ML, Di Lorenzo E, Bruno F, Demetres M, Carmeci A, Conrotto F, Mancone M, De Ferrari GM, Gaudino M, D'Ascenzo F. Percutaneous coronary intervention versus coronary artery bypass grafting for left main disease according to age: A meta-analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00654-8. [PMID: 39067814 DOI: 10.1016/j.jtcvs.2024.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/15/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La Sapienza University of Rome, Rome, Italy.
| | - Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La Sapienza University of Rome, Rome, Italy
| | - Attilio Leone
- Division of Cardiology, SG Moscati Hospital, Avellino, Italy; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Martina Pecoraro
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pierre Meynet
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Luisa Carbone
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Antonino Carmeci
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La Sapienza University of Rome, Rome, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Turin, Turin, Italy
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Moras E, Zaid S, Gandhi K, Barman N, Birnbaum Y, Virani SS, Tamis-Holland J, Jneid H, Krittanawong C. Pharmacotherapy for Coronary Artery Disease and Acute Coronary Syndrome in the Aging Population. Curr Atheroscler Rep 2024; 26:231-248. [PMID: 38722473 DOI: 10.1007/s11883-024-01203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW To provide a comprehensive summary of relevant studies and evidence concerning the utilization of different pharmacotherapeutic and revascularization strategies in managing coronary artery disease and acute coronary syndrome specifically in the older adult population. RECENT FINDINGS Approximately 30% to 40% of hospitalized patients with acute coronary syndrome are older adults, among whom the majority of cardiovascular-related deaths occur. When compared to younger patients, these individuals generally experience inferior clinical outcomes. Most clinical trials assessing the efficacy and safety of various therapeutics have primarily enrolled patients under the age of 75, in addition to excluding those with geriatric complexities. In this review, we emphasize the need for a personalized and comprehensive approach to pharmacotherapy for coronary heart disease and acute coronary syndrome in older adults, considering concomitant geriatric syndromes and age-related factors to optimize treatment outcomes while minimizing potential risks and complications. In the realm of clinical practice, cardiovascular and geriatric risks are closely intertwined, with both being significant factors in determining treatments aimed at reducing negative outcomes and attaining health conditions most valued by older adults.
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Affiliation(s)
- Errol Moras
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syed Zaid
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Kruti Gandhi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nitin Barman
- Cardiac Catheterization Laboratory, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Yochai Birnbaum
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Houston, TX, USA
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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4
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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5
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Damluji AA, Forman DE, Wang TY, Chikwe J, Kunadian V, Rich MW, Young BA, Page RL, DeVon HA, Alexander KP. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e32-e62. [PMID: 36503287 DOI: 10.1161/cir.0000000000001112] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.
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Seco M, Paterson HS, Gaudino M, Vallely MP. Selecting the optimal treatment for left main coronary disease: The importance of identifying subgroups of patients. J Card Surg 2022; 37:4190-4195. [PMID: 36168863 DOI: 10.1111/jocs.16565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 01/06/2023]
Abstract
Randomized trials of stenting versus surgery for patients with unprotected left main (LM) coronary stenosis have largely shown similar survival between the two interventions. However, patients with LM stenosis represent a heterogeneous group in which subgroups likely to benefit from one therapy more than another are difficult to identify. Increasing coronary disease burden is the most accepted subgrouping for identifying optimal therapy but this can be defined in more detail allowing greater discrimination. Competitive flow reduces bypass graft patency in patients with isolated LM stenosis and complex bifurcation stenoses reduce the effectiveness of coronary stenting. The evidence for LM stenosis subgroupings is presented.
