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Felbel D, Bozic F, Mayer B, Krohn-Grimberghe M, Paukovitsch M, d’Almeida S, Mörike J, Gonska B, Imhof A, Buckert D, Rottbauer W, Markovic S, Stephan T. Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease-a meta-analysis. Front Cardiovasc Med 2023; 10:1213992. [PMID: 37671137 PMCID: PMC10475729 DOI: 10.3389/fcvm.2023.1213992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. Methods Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. Results Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03-0.05 (DES) vs. 0.03-0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02-0.04) vs. 0.02 (0.01-0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02-0.05)] compared with 1% in the DCB group [0.01 (0.00-0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07-0.10) vs. 0.04 (0.02-0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. Conclusion This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.
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Affiliation(s)
- Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Filip Bozic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Marvin Krohn-Grimberghe
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sascha d’Almeida
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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2
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Christ M. Invasive Treatment in Patients With Acute Myocardial Infarction and End-Stage Renal Disease: Does One Size Fits for All? Am J Cardiol 2023; 201:364-366. [PMID: 37407389 DOI: 10.1016/j.amjcard.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Michael Christ
- Emergency Department, Luzerner Kantonsspital & University of Luzern, Luzern, Switzerland.
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3
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Chen H, Spirito A, Sartori S, Nicolas J, Cao D, Zhang Z, Baber U, Kamaleldin K, Guthrie J, Vogel B, Sweeny J, Krishnan P, Sharma SK, Kini A, Dangas G, Mehran R. Impact of complex percutaneous coronary intervention features on clinical outcomes in patients with or without chronic kidney disease. Catheter Cardiovasc Interv 2023; 101:511-519. [PMID: 36691863 DOI: 10.1002/ccd.30569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at higher risk of ischemic and bleeding events after percutaneous coronary intervention (PCI). Complex PCI (CPCI) is associated with higher rates of ischemic complications. Whether CPCI confers an additive risk of adverse events in CKD patients is unclear. METHODS Patients who underwent PCI at a single tertiary-care-center between 2012 and 2019 were stratified by CKD status and CPCI. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target-vessel revascularization (TVR) at 1-year follow-up. Secondary outcomes included the individual components of the primary outcome and major bleeding. RESULTS Out of 15,071 patients, 4537 (30.1%) had CKD and 10,534 (69.9%) had no CKD. Patients undergoing CPCI were 1151 (25.4%) and 2983 (28.3%) in the two cohorts, respectively. At one year, CPCI compared with no CPCI was associated with higher risk of MACE in both CKD (Adj. HR 1.72, 95% confidence interval [CI] 1.45-2.06, p < 0.001) and no-CKD patients (Adj. hazard ratios [HR] 2.19, 95% CI 1.91-2.51, p < 0.001; p of interaction 0.057), determined by an excess of death, MI and TVR in CKD patients and of TVR and MI only in no-CKD. CPCI was related with a consistent increase of major bleeding in the CKD (Adj. HR 1.49, 95% CI 1.18-1.87, p < 0.001) and no-CKD group (Adj. HR 1.23, 95% CI 0.98-1.54, p = 0.071, p of interaction 0.206). CONCLUSION At 1-year follow-up, CPCI was associated with higher risk of MACE and major bleeding irrespective of concomitant CKD. CPCI predicted mortality in CKD patients only.
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Affiliation(s)
- Huazhen Chen
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Karim Kamaleldin
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jeffers Guthrie
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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4
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Santosa Y, Harca AD, Yuwono A, Hermanto A, Oliver MS, Sukmadja E, Soewardi R. Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study. Cureus 2022; 14:e30312. [DOI: 10.7759/cureus.30312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
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5
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Room for improvement: diagnosing and managing acute coronary syndromes in persons with reduced eGFR. Kidney Int 2022; 102:20-22. [PMID: 35738829 DOI: 10.1016/j.kint.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
Cardiovascular events are the leading cause of death in chronic kidney disease. A recent analysis from the High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome trial focused on results in those with reduced estimated glomerular filtration rate. This commentary discusses aspects of acute coronary syndrome diagnosis in this group and the differential approach to acute coronary syndrome management that was observed between those with normal and reduced kidney function.
