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Hwang JJ, Wang YC. Responses to comments on "Impact of post-implantation time on bioresorbable vascular scaffold outcomes for type C versus non-type C coronary lesions: A longer-term study". J Formos Med Assoc 2024:S0929-6646(24)00304-8. [PMID: 38969581 DOI: 10.1016/j.jfma.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Affiliation(s)
- Juey-Jen Hwang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Yi-Chih Wang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Kutkut I, Jovin TG, Jovin IS. Chronic kidney disease as a risk factor for poor outcomes after endovascular stroke intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:126-127. [PMID: 34764030 DOI: 10.1016/j.carrev.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Issa Kutkut
- VCU Pauley Heart Center, Richmond, VA, United States of America
| | - Tudor G Jovin
- Department of Neurology, Cooper University Hospital, Camden, NJ, United States of America
| | - Ion S Jovin
- VCU Pauley Heart Center, Richmond, VA, United States of America; McGuire VAMC, Richmond, VA, United States of America.
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Steiner J, Kerschl M, Erbay A, Abdelwahed YS, Jakob P, Landmesser U, Leistner DM, Stähli BE. Impact of renal function on outcomes of patients with cardiac troponin elevation and non-obstructive coronary arteries. Int J Cardiol 2021; 333:29-34. [PMID: 33621626 DOI: 10.1016/j.ijcard.2021.02.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with signs and symptoms suggestive of myocardial infarction and non-obstructive coronary arteries are at increased risk of adverse events. The aim of this study was to investigate the predictive role of renal function in troponin-positive patients with non-obstructive coronary arteries. METHODS A total of 564 troponin-positive patients with non-obstructive coronary arteries at coronary angiography and available baseline creatinine levels were stratified according to baseline renal function (normal/stage 1: estimated glomerular filtration rate [eGFR] >90 ml/min/1.73m2, stage 2: 60 to 89 ml/min/1.73m2, stage 3: 30 to 59 ml/min/1.73m2, and stage 4: <30 ml/min/1.73m2). The primary outcome measure was mortality at a median follow-up of 100 [12-380] days. RESULTS A total of 73 (12.9%), 195 (34.6%), 231 (41.0%), and 65 (11.5%) patients were in the normal/stage 1, stage 2, stage 3, and stage 4 renal dysfunction groups. With progressive renal impairment, patients were older, more frequently presented with established coronary or peripheral artery disease, and had an increased prevalence of cardiovascular risk factors. Cumulative mortality increased with progressive renal dysfunction (normal/stage 1: 0.0%, stage 2: 3.6%, stage 3: 12.1%, and stage 4: 32.3%, log rank p < 0.001). A 10 ml/min/1.73m2 incremental decrease in eGFR was associated with an adjusted HR for mortality of 1.43 (95% CI 1.20-1.72, p < 0.001). CONCLUSIONS Renal impairment was associated with mortality in patients presenting with elevated cardiac troponin and non-obstructive coronary arteries. Hence, renal function should be incorporated into the risk stratification of these patients.
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Affiliation(s)
- Julia Steiner
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Marei Kerschl
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Aslihan Erbay
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Philipp Jakob
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Barbara E Stähli
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Prasitlumkum N, Cheungpasitporn W, Sato R, Thangjui S, Thongprayoon C, Kewcharoen J, Bathini T, Vallabhajosyula S, Ratanapo S, Chokesuwattanaskul R. Comparison of coronary artery bypass graft versus drug-eluting stents in dialysis patients: an updated systemic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2021; 22:285-296. [PMID: 33633044 DOI: 10.2459/jcm.0000000000001167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION As percutaneous coronary intervention (PCI) technologies have been far improved, we hence conducted an updated systemic review and meta-analysis to determine the comparability between coronary artery bypass graft (CABG) and PCI with drug-eluting stent (DES) in ESRD patients. METHODS We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED and the Cochrane from inception to January 2020. Included studies were published observational studies that compared the risk of cardiovascular outcomes among dialysis patients with CABG and DES. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Subgroup analyses and meta-regression were performed to explore heterogeneity. RESULTS Thirteen studies were included in this analysis, involving total 56 422 (CABG 21 740 and PCI 34 682). Compared with DES, our study demonstrated CABG had higher 30-day mortality [odds ratio (OR) 3.85, P = 0.009] but lower cardiac mortality (OR 0.78, P < 0.001), myocardial infarction (OR 0.5, P < 0.001) and repeat revascularization (OR 0.35, P < 0.001). No statistical differences were found between CABG and DES for long-term mortality (OR 0.92, P = 0.055), composite outcomes (OR 0.88, P = 0.112) and stroke (OR 1.49, P = 0.457). Meta-regression suggested diabetes and the presence of left main coronary artery disease as an effect modifier of long-term mortality. CONCLUSION PCI with DES shared similar long-term mortality, composite outcomes and stroke outcomes to CABG among dialysis patients but still was associated with an improved 30-day survival. However, CABG had better rates of myocardial infarction, repeat revascularization and cardiac mortality.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ryota Sato
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Ohio, USA
| | - Sittinun Thangjui
- Department of Internal Medicine, Basset Healthcare Network, Cooperstown, New York
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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The birth, decline, and contemporary re-emergence of endovascular brachytherapy for prevention of in-stent restenosis. Brachytherapy 2020; 20:485-493. [PMID: 33132069 DOI: 10.1016/j.brachy.2020.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/13/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023]
Abstract
Despite the advent of drug-eluting stents and dual antiplatelet therapy in the interventional management of cardiovascular disease, restenosis rates remain high with significant sequelae. Endovascular brachytherapy-popular in the 1990s and early 2000s-has recently resurfaced as a cost-effective treatment option. In this work, we outline the history of endovascular brachytherapy starting with its earliest promise in the 1990s. We discuss the development of drug-eluting stents and dual antiplatelet strategies and their impact on the perceived benefit of endovascular brachytherapy. For the contemporary era, we propose novel roles for endovascular brachytherapy in complex coronary artery disease and in high-risk patients managed with drug-eluting stents. We discuss the impetus for reducing the requirement and duration of dual antiplatelet therapy using endovascular brachytherapy. We also review innovative opportunities for endovascular brachytherapy after bare-metal stent placement in both coronary and noncoronary territories and offer economic arguments in favor of endovascular brachytherapy. Trials of endovascular brachytherapy in these regimes are merited.