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Affiliation(s)
- Michael Seco
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Hugh S Paterson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Michael P Vallely
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Li P, Zhang H, Luo C, Ji Z, Zheng Z, Li Z, Wu F, Li J, Hong L. Occurrence and Risk Factors of Adverse Drug Reactions in Patients Receiving Bivalirudin as Anticoagulant During Percutaneous Coronary Intervention: A Prospective, Multi-Center, Intensive Monitoring Study. Front Cardiovasc Med 2022; 8:781632. [PMID: 35573935 PMCID: PMC9099409 DOI: 10.3389/fcvm.2021.781632] [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: 09/23/2021] [Accepted: 12/27/2021] [Indexed: 01/04/2023] Open
Abstract
BackgroundBivalirudin is a common anticoagulant during percutaneous coronary intervention (PCI); however, since its application in China, it still lacks comprehensive evaluation of adverse events (AEs) or adverse drug reactions (ADRs) under the real-clinical setting conditions with a large-sample-size population. Therefore, this prospective, multi-center, intensive monitoring study aimed to comprehensively investigate the occurrence and risk factors of AEs and ADRs during PCI with bivalirudin as an anticoagulant.MethodsA total of 3,049 patients who underwent PCI with bivalirudin as anticoagulant from 27 Chinese medical centers were enrolled. Safety data (AEs/ADRs) were collected from hospital admission to 72 h after bivalirudin administration; then, patients were followed up at the 30th day with the safety data collected as well.ResultsA total of 414 (13.58%) patients occurred AEs, among which 31 (1.02%) cases suffered from severe AEs and 8 (0.26%) cases died due to AEs. Importantly, 118 (3.87%) patients occurred bivalirudin related ADRs, among which 7 (0.23%) cases suffered from severe ADRs while no case (0%) died due to ADRs. Of note, 7 (0.23%) patients showed new ADRs, 34 (1.12%) patients experienced bleeding, and 79 (2.59%) patients had thrombocytopenia. Furthermore, age, renal function impairment, CRUSADE high risk stratification independently correlated with total ADRs risk; CRUSADE high risk stratification, emergency operation, full dose bivalirudin independently associated with bleeding risk; age, renal function impairment independently related to thrombocytopenia risk.ConclusionBivalirudin is well-tolerated as an anticoagulant for PCI procedure; meanwhile, older age, renal function impairment, and CRUSADE high risk stratification serve as independent risk factors of bivalirudin related ADRs.
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Affiliation(s)
- Ping Li
- Department of Cardiology, The First People's Hospital of Yulin, Yulin, China
| | - Hongyan Zhang
- Department of Cardiology, Affiliated Hospital of Qilu Medical University (The People's Hospital of Xin Tai City), Xintai, China
| | - Caidong Luo
- Department of Cardiology, Mianyang Central Hospital, Mianyang, China
| | - Zheng Ji
- First Department of Cardiology, Tangshan Workers' Hospital, Tangshan, China
| | - Zeqi Zheng
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhenyong Li
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Fan Wu
- Second Department of Cardiology, Xuchang Central Hospital, Xuchang, China
| | - Jinlong Li
- Department of Cardiology, The Affiliated Taian City Central Hospital of Qingdao University, Tai'an, China
- Jinlong Li
| | - Lang Hong
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- *Correspondence: Lang Hong
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Chen B, Yu F, Chen W, Wang Y, Hao F. Acute Urticaria in Inpatients Undergoing Non-emergent Coronary Angiography With Corticosteroid Prophylaxis: A Retrospective Study. Front Med (Lausanne) 2021; 8:616015. [PMID: 34179031 PMCID: PMC8222595 DOI: 10.3389/fmed.2021.616015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Acute urticaria (AU) is the most frequently reported immediate hypersensitivity reaction in skin by administration of iodinated contrast media (ICM). We aimed to establish the pattern and identify the risk factors of AU among inpatients undergoing non-emergent coronary angiography (CAG) with prophylactic corticosteroids in China. Methods: Medical records of 19,326 adult inpatients undergoing non-emergent CAG with prophylactic methylprednisolone in 2013–2019 were retrospectively investigated. AU was identified within 1 h post-ICM administration, and diffuse involvement was defined when wheals occur in two or more body parts, including the back, abdomen, chest, and extremities. Age- and sex-matched inpatients (1:4) without AU were randomly selected for assessment of risk factors. Results: Approximately 0.8% of CAG inpatients had AU, including 101 diffuse and 64 limited form. The diffuse AU was more common in settings of non-diagnostic CAG, iohexol used, average ICM injection≥3 ml/min, recurrent CAG, and past history of immediate hypersensitivity to ICM. Inpatients with preexisting allergies, decreased evaluated glomerular filtration rate, and increased high sensitivity C reactive protein or neutrophil-to-lymphocyte ratio prior to CAG had a higher probability of AU (odds ratio >1, P < 0.05 for all variables). All AU inpatients complained of pruritus, and mild itching predominated. AU dissipated in several days under treatment of ebastine or levocetirizine 10 mg/daily, but ebastine showed superiority. Conclusions: ICM-induced AU is not uncommon in non-emergent CAG inpatients with prophylactic methylprednisolone. Preexisting allergies, renal dysfunction, and mild inflammation are high-risk factors, and antihistamine monotherapy is a favorable candidate for ICM-related AU.