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6
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Mahfoud F, Farah A, Ohlow MA, Mangner N, Wöhrle J, Möbius-Winkler S, Weilenmann D, Leibundgut G, Cuculi F, Gilgen N, Kaiser C, Cattaneo M, Scheller B, Jeger RV. Drug-coated balloons for small coronary artery disease in patients with chronic kidney disease: a pre-specified analysis of the BASKET-SMALL 2 trial. Clin Res Cardiol 2022; 111:806-815. [PMID: 35220449 PMCID: PMC9242956 DOI: 10.1007/s00392-022-01995-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on the safety and efficacy of drug-coated balloon (DCB) compared to drug-eluting stent (DES) in patients with chronic kidney disease (CKD) are scarce, particularly at long term. This pre-specified analysis aimed to investigate the 3-year efficacy and safety of DCB versus DES for small coronary artery disease (< 3 mm) according to renal function at baseline. METHODS BASKET-SMALL-2 was a large multi-center, randomized, controlled trial that tested the efficacy and safety of DCBs (n = 382) against DESs (n = 376) in small vessel disease. CKD was defined as eGFR < 60 ml/min/1.73m2. The primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization (MACE) during 3 years. RESULTS A total of 174/758 (23%) patients had CKD, out of which 91 were randomized to DCB and 83 to DES implantation. The primary efficacy outcome during 3 years was similar in both, DCB and DES patients (HR 0.98; 95%-CI 0.67-1.44; p = 0.937) and patients with and without CKD (HR 1.18; 95%-CI 0.76-1.83; p = 0.462), respectively. Rates of cardiac death and all-cause death were significantly higher among patients with CKD but not affected by treatment with DCB or DES. Major bleeding events were lower in the DCB when compared to the DES group (12 vs. 3, HR 0.26; 95%-CI 0.07-0.92; p = 0.037) and not influenced by presence of CKD. CONCLUSIONS The long-term efficacy and safety of DCB was similar in patients with and without CKD. The use of DCB was associated with significantly fewer major bleeding events (NCT01574534). Central Illustration. Drug-coated balloon versus drug-eluting stents in small coronary artery disease with and without chronic kidney disease, a prespecified subgroup analysis of the BASKET-SMALL 2 trial.
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Affiliation(s)
- Felix Mahfoud
- Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, IMED, Geb. 41.1, 66421, Homburg, Saar, Germany.
| | - Ahmed Farah
- Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | | | | | | | | | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marco Cattaneo
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bruno Scheller
- Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, IMED, Geb. 41.1, 66421, Homburg, Saar, Germany
| | - Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland
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7
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Limpijankit T, Chandavimol M, Srimahachota S, Kanoksilp A, Jianmongkol P, Siriyotha S, Thakkinstian A, Buddhari W, Sansanayudh N. Dose-dependent effect of impaired renal function on all-cause mortality in patients following percutaneous coronary intervention. Clin Cardiol 2022; 45:882-891. [PMID: 35758306 PMCID: PMC9346964 DOI: 10.1002/clc.23877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To determine the risk prediction of various degrees of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention (PCI). Background Patients with chronic kidney disease (CKD) are at high risk of all‐cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks. Methods This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2): I (≥90), II (60−89), III (30−59), IV (15−29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One‐year all‐cause mortality was reported with risk prediction based on CKD stages and other risk factors. Results Patients with CKD stage I−V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One‐year overall survival among CKD stages I−V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log‐rank test). After adjusting covariables, the hazard ratios of all‐cause mortality for CKD stages II−V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001). Conclusion Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose‐dependent effect with decreased 1‐year survival. This finding may be useful for risk classification and to guide decision‐making.