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Moroni F, Spangaro A, Carlino M, Baber U, Brilakis ES, Azzalini L. Impact of renal function on the immediate and long-term outcomes of percutaneous recanalization of coronary chronic total occlusions: A systematic review and meta-analysis. Int J Cardiol 2020; 317:200-206. [DOI: 10.1016/j.ijcard.2020.05.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022]
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One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry. Clin Res Cardiol 2019; 109:845-856. [PMID: 31792571 PMCID: PMC7308257 DOI: 10.1007/s00392-019-01575-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Background Chronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD). Objective The outcome following revascularization using contemporary technologies (new-generation abluminal sirolimus-eluting stents with thin struts) in patients with CKD (i.e., glomerular filtration rate of < 60 mL/min/1.73m2) and in patients with hemodialysis (HD) is unknown. Methods e-Ultimaster is a prospective, single-arm, multi-center registry with clinical follow-up at 3 months and 1 year. Results A total of 19,475 patients were enrolled, including 1466 patients with CKD, with 167 undergoing HD. Patients with CKD had a higher prevalence of overall comorbidities, multiple/small vessel disease (≤ 2.75 mm), bifurcation lesions, and more often left main artery treatments (all p < 0.0001) when compared with patients with normal renal function (reference). CKD patients had a higher risk of target lesion failure (unadjusted OR, 2.51 [95% CI 2.04–3.08]), target vessel failure (OR, 2.44 [95% CI 2.01–2.96]), patient-oriented composite end point (OR, 2.19 [95% CI 1.87–2.56]), and major adverse cardiovascular events (OR, 2.34 [95% CI 1.93–2.83, p for all < 0.0001]) as reference. The rates of target lesion revascularization (OR, 1.17 [95% CI 0.79–1.73], p = 0.44) were not different. Bleeding complications were more frequently observed in CKD than in the reference (all p < 0.0001). Conclusion In this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population. They experienced higher rate of adverse events at 1-year follow-up. Graphic abstract One-year summary outcomes of contemporary PCI in renal insufficiency. CKD chronic kidney disease, POCE patient oriented composite endpoint, MACE major adverse cardiovascular events, TLF target lesion failure, TLR target lesion revascularization, ST stent thrombosis ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-019-01575-y) contains supplementary material, which is available to authorized users.
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Shimizu A, Sonoda S, Muraoka Y, Setoyama K, Inoue K, Miura T, Anai R, Sanuki Y, Miyamoto T, Oginosawa Y, Tsuda Y, Araki M, Otsuji Y. Bleeding and ischemic events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients. J Cardiol 2019; 73:470-478. [DOI: 10.1016/j.jjcc.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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Wu P, Luo F, Fang Z. Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis. Cardiorenal Med 2019; 9:145-159. [PMID: 30844786 DOI: 10.1159/000494116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Early revascularization can lead to better prognosis in multivessel coronary artery disease (CAD) patients with chronic kidney disease (CKD). However, whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is better remains unknown. Methods: We searched PubMed and the Cochrane Library database from inception until December 9, 2017, for articles that compare outcomes of CABG and PCI in multivessel CAD patients with CKD. We pooled the odds ratios with a fixed-effects model when I2 < 50% or a random-effects model when I2 > 75% and conducted heterogeneity and quality assessments as well as publication bias analyses. Results: A total of 17 studies with 62,343 patients were included. Compared with CABG, the pooled analysis showed that PCI had a lower risk of short-term all-cause death (OR, 0.56; 95% CI, 0.37–0.84) and cerebrovascular accidents (OR, 0.65; 95% CI, 0.53–0.79) but a higher risk of cardiac death (OR, 1.29; 95% CI, 1.21–1.37), myocardial infarction (MI) (OR, 1.73; 95% CI, 1.35–2.21), and repeat revascularization (RR) (OR, 3.9; 95% CI, 2.99–5.09). There was no significant difference in the risk of long-term all-cause death (OR, 1.08; 95% CI, 0.95–1.23) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 1.58; 95% CI, 0.99–2.52) between the PCI and CABG groups. A subgroup analysis restricted to patients treated with dialysis or with PCI-drug-eluting stent yielded similar results. Conclusions: PCI for patients with CKD and multivessel disease (multivessel CAD) had advantages over CABG with regard to short-term all-cause death and cerebrovascular accidents, but disadvantages regarding the risk of myocardial death, MI, and RR; there was no significant difference in the risk of long-term all-cause death and MACCE. Large randomized controlled trials are needed to confirm our findings.
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Affiliation(s)
- Panyun Wu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fei Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,
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Hypertension and chronic kidney disease affect long-term outcomes in patients with stable coronary artery disease receiving percutaneous coronary intervention. Sci Rep 2018; 8:17673. [PMID: 30518771 PMCID: PMC6281739 DOI: 10.1038/s41598-018-35982-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is commonly used for patients with coronary artery disease (CAD). However, the effects of chronic kidney disease (CKD) and hypertension (HT) on long-term outcomes in patients with stable CAD receiving PCI are still unclear. A total of 1,676 patients treated with PCI were prospectively enrolled and divided into 4 groups according to the presence or absence of HT or CKD. General characteristics, clinical medications, risk factors, angiographic findings, and long-term outcomes were analyzed. Patients with CKD had the highest rate of all-cause and cardiovascular (CV) mortality (both P < 0.01). Patients with CKD alone had the lowest event-free rate of all-cause and CV deaths (both P < 0.001). Based on Cox proportional hazard model, patients with CKD alone had the highest risk of all-cause death (HR:2.86, 95% CI:1.73–4.75) and CV death (HR: 3.57,95% CI:2.01–6.33); while patients with both CKD and HT had the highest risk of repeat PCI (HR: 1.42, 95% CI:1.09–1.85).We found that in stable CAD patients after undergoing PCI, those with CKD alone had the highest long-term mortality. Comorbid CKD appears to increase risk in patient with HT, whereas comorbid HT doesn’t seem to increase risk in patients with CKD.