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Affiliation(s)
- Bangtao Chen
- Department of Dermatology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fubing Yu
- Department of Dermatology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Yong Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, China
| | - Fei Hao
- Department of Dermatology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Liu H, Yan X, Yu J. Long noncoding RNA NEAT1/microRNA-125a axis predicts increased major adverse cardiac and cerebrovascular event risk independently in patients with unprotected left main coronary artery disease underwent coronary artery bypass grafting. J Clin Lab Anal 2020; 34:e23299. [PMID: 32185824 PMCID: PMC7370784 DOI: 10.1002/jcla.23299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 01/24/2023] Open
Abstract
Background The study aimed to investigate the long noncoding RNA nuclear‐enriched abundant transcript 1 (lnc‐NEAT1) and microRNA‐125a (miR‐125a) expressions, and further explore the role of lnc‐NEAT1/miR‐125a axis in predicting major adverse cardiac and cerebrovascular event (MACCE) risk in patients with unprotected left main coronary artery disease (ULMCAD) underwent coronary artery bypass grafting (CABG). Methods A total of 280 patients with ULMCAD underwent CABG were consecutively enrolled in our prospective study, and their plasma samples were collected before CABG for the detection of lnc‐NEAT1 and miR‐125a expressions by reverse transcription quantitative polymerase chain reaction. Lnc‐NEAT1/miR‐125a axis was calculated via dividing lnc‐NEAT1 by miR‐125a. After CABG, regular follow‐up was continued until MACCE occurrence or 36 months. Results Lnc‐NEAT1 expression, miR‐125a expression, and lnc‐NEAT1/miR‐125a axis were 0.998 (IQR: 0.440‐1.720, range: 0.116‐5.771), 0.997 (IQR: 0.461‐1.650, range: 0.055‐3.621), and 1.018 (IQR: 0.384‐2.782, range: 0.041‐52.832), respectively. And lnc‐NEAT1 was negatively associated with miR‐125a. The 1‐, 2‐, and 3‐year MACCE occurrence was 19 (6.8%), 29 (10.4%), and 38 (13.6%), respectively. Lnc‐NEAT1/miR‐125a axis (χ2 = 11.207, P = .001) and lnc‐NEAT1 expression (χ2 = 5.345, P = .021) positively associated with accumulating MACCE occurrence, while miR‐125a expression (χ2 = 5.869, P = .015) negatively correlated with accumulating MACCE occurrence. Notably, lnc‐NEAT1/miR‐125a axis presented numerically better predictive value compared with lnc‐NEAT1 or miR‐125a alone for MACCE risk. Furthermore, lnc‐NEAT1/miR‐125a axis high, elderly age, increased BMI, diabetes, previous stroke, LVEF, and higher disease extent (all P < .05) were independent predictive factors for increased accumulating MACCE occurrence. Conclusion Lnc‐NEAT1/miR‐125a axis, as a combined index, presents potential value to be a prognostic biomarker for MACCE risk in ULMCAD management.
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Affiliation(s)
- Haining Liu
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Xiulian Yan
- Department of Cardiology, People's Hospital of Gaoqing, Zibo, China
| | - Jingbin Yu
- Department of Cardiology, Zibo Central Hospital, Zibo, China
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Khan MR, Kayani WT, Ahmad W, Manan M, Hira RS, Hamzeh I, Jneid H, Virani SS, Kleiman N, Lakkis N, Alam M. Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta-analysis and meta-regression. Clin Cardiol 2019; 42:1071-1078. [PMID: 31486094 PMCID: PMC6837018 DOI: 10.1002/clc.23253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022] Open
Abstract
Background Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD. Methods We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta‐analyses (4880 patients) of clinical outcomes [all‐cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12‐24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta‐regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects model. Results All‐cause mortality between PCI and CABG was comparable at 30‐days (OR0.77, 95% CI 0.42‐ 1.41) and 12‐24‐months (OR 1.22, 95% CI 0.78‐1.93). PCI was associated with a markedly lower rate of stroke at 30‐day follow‐up in octogenarians (OR 0.14, 95% CI 0.02‐0.76) but an overall higher rate of repeat revascularization. At ≥36‐months, MACCE (OR 1.26,95% CI 0.99‐1.60) and all‐cause mortality (OR 1.39, 95% CI 1.00‐1.93) showed a trend favoring CABG but did not reach statistical significance. On meta‐regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042). Conclusions PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All‐cause mortality was comparable between the two arms with a trend favoring CABG at ≥36‐months.PCI was however associated with increasing mortality with advancing age as compared to CABG.
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Affiliation(s)
- Mahin R Khan
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, Michigan
| | - Waleed T Kayani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Waqas Ahmad
- Department of Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Malalai Manan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Ihab Hamzeh
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Neal Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Nasser Lakkis
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Mahboob Alam
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
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