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Affiliation(s)
- Thosaphol Limpijankit
- Department of Medicine, Division of Cardiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mann Chandavimol
- Department of Medicine, Division of Cardiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Srimahachota
- Department of Medicine, Division of Cardiovascular Diseases, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anek Kanoksilp
- Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Poj Jianmongkol
- Department of Cardiology, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wacin Buddhari
- Department of Medicine, Division of Cardiovascular Diseases, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nakarin Sansanayudh
- Department of Internal Medicine, Cardiology Unit, Pharmongkutklao Hospital, Bangkok, Thailand
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8
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Impact of impaired renal function on outcomes of chronic total occlusion undergoing revascularization: a systemic review and meta-analysis. Int Urol Nephrol 2022; 54:3179-3191. [PMID: 35689780 DOI: 10.1007/s11255-022-03192-7] [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: 11/16/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients with chronic kidney disease (CKD) have an associated burden of coronary artery disease, including chronic total occlusions (CTO). It is unclear how the presence of CKD affects the outcomes of CTO revascularization. Previous reviews have not taken into account all relevant published studies that examined the association of CKD with outcomes of CTO revascularization. METHODS A systematic search was conducted using PubMed, Scopus, and Google Scholar databases for studies investigating patients with or without CKD who also had coronary chronic total occlusion undergoing revascularization procedures Statistical analysis was performed using STATA software. Effect sizes were reported as pooled relative risk (RR). RESULTS A total of 13 studies were included. CKD patients showed elevated risk of in-hospital mortality (RR 4.25, 95% CI 2.64, 6.82) and mortality at latest follow-up (RR 3.24, 95% CI 2.56, 4.11), elevated risk of major cardio or cerebrovascular events (RR 1.65, 95% CI 1.38, 1.98), major bleeding (RR 2.85, 95% CI 1.96, 4.13), and contrast-induced acute kidney injury (RR 3.06, 95% CI 1.70, 5.52). CKD patients also showed lower chances of technical success (RR 0.95, 95% CI 0.91, 1.00). CONCLUSIONS The presence of CKD increases the risk of mortality, complications and adversely affects the success of CTO revascularization. Patients with CKD undergoing revascularization should have their kidney function comprehensively evaluated and these patients should be carefully monitored.
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9
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Li Q, Chen Y, Yu L, Zhu L, Wang Z, Jiao S, Wu C, Tu Y, Wu Y, Guo Z, Gao Y, Zheng J, Sun Y. The relationship between lipoprotein(a) and cardiovascular events in acute coronary syndrome patients with and without chronic kidney disease. Atherosclerosis 2022; 349:204-210. [DOI: 10.1016/j.atherosclerosis.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
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10
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Shamkhani W, Kinnaird T, Ludman P, Rashid M, Mamas MA. Sex differences in high‐risk but indicated coronary interventions (CHiP): National report from British Cardiovascular Intervention Society Registry. Catheter Cardiovasc Interv 2022; 99:447-456. [DOI: 10.1002/ccd.30081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Warkaa Shamkhani
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology Royal Stoke University Hospital Stoke‐on‐Trent North Midlands UK
| | - Tim Kinnaird
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology University Hospital of Wales Cardiff Cardiff UK
| | - Peter Ludman
- Department of Cardiology Queen Elizabeth Hospital Birmingham West Midlands UK
| | - Muhammad Rashid
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology Royal Stoke University Hospital Stoke‐on‐Trent North Midlands UK
| | - Mamas A. Mamas
- Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke‐on‐Trent North Midlands UK
- Department of Cardiology Royal Stoke University Hospital Stoke‐on‐Trent North Midlands UK
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11
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Mangiacapra F, Paolucci L, Viscusi MM, Mangiacapra R, Ferraro PM, Nusca A, Melfi R, De Luca L, Gabrielli D, Ussia GP, Grigioni F. Prevalence and clinical impact of high platelet reactivity in patients with chronic kidney disease treated with percutaneous coronary intervention: An updated systematic review and meta‐analysis. Catheter Cardiovasc Interv 2022; 99:1086-1094. [DOI: 10.1002/ccd.30071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Luca Paolucci
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Michele M. Viscusi
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Roberto Mangiacapra
- U.O.C. Nefrologia Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Pietro M. Ferraro
- U.O.C. Nefrologia Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Annunziata Nusca
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Rosetta Melfi
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | | | | | - Gian P. Ussia
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Department of Medicine Campus Bio‐Medico University Rome Italy
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12