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Foroughinia F, Movahed Nouri B, Kojuri J, Ostovan MA. Impact of Omega-3 Supplementation on High Sensitive C-Reactive Protein Level and 30-Day Major Adverse Cardiac Events After the Implementation of Coronary Stent in Patients with Chronic Kidney Disease: A Randomized Clinical Study. Adv Pharm Bull 2018; 8:471-478. [PMID: 30276144 PMCID: PMC6156476 DOI: 10.15171/apb.2018.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose: Studies have revealed that patients with chronic kidney disease (CKD) are more susceptible to adverse effects of percutaneous coronary intervention (PCI). In addition, the role of elevated high sensitive C-reactive protein (hs-CRP) in the prediction of adverse cardiac outcomes after coronary stent implantation has already been shown. Therefore, in this study, we aimed to evaluate the effect of omega-3 supplementation on hs-CRP and 30-day major adverse cardiac events (MACE) in patients with CKD undergoing elective PCI. Methods: In this randomized trial, 80 CKD patients who were candidates for elective PCI, were randomly assigned to two groups; the first group received a single dose of omega-3 (2500 mg, 12 h before PCI) as well as the standard drug regimen of PCI and the second group received placebo plus the standard therapy (325 mg loading dose of aspirin, 600 mg loading dose of clopidogrel, and weight-adjusted intravenous heparin). Hs-CRP levels were measured at baseline and 24 h after the intervention as a primary endpoint. The secondary endpoint was the incidence of MACE over a 30-day period after PCI. Results: Omega-3 did not significantly decrease post-PCI serum level of hs-CRP; however, the overall 30-day MACE was significantly lower in the omega-3 group compared to the control group (p=0.05). Conclusion: Our results revealed the positive effect of the omega-3 supplement on decreasing 30-day MACE; hence, omega-3 may be considered as an effective adjunctive therapy to the standard drug regimen used before PCI. The evaluation of the effect of omega-3 on long-term MACE is recommended for future studies.
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Affiliation(s)
- Farzaneh Foroughinia
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Clinical Pharmacy Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Javad Kojuri
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Stähli BE, Gebhard C, Gick M, Ferenc M, Mashayekhi K, Buettner HJ, Neumann FJ, Toma A. Outcomes after percutaneous coronary intervention for chronic total occlusion according to baseline renal function. Clin Res Cardiol 2017; 107:259-267. [PMID: 29134346 DOI: 10.1007/s00392-017-1179-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/06/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) adversely affects outcomes in patients with coronary artery disease. Data on the impact of renal impairment on prognosis of patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are scarce. METHODS A total of 2002 patients undergoing CTO PCI were stratified according to baseline renal function (group 1: estimated glomerular filtration rate [eGFR] ≥ 90 ml/min/1.73 m2, group 2: 60 to 89 ml/min/1.73 m2, group 3: 30 to 59 ml/min/1.73 m2, and group 4: <30 ml/min/1.73 m2). The primary outcome measure was all-cause mortality at a median follow-up of 2.6 (interquartile range 1.1-3.1) years. RESULTS All-cause mortality increased with decreasing renal function (group 1: 5.0%, group 2: 9.5%, group 3: 26.4%, and group 4: 38.7%, log rank p < 0.001). Continuous eGFR values were significantly related with all-cause mortality (adjusted HR 0.98, 95% CI 0.98-0.99, p < 0.001). Procedural failure was associated with all-cause mortality both in patients with an eGFR < 60 ml/min/1.73 m2 (42.6 vs. 23.7%, adjusted HR 1.59, 95% CI 1.08-2.32, p = 0.02) and in those with an eGFR ≥ 60 ml/min/1.73 m2 (14.6 vs. 6.5%, adjusted HR 1.73, 95% CI 1.15-2.60, p = 0.009, interaction p = 0.47). CONCLUSIONS Although renal impairment is associated with all-cause mortality in patients undergoing CTO PCI, successful CTO recanalization is related to improved survival irrespective of renal function.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, Charité Berlin, University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Cathérine Gebhard
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany
| | - Michael Gick
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany
| | - Heinz Joachim Buettner
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany
| | - Aurel Toma
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
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Lin MJ, Lee J, Chen CY, Huang CC, Wu HP. Chronic kidney disease and diabetes associated with long-term outcomes in patients receiving percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:242. [PMID: 28893175 PMCID: PMC5594538 DOI: 10.1186/s12872-017-0673-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background The effect of diabetes mellitus (DM) and chronic kidney disease (CKD) on long-term outcomes in patients receiving percutaneous coronary intervention (PCI) is unclear. Methods A total of 1394 patients who underwent PCI were prospectively enrolled and divided into 4 groups according to the presence or absence of DM or CKD. Baseline characteristics, risk factors, medications, and angiographic findings were compared. Determinants of long-term outcomes in patients undergoing PCI were analyzed. Results Patients with DM and CKD had the highest all-cause mortality and cardiovascular mortality (both P < 0.01) but there were no differences existed in myocardial infarction (MI) or repeated PCI among the 4 groups (P = 0.19, P = 0.87, respectively). Patients with DM and CKD had the lowest even-free rate of all-cause mortality, cardiovascular mortality, MI, and repeated PCI (P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively). In the Cox proportional hazard model, patients with both DM and CKD had the highest risk of all-cause mortality (HR: 3.25, 95% CI: 1.85–5.59), cardiovascular mortality (HR: 3.58, 95% CI: 1.97–6.49), MI (HR: 2.43, 95% CI: 1.23–4.08), and repeated PCI (HR: 1.79, 95% CI: 1.33–2.41). Patients with CKD alone had the second highest risk of all-cause mortality (HR: 2.04, 95% CI: 1.15–3.63), cardiovascular mortality (HR: 2.13, 95% CI: 1.13–4.01), and repeated PCI (HR: 1.47, 95% CI: 1.09–1.97). Conclusions DM and CKD had additive effect on adverse long-term outcomes in patients receiving PCI; CKD was a more significant adverse predictor than DM.
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Affiliation(s)
- Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical foundation, Taichung, Taiwan.,Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Chen
- Department of Pediatric Emergency Medicine, Changhua Christian Children's Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chen Huang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Han-Ping Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Asami M, Aoki J, Sato T, Tanimoto S, Watanabe M, Horiuchi Y, Furui K, Yasuhara K, Sato Y, Hashimoto T, Yachi S, Hara K, Tanabe K. Impact of stent type and prolonged dual antiplatelet therapy on long-term clinical outcomes in hemodialysis patients with coronary artery disease. Cardiovasc Interv Ther 2016; 33:84-94. [DOI: 10.1007/s12928-016-0447-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/24/2016] [Indexed: 11/28/2022]
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Patel AD, Ibrahim M, Swaminathan RV, Minhas IU, Kim LK, Venkatesh P, Feldman DN, Minutello RM, Bergman GW, Wong SC, Singh HS. Five-year mortality outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2016; 89:E124-E132. [PMID: 27519355 DOI: 10.1002/ccd.26664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine peri-procedural and long-term outcomes in patients with chronic kidney disease (CKD) undergoing percutaneous coronary interventions (PCI). BACKGROUND Patients with advanced CKD are considered high risk when undergoing PCI. Limited published data exist on quantifying risk and assessment of long-term outcomes after PCI in this group. METHODS Examining the Cornell Coronary Registry, we prospectively collected data of 6,478 consecutive patients who underwent elective or urgent PCI between 2009 and 2013. Patients were grouped into CKD stages by estimated glomerular filtration rate (eGFR) according to KDOQI guidelines. Procedural and 30-day outcomes are reported with assessment of long-term differences in 5-year all-cause mortality. RESULTS Patients were grouped by CKD stages: 1,351 patients with eGFR ≥90 mL/min/1.73 m2 (stage 1), 2,882 with eGFR 60-89 (stage 2), 1,742 with eGFR 30-59 (stage 3), 191 with eGFR 15-29 (stage 4), and 312 with eGFR <15 or on dialysis (stage 5). The incidence of post-procedural acute heart failure, stroke, new dialysis requirement, transfusions, and bleeding events were higher in patients with greater CKD stage (P < 0.05). Five-year Kaplan-Meier overall survival among CKD stages 1-5 was 98.1, 95.5, 91.8, 82.5, and 76.9%, respectively (P < 0.001 by log-rank test). The hazard ratios of all-cause mortality for CKD stages 2-5 as compared to stage 1 by multivariate Cox regression analysis were as follows: 1.32 (P = 0.26), 2.04 (P < 0.01), 2.79 (P < 0.01), and 5.49 (P < 0.001). CONCLUSION Among patients undergoing PCI, lower GFR is associated with decreased long-term survival. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Agam D Patel
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Mohammed Ibrahim
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Rajesh V Swaminathan
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Irfan U Minhas
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Luke K Kim
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Prashanth Venkatesh
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Dmitriy N Feldman
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Robert M Minutello
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Geoffrey W Bergman
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - S Chiu Wong
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Harsimran S Singh
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Siddiqi OK, Smoot KJ, Dufour AB, Cho K, Young M, Gagnon DR, Ly S, Temiyasathit S, Faxon DP, Gaziano JM, Kinlay S. Outcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease. Heart 2015. [PMID: 26209334 DOI: 10.1136/heartjnl-2014-307168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS). METHODS We studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate <60 mL/min) or normal renal function. We used landmark analyses from 12 months after PCI with Cox proportional hazards multivariable and propensity-adjusted models to assess the effect of prolonged clopidogrel (more than 12 months) versus 12 months or less after PCI on clinical outcomes from 1 year to 4 years after PCI. RESULTS Of 23 042 eligible subjects receiving PCI, 4880 (21%) had CKD. Compared with normal renal function, patients with CKD had higher risks of death or MI 1-4 years after DES (21% vs 12%, HR=1.75; 95% CI 1.51 to 2.04) or BMS (28% vs 15%, HR=2.10; 95% CI 1.90 to 2.32). In patients with CKD receiving DES, clopidogrel use of more than 12 months after PCI was associated with lower risks of death or MI (18% vs 24%, HR=0.74; 95% CI 0.58 to 0.95), and death (15% vs 23%, HR=0.61; 95% CI 0.47 to 0.80), but had no effect on repeat revascularisation 1-4 years after PCI. CONCLUSIONS In patients with CKD, prolonging clopidogrel beyond 12 months after PCI may decrease the risk of death or MI only in patients receiving first-generation DES. These results support a patient-tailored approach to prolonging clopidogrel after PCI.
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Affiliation(s)
- Omar K Siddiqi
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA Cardiovascular Division, Boston Medical Center, Boston, Massachusetts, USA
| | - Kyle J Smoot
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Alyssa B Dufour
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Kelly Cho
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Young
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - David R Gagnon
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha Ly
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Sara Temiyasathit
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - David P Faxon
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Michael Gaziano
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA MAVERIC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott Kinlay
- Cardiovascular Division, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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17
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Lahtela HM, Kiviniemi TO, Puurunen MK, Schlitt A, Rubboli A, Ylitalo A, Valencia J, Lip GYH, Airaksinen KEJ. Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial. PLoS One 2015; 10:e0128492. [PMID: 26030623 PMCID: PMC4451758 DOI: 10.1371/journal.pone.0128492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/27/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Renal impairment is a well-known risk factor for cardiovascular complications, but the effect of different stages of renal impairment on thrombotic/thromboembolic and bleeding complications in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains largely unknown. We sought to evaluate the incidence and clinical impact of four stages of renal impairment in patients with AF undergoing PCI. METHODS We assessed renal function by estimated glomerular filtration rate (eGFR) and outcomes in 781 AF patients undergoing PCI by using the data from a prospective European multicenter registry. End-points included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE) and bleeding events at 12 months. RESULTS A total of 195 (25%) patients had normal renal function (eGFR ≥90 mL/min), 290 (37%) mild renal impairment (eGFR 60-89), 263 (34%) moderate renal impairment (eGFR 30-59) and 33 (4%) severe renal impairment (eGFR <30). Degree of renal impairment remained an independent predictor of mortality and MACCE in an adjusted a Cox regression model. Even patients with mild renal impairment had a higher risk of all-cause mortality (HR 2.25, 95%CI 1.02-4.98, p=0.04) and borderline risk for MACCE (HR 1.56, 95%CI 0.98- 2.50, p=0.06) compared to those with normal renal function. CONCLUSIONS Renal impairment is common in patients with AF undergoing PCI and even mild renal impairment has an adverse prognostic effect in these patients requiring multiple antithrombotic medications.