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Engelbertz C, Pinnschmidt HO, Freisinger E, Reinecke H, Schmitz B, Fobker M, Schmieder RE, Wegscheider K, Breithardt G, Pavenstädt H, Brand E. Sex-specific differences and long-term outcome of patients with coronary artery disease and chronic kidney disease: the Coronary Artery Disease and Renal Failure (CAD-REF) Registry. Clin Res Cardiol 2021; 110:1625-1636. [PMID: 34036426 PMCID: PMC8484247 DOI: 10.1007/s00392-021-01864-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiovascular morbidity and mortality are closely linked to chronic kidney disease (CKD). Sex-specific long-term outcome data of patients with coronary artery disease (CAD) and CKD are scarce. METHODS In the prospective observational multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry, 773 (23.1%) women and 2,579 (76.9%) men with angiographically documented CAD and different stages of CKD were consecutively enrolled and followed for up to 8 years. Long-term outcome was evaluated using survival analysis and multivariable Cox-regression models. RESULTS At enrollment, women were significantly older than men, and suffered from more comorbidities like CKD, hypertension, diabetes mellitus, and multivessel coronary disease. Regarding long-term mortality, no sex-specific differences were observed (Kaplan-Meier survival estimates: 69% in women vs. 69% in men, plog-rank = 0.7). Survival rates decreased from 89% for patients without CKD at enrollment to 72% for patients with CKD stages 1-2 at enrollment and 49% for patients with CKD stages 3-5 at enrollment (plog-rank < 0.001). Cox-regression analysis revealed that sex or multivessel coronary disease were no independent predictors of long-term mortality, while age, CKD stages 3-5, albumin/creatinine ratio, diabetes, valvular heart disease, peripheral artery disease, and left-ventricular ejection fraction were predictors of long-term mortality. CONCLUSIONS Sex differences in CAD patients mainly exist in the cardiovascular risk profile and the extent of CAD. Long-term mortality was not depended on sex or multivessel disease. More attention should be given to treatment of comorbidities such as CKD and peripheral artery disease being independent predictors of death. Clinical Trail Registration ClinicalTrials.gov Identifier: NCT00679419.
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Affiliation(s)
- Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Freisinger
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Boris Schmitz
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Muenster, Muenster, Germany
| | - Manfred Fobker
- Center of Laboratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Günter Breithardt
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Hermann Pavenstädt
- Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany.
- Allg. Innere Medizin sowie Nieren- und Hochdruckkrankheiten und Rheumatologie, Medizinische Klinik D, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
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13
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Pribylova NN, Yakovleva MV, Pribylov CA, Barbashina TA, Gavriljuk EV, Mal GS, Pribylov VS. [Vasoprotective effects hypotensive therapy in patients with coronary heart disease combined with chronic kidney disease stage 2-3 after coronary stenting]. ACTA ACUST UNITED AC 2021; 61:14-22. [PMID: 34549689 DOI: 10.18087/cardio.2021.8.n1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/25/2021] [Accepted: 03/09/2021] [Indexed: 11/18/2022]
Abstract
Aim To study the condition of coronary vasculature by data of coronarography (CG) in patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH) associated with stage 2-4 chronic kidney disease (CKD) and to evaluate the effect of a 12-week complex treatment with perindopril or with a combination of perindopril/amlodipine on changes in vascular wall stiffness, endothelial function, and structure and function parameters in this patient category after coronary stenting.Material and methodsr This study included 87 patients with chronic IHD and AH associated with stage 2-3 CKD for whom CG was performed due to ineffectiveness of the antianginal therapy. The patients were divided into three subgroups: subgroup 1 included 28 patients who received a conservative treatment with perindopril 10 mg/day; subgroup 2 consisted of 25 patients who underwent coronary stenting and were prescribed perindopril; subgroup 3 consisted of 34 patients who underwent stenting and were prescribed the perindopril/amlodipine combination. The reference group included 47 patients with IHD and AH with preserved kidney function. Anatomic and functional parameters of the heart, arterial stiffness, pulse wave velocity, cardio-ankle vascular index, augmentation index, central aortic systolic and pulse pressure, endothelium-dependent vasodilation, plasma concentration of endothelin-1 (ET-1), and plasma concentration of nitric oxide metabolites were evaluated at baseline and after 12 weeks of treatment.Results In patients with IHD, AH, and stage 2-3 CKD, arterial stiffness was more pronounced than in patients with preserved kidney function. Concentrations of ET-1 were significantly higher and levels of nitric oxide were lower in CKD. Supplementing the complex therapy with perindopril resulted in a considerable hypotensive effect in all subgroups, improvement of the kidney function, and positive dynamics of arterial stiffness and endothelial function. Changes in these parameters were more pronounced in patients after coronary stenting than in patients receiving only a conservative treatment. The use of perindopril/amlodipine following stenting exerted the most significant angioprotective and cardioprotective effect.Conclusion Patients with IHD and AH in combination with early CKD have pronounced impairment of the condition of arterial blood vessels and the heart. Addition of perindopril to the treatment not only exerted a hypotensive effect but also beneficially influenced mechanisms of progression of this combined pathology.