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Affiliation(s)
- Heli M. Lahtela
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas O. Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Marja K. Puurunen
- Hemostasis laboratory, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Axel Schlitt
- Medical Faculty, Martin Luther University Halle-Wittenberg and Paracelsus-Harz-Clinic Bad Suderode, Halle, Germany
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy
| | - Antti Ylitalo
- Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland; Medical Research Center, University of Oulu, Oulu, Finland
| | - José Valencia
- Department of Cardiology, General Hospital University of Alicante, Alicante, Spain
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
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18
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Wiernek SL, Kiesz RS, Wiernek BK, Buszman PP, Janas A, Martin JL, Trela B, Szewc RG, Buszman PE. Treatment of symptomatic coronary artery disease in patients with end-stage renal disease on hemodialysis with paclitaxel-eluting TAXUS stent. Hemodial Int 2015; 19:402-11. [PMID: 25560380 DOI: 10.1111/hdi.12259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Percutaneous coronary intervention (PCI) utilizing drug-eluting stents is becoming a very common revascularization technique in the dialysis cohort; therefore, we sought to identify the impact of dialysis on outcomes in this group of patients. This is a multicenter registry comparing results of 290 patients (186 with normal kidney function, 104 on dialysis) who underwent PCI with exclusive use of paclitaxel-eluting TAXUS stent. The primary endpoint was an assessment of major adverse cardiac events (MACE) at 1- and 2-year observation. Mean follow-up was 23.3 ± 6.1 months. Results at 12 months showed: MACE 11.8% vs. 7.7% (P = not significant [ns]), composite major adverse cardiac and cerebrovascular events (MACCE) 12.4% vs. 11.5% (P = ns), all-cause death 2.7% vs. 8.6% (P < 0.05), cardiac death 2.7% vs. 1.9% (P = ns), target vessel revascularization (TVR) 9.1% vs. 6.7% (P = ns), acute myocardial infarction (AMI) 3.8% vs. 2.9% (P = ns), cerebrovascular events (CVA) 0.5% vs. 1.0% (P = ns); and results at 24 months showed: MACE 17.7% vs. 18.3% (P = ns), MACCE 21.5% vs. 26.0% (P = ns), all-cause death 4.3% vs. 14.4% (P < 0.01), cardiac death 3.2% vs. 1.9% (P = ns), TVR 14.0% vs. 16.3% (P = ns), AMI 5.4% vs. 5.8% (P = ns), CVA 3.2% vs. 2.9% (P = ns) for non-end-stage renal disease (ESRD) and dialysis group, respectively. Prior coronary artery bypass graft (CABG) was found to be single risk factor for MACE, TVR, and MACCE in patients with ESRD, while dialysis and prior CABG were found to be single risk factors for death in the entire population. PCI with TAXUS is a feasible procedure and presents promising results in dialysis-dependent patients.
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Affiliation(s)
- Szymon L Wiernek
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,Norwalk Hospital, Yale School of Medicine, Norwalk, Connecticut, USA
| | - R Stefan Kiesz
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,University of Texas Health Science Center, San Antonio, Texas, USA
| | - Barbara K Wiernek
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,Medical University of Silesia, Katowice, Poland
| | - Piotr P Buszman
- American Heart of Poland, Katowice, Poland.,Medical University of Silesia, Zabrze, Poland
| | - Adam Janas
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,American Heart of Poland, Katowice, Poland
| | - Jack L Martin
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Robert G Szewc
- University of Texas Health Science Center, San Antonio, Texas, USA.,Kidney Specialists, San Antonio, Texas, USA
| | - Pawel E Buszman
- Medical University of Silesia, Katowice, Poland.,American Heart of Poland, Katowice, Poland
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19
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Schelp V, Freitag-Wolf S, Hinzmann D, Bramlage P, Frey N, Frank D. Large-scale experience with an anchorless vascular closure device in a real-life clinical setting. Clin Res Cardiol 2014; 104:145-53. [PMID: 25293675 DOI: 10.1007/s00392-014-0766-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
AIMS This study was designed to evaluate safety and effectiveness of the vascular closure device Exoseal (Cordis) for hemostatic control following cardiac catheterization in a real-life clinical setting. METHODS AND RESULTS This prospective, single-center study enrolled n = 2,031 consecutive patients who underwent coronary angiography via the femoral artery ± PCI (n = 801). Patients were excluded if they had radial access, percutaneous repair of structural heart disease, or if they had severe peripheral artery disease. If clinical abnormalities were discovered at the access site, color Doppler ultrasound was performed. The composite primary endpoint was defined as bleeding/vascular complications and device failure, and it was experienced by 5.4 % (n = 110) of patients. The most frequent complications were pseudoaneurysm (2.9 %, n = 58) and access-site hematoma >6 cm (1.8 %, n = 37). The overall device failure rate was 0.7 % (n = 14). Multiple logistic regression analysis demonstrated that the strongest independent predictors of bleeding/vascular complications and/or device failure were procedure duration (OR 2.1, CI 1.4-3.2), PCI (OR 2.7, CI 1.7-4.2), GP IIb/IIIa inhibitors (OR 2.9, CI 1.5-5.7), and age (OR 2.2, CI 1.4-3.5). CONCLUSIONS These results indicate that Exoseal was safe in a broad collective of patients. However, lengthy procedures, PCIs, the use of GP IIb/IIIa inhibitors, and elderly patients require special attention.
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Affiliation(s)
- Verena Schelp
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel Schittenhelmstr. 12, 24105, Kiel, Germany
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20
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Yoshikawa D, Ishii H, Suzuki S, Takeshita K, Kumagai S, Hayashi M, Niwa T, Izawa H, Murohara T. Plasma indoxyl sulfate and estimated glomerular filtration rate. Circ J 2014; 78:2477-82. [PMID: 25109428 DOI: 10.1253/circj.cj-14-0401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Indoxyl sulfate (IS), a uremic toxin, has cardiovascular as well as uremic toxicity. We evaluated the prognostic value of blood IS level for long-term outcome. METHODS AND RESULTS This study followed 311 patients with coronary artery disease. Plasma IS level and estimated glomerular filtration rate (eGFR) were determined. The endpoint was a major adverse cardiac event (MACE). Median follow-up was 759 days. IS was significantly higher in patients with MACE than in those without (P<0.001). Patients were divided according to quartiles (Q) of plasma IS level (Q1, Q2, Q3, and Q4). On Kaplan-Meier analysis a significantly lower MACE-free rate was obtained for Q4 compared with the other quartiles (P<0.001). In patients with eGFR ≥90, 89-60, 59-30, 29-15, and <15 ml·min(-1)·1.73 m(-2), the percentage of patients in Q4 was 0%, 13%, 29%, 100%, and 100%, respectively. In patients with eGFR 89-60 ml·min(-1)·1.73 m(-2), there was no significant difference in MACE-free rate between Q4 and the other quartiles; in patients with eGFR 59-30 ml·min(-1)·1.73 m(-2), a significantly lower MACE-free rate was obtained for Q4 compared with the other quartiles (P=0.832 and P=0.015, respectively). CONCLUSIONS Plasma IS level is a significant predictor of MACE, especially in patients with eGFR 59-30 ml·min(-1)·1.73 m(-2).
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Affiliation(s)
- Daiji Yoshikawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
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21
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Wiebe J, Möllmann H, Most A, Dörr O, Weipert K, Rixe J, Liebetrau C, Elsässer A, Achenbach S, Hamm C, Nef H. Short-term outcome of patients with ST-segment elevation myocardial infarction (STEMI) treated with an everolimus-eluting bioresorbable vascular scaffold. Clin Res Cardiol 2013; 103:141-8. [PMID: 24136291 DOI: 10.1007/s00392-013-0630-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate safety and efficacy of the everolimus-eluting bioresorbable scaffold (BVS) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND According to the current guidelines, drug-eluting stents are the treatment of choice in patients with STEMI. BVS represents a new technology capable to restore the native vessel vasomotion and potentially avoiding long-term limitations such as stent thrombosis. METHODS From October 2012 to May 2013, patients with evidence of STEMI eligible for BVS implantation were included in this study. Exclusion criteria were not defined. RESULTS A total of 25 patients, respectively 31 lesions, were treated. Procedural success was achieved in 97%. Two major adverse cardiac events occurred during hospitalization and follow-up: one patient with cardiogenic shock at the index procedure subsequently died. One patient suffered from instable angina with need for interventional revascularization of a previously untreated vessel. One target vessel failure as a consequence of an intra-procedural dissection was seen. However, no target lesion failure was noted. During 132.7 ± 68.7 days of follow-up none of the patients died. CONCLUSION Our findings suggest that implantation of BVS in STEMI patients is feasible in this small cohort of highly selected patients. Further evaluation in randomized-controlled trials is needed.
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Affiliation(s)
- Jens Wiebe
- Department of Cardiology, Medizinische Klinik I, University of Giessen, Klinikstrasse 33, 35392, Giessen, Germany
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22
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Ndrepepa G, Neumann FJ, Cassese S, Fusaro M, Ott I, Schulz S, Hoppmann P, Richardt G, Laugwitz KL, Schunkert H, Kastrati A. Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease. Clin Res Cardiol 2013; 103:49-56. [PMID: 24092474 DOI: 10.1007/s00392-013-0622-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited information exists on the prognostic impact of bleeding after percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD). We investigated the impact of bleeding after PCI on the outcome of these patients. METHODS The study included 2,934 patients with estimated creatinine clearance <60 ml/min. Bleeding events within 30 days after PCI were assessed using the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 1-year mortality. RESULTS Bleeding events occurred in 485 patients (16.5 %). BARC classes were: class 1 (n = 155), class 2 (n = 73), class 3a (n = 182), class 3b (n = 68), class 3c (n = 6) and class 4 (n = 1). There were 212 deaths over the first year after PCI: 60 deaths in patients who bled and 152 deaths in patients who did not bleed (Kaplan-Meier [KM] estimates, 12.5 and 6.3 %; odds ratio [OR] = 2.11, 95 % confidence interval [CI] 1.57-2.83, P < 0.001). Nonfatal myocardial infarction occurred in 71 patients who bled and in 141 patients who did not bleed (KM estimates, 14.8 and 5.8 %; OR = 2.70 [2.05-3.55], P < 0.001). After adjustment, bleeding was independently associated with increased risk of 1-year mortality (adjusted hazard ratio [HR] = 1.90 [1.33-2.72], P < 0.001) and myocardial infarction (adjusted HR = 2.74 [1.99-3.78], P < 0.001). Bleeding improved the discriminatory power of the multivariable model for prediction of mortality (absolute and relative integrated discrimination improvement [IDI], 0.011 and 15.4 %; P = 0.004) or myocardial infarction (absolute and relative IDI, 0.017 and 70.8 %; P < 0.001). CONCLUSIONS Peri-PCI bleeding in patients with CKD is independently associated with the increased risk of 1-year mortality and nonfatal myocardial infarction.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum, Lazarettstrasse 36, 80636, Munich, Germany,
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Chen YY, Wang JF, Zhang YJ, Xie SL, Nie RQ. Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis. Eur J Intern Med 2013; 24:354-61. [PMID: 23602222 DOI: 10.1016/j.ejim.2013.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/15/2013] [Accepted: 03/18/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have high risks of coronary artery disease (CAD). Coronary revascularization is beneficial for long-term survival, but the optimal strategy remains still controversial. METHODS We searched studies that have compared percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for revascularization of the coronary arteries in CKD patients. Short-term (30 days or in-hospital) mortality, long-term (at least 12 months) all-cause mortality, cardiac mortality and the incidence of late myocardial infarction and recurrence of revascularization were estimated. RESULTS 28 studies with 38,740 patients were included. All were retrospective studies from 1977 to 2012. Meta-analysis showed that PCI group had lower short-term mortality (OR 0.55, 95% CI 0.41 to 0.73, P<0.01), but had higher long-term all-cause mortality (OR 1.29, 95% CI 1.23 to 1.35, P<0.01). Higher cardiac mortality (OR 1.08, 95% CI 1.01 to 1.15, P<0.05), higher incidence of late myocardial infarction (OR 1.78, 95% CI 1.65 to 1.91, P<0.01) and recurring revascularization rate (OR 2.94, 95%CI 2.15 to 4.01, P<0.01) is found amongst PCI treated patients compared to CABG group. CONCLUSIONS CKD patients with CAD received CABG had higher risk of short-term mortality but lower risks of long-term all-cause mortality, cardiac mortality and late myocardial infarction compared to PCI. This could be due to less probable repeated revascularization.
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Affiliation(s)
- Yu-Yang Chen
- Department of Cardiology, The Second Affiliated Hospital of Sun Yat-sen University, West Yanjiang Road 107, Guangzhou, Guangdong, 510120, China
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24
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Sinning C, Lillpopp L, Appelbaum S, Ojeda F, Zeller T, Schnabel R, Lubos E, Jagodzinski A, Keller T, Munzel T, Bickel C, Blankenberg S. Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol 2013; 102:495-503. [DOI: 10.1007/s00392-013-0555-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/04/2013] [Indexed: 12/17/2022]
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Wanitschek M, Pfisterer M, Hvelplund A, De Servi S, Bertel O, Jeger R, Rickenbacher P, Iversen A, Jensen JS, Galatius S, Kaiser C, Alber H. Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease. Int J Cardiol 2013; 168:2381-8. [PMID: 23453439 DOI: 10.1016/j.ijcard.2013.01.257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
Abstract
AIMS Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known. METHODS AND RESULTS In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥ 3.0mm) were randomised 2:1 to DES or BMS. In an a priori planned secondary analysis, outcomes were evaluated according to renal function defined by estimated glomerular filtration rates (eGFR; normal: eGFR ≥ 60 ml/min/1.73 m(2); CKD: eGFR<60 ml/min/1.73 m(2)). The primary endpoint was the first major adverse cardiac event (MACE: cardiac death, myocardial infarction, target vessel revascularisation) up to 2 years. A Cox proportional-hazard model was used to evaluate adjusted relative risks (hazard rates, HRs) for BMS versus DES. The interaction of stent type and renal function was tested. CKD patients (189 (11.2%)/1681 with such data) had a 2-year MACE rate of 8.5% versus 7.4% in those without CKD [HR 0.98 (0.56-1.72), p=0.95] with cardiac mortalities of 5.3% and 1.5%, respectively (p=0.002, non-significant after baseline adjustments). The MACE rate was lower in CKD patients with DES than with BMS [4.9% versus 15.2%, p=0.017, HR 0.29(0.10-0.80)] as was the MACE rate in patients without CKD [5.6% with DES versus 11.1% with BMS, p<0.0001, HR 0.51(0.35-0.75)]. No significant interaction between stent type and renal function was found. CONCLUSIONS This analysis of patients needing large coronary artery stenting confirms the increased mortality of CKD patients and documents a long-term benefit of DES compared to BMS irrespective of kidney function.
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Use of thrombolysis in myocardial infarction risk score to predict bleeding complications in patients with unstable angina and non-ST elevation myocardial infarction undergoing percutaneous coronary intervention. Cardiovasc Interv Ther 2013; 28:242-9. [PMID: 23361950 DOI: 10.1007/s12928-013-0162-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
Abstract
Thrombolysis in myocardial infarction (TIMI) is a prognostic score developed for managing the high risk of cardiac events immediately after unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI). In Asian populations that have a higher rate of bleeding complications, data about TIMI score are lacking. Using a Japanese multicenter registry, we investigated the impact of utilizing TIMI score in UA/NSTEMI patients, focusing on bleeding complications. The TIMI score was calculated for 587 patients who underwent percutaneous coronary intervention (PCI) for UA/NSTEMI (2008-2010). They were classified into low-risk (TIMI score 0-2, N = 268, 45.6 %), intermediate-risk (TIMI score 3-4, N = 264, 45.0 %) and high-risk (TIMI score 5-7, N = 55, 9.4 %) groups; patient characteristics for each group were statistically analyzed. The patients in the higher TIMI score group were older (p < 0.001), had lower GFR (p = 0.021) and hemoglobin level after PCI (p < 0.001), and severe coronary disease pattern (p = 0.014 and p = 0.023, respectively, for left main and three-vessel disease). The TIMI score was significantly associated with requirement of blood transfusion (low-risk, moderate-risk, and high-risk groups: 1.1, 4.2, and 7.3 %, respectively; p = 0.021), and the incidence of access site bleeding (1.1, 2.7, and 5.5 %, p = 0.112). The TIMI score might aid in subjectively quantifying the risk of in-hospital complication rates such as access site bleeding.
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27
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Baars T, Kleinbongard P, Böse D, Konorza T, Möhlenkamp S, Hippler J, Erbel R, Heusch G. Saphenous vein aorto-coronary graft atherosclerosis in patients with chronic kidney disease: more plaque calcification and necrosis, but less vasoconstrictor potential. Basic Res Cardiol 2012; 107:303. [PMID: 23052640 DOI: 10.1007/s00395-012-0303-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/20/2012] [Accepted: 09/24/2012] [Indexed: 12/12/2022]
Abstract
Atherosclerotic coronary arteries are more calcified in patients with than without chronic kidney disease (CKD). We addressed the potential for coronary microvascular obstruction in patients with and without CKD during stenting for saphenous vein aorto-coronary graft (SVG) stenosis under protection with a distal occlusion/aspiration device. In patients with and without CKD (n = 20/20), SVG plaque composition was analyzed from virtual histology using intravascular ultrasound analysis before stent implantation. There was more dense calcium and more necrotic core in patients with than without CKD (14 ± 3 vs. 3 ± 1 % and 21 ± 3 vs. 12 ± 2 % of plaque volume, respectively). Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Patients with CKD had more particulate debris and calcium release than patients without CKD. In contrast, the release of serotonin was less in patients with than without CKD (0.4 ± 0.1 vs. 1.2 ± 0.3 μmol/L), whereas that of catecholamines, endothelin, tissue factor, thromboxane, tumor necrosis factor α, and C reactive protein was not significantly different. Confirming the biochemical results, aspirate plasma from patients with CKD induced less vasoconstriction of rat mesenteric arteries than that from patients without CKD (with endothelium (+E), 26 ± 7 %; without endothelium (-E): 28 ± 7 % vs. +E, 68 ± 12 %; -E: 95 ± 16 % of maximum KCl-induced vasoconstriction). Graft atherosclerosis of patients with CKD is more degenerated and releases more particulate debris and calcium, but the aspirate has surprisingly less serotonin and vasoconstrictor potential.
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Affiliation(s)
- Theodor Baars
- Institut für Pathophysiologie Universitätsklinikum Essen, Universität Duisburg-Essen, Germany
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28
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Yonetsu T, Kato K, Kim SJ, Xing L, Jia H, McNulty I, Lee H, Zhang S, Uemura S, Jang Y, Kang SJ, Park SJ, Lee S, Yu B, Kakuta T, Jang IK. Predictors for Neoatherosclerosis. Circ Cardiovasc Imaging 2012; 5:660-6. [DOI: 10.1161/circimaging.112.976167] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Recent studies have reported development of neoatherosclerosis (NA) inside the stents several years after stent implantation. The aim of this study was to determine the predictors for NA using optical coherence tomography.
Methods and Results—
From a total of 1080 patients who underwent optical coherence tomography, we identified 179 stents in 151 patients in which the mean neointimal thickness was >100 µm. The presence of lipid-laden neointima or calcification inside the stents was defined as NA in the present study. Patient characteristics, stent type, and time since stent implantation (stent age) were compared between stents with or without NA. Univariable and multivariable logistic regression analyses were used to assess the independent predictors. In univariate analysis, stent age ≥48 months (Odds ratio [OR], 4.48; [95% CI 2.68-9.65];
P
<0.001), drug-eluting stents (OR, 2.66; [95% CI, 1.38–5.16];
P
=0.004), age ≥65 years (OR, 1.91; [95% CI, 1.05–3.44];
P
=0.032), current smoking (OR, 2.30; [95% CI, 1.10–4.82];
P
=0.024), chronic kidney disease (OR, 4.17; [95% CI, 1.42–12.23];
P
=0.009), and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockade use (OR, 0.42; [95% CI, 0.22–0.80];
P
=0.008) were significant predictors. In multivariate analysis, stent age ≥48 months, all subtypes of drug-eluting stent, current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade use remained independent predictors for NA.
Conclusions—
In addition to the stent type and the stent age, patient characteristics, including current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade, were associated with the presence of NA. This result may support the importance of secondary prevention after stent implantation.
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Affiliation(s)
- Taishi Yonetsu
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Koji Kato
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Soo-Joong Kim
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Lei Xing
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Haibo Jia
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Iris McNulty
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Hang Lee
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Shaosong Zhang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Shiro Uemura
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Yangsoo Jang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Soo-Jin Kang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Seung-Jung Park
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Stephen Lee
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Bo Yu
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Tsunekazu Kakuta
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Ik-Kyung Jang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
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29
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Donahue M, Briguori C. Stent thrombosis in patients with chronic kidney disease. Expert Rev Cardiovasc Ther 2012; 10:617-26. [PMID: 22651837 DOI: 10.1586/erc.12.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic kidney disease is a strong predictor of adverse cardiac events, including death, myocardial infarction and stent thrombosis (ST), after percutaneous coronary intervention. In the past few years, the development of new therapeutic strategies (including both drugs and devices) and a more complete understanding of the pathophysiology and predictive factors of thrombosis have led to a significant reduction of this complication. Despite this, ST still remains a dramatic event due to its morbidity and mortality. Further efforts should be pursued to identify patients at high risk of ST in order to adopt a more effective preventive strategy. This review sought to examine the total weight of evidence regarding ST with the use of drug-eluting stents in patients with chronic kidney disease.
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Affiliation(s)
- Michael Donahue
- Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy
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30
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Kehmeier ES, Lepper W, Kropp M, Heiss C, Hendgen-Cotta U, Balzer J, Neizel M, Meyer C, Merx MW, Verde PE, Ohmann C, Heusch G, Kelm M, Rassaf T. TNF-α, myocardial perfusion and function in patients with ST-segment elevation myocardial infarction and primary percutaneous coronary intervention. Clin Res Cardiol 2012; 101:815-27. [DOI: 10.1007/s00392-012-0465-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/19/2012] [Indexed: 02/01/2023]
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31
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Concurrent drug eluting/bare metal stent implantation during percutaneous coronary intervention in target vessel: outcomes and 1-year follow-up. Clin Res Cardiol 2011; 101:281-8. [DOI: 10.1007/s00392-011-0390-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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