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Affiliation(s)
| | | | | | | | | | - G S Mal
- Kursk State Medical University, Kursk
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14
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Differential impact of type 1 and type 2 diabetes mellitus on outcomes among 1.4 million US patients undergoing percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:83-88. [PMID: 34446373 DOI: 10.1016/j.carrev.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim was to determine the impact of diabetes mellitus (DM) on outcomes after percutaneous coronary intervention (PCI). There is limited data on the impact of DM and its subtypes among patients who underwent PCI during hospitalization. METHODS All PCI hospitalizations from the National Inpatient Sample (October 2015-December 2018) were stratified by the presence and subtype of DM. Multivariable logistic regression was performed to determine the adjusted odds ratios (aOR) of in-hospital adverse outcomes in type 1 DM (T1DM) and type 2 DM (T2DM) compared to no-DM. RESULTS Out of 1,363,800 individuals undergoing PCI, 12,640 (0.9%) had T1DM and 539,690 (39.6%) had T2DM. T1DM patients had increased aOR of major adverse cardiovascular and cerebrovascular events (MACCE) (1.26, 95%CI 1.17-1.35), mortality (1.56, 95%CI 1.41-1.72), major bleeding (1.63, 95%CI 1.45-1.84), and stroke (1.75, 95%CI 1.51-2.02), while T2DM patients had only increased aOR of MACCE (1.02, 95%CI 1.01-1.04), mortality (1.10, 95%CI 1.08-1.13) and stroke (1.22, 95%CI 1.18-1.27), compared to no-DM patients. However, both T1DM and T2DM had lower aOR of cardiac complications (0.87, 95%CI 0.77-0.97 and 0.87, 95%CI 0.85-0.89, respectively), in comparison to no-DM patients. When accounting for the indication, both DM subgroups had higher aOR of MACCE, mortality, and stroke compared to no-DM patients in the acute coronary syndrome setting (p < 0.001, for all), while only increased aOR of stroke (1.59, 95%CI 1.17-2.15 for T1DM and 1.12, 95%CI 1.05-1.20 for T2DM) persisted in the elective setting. CONCLUSIONS Patients with DM who have undergone PCI during hospitalization are more likely to experience adverse in-hospital outcomes, and T1DM patients are a particularly high-risk cohort.
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15
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Mangiacapra F, Sticchi A, Bressi E, Mangiacapra R, Viscusi MM, Colaiori I, Ricottini E, Cavallari I, Spoto S, Ussia GP, Ferraro PM, Grigioni F. Impact of Chronic Kidney Disease and Platelet Reactivity on Clinical Outcomes Following Percutaneous Coronary Intervention. J Cardiovasc Transl Res 2021; 14:1085-1092. [PMID: 33851372 DOI: 10.1007/s12265-021-10126-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
We investigated the interaction between chronic kidney disease (CKD) and high platelet reactivity (HPR) in determining long-term clinical outcomes following elective PCI for stable coronary artery disease (CAD). A total of 500 patients treated with aspirin and clopidogrel were divided based on the presence of CKD (defined as glomerular filtration rate of < 60 ml/min/1.73 m2) and HPR (defined as a P2Y12 reaction unit value ≥ 240 at VerifyNow assay). Primary endpoint was the occurrence of major adverse clinical events (MACE) at 5 years. Patients with both CKD and HPR showed the highest estimates of MACE (25.6%, p = 0.005), all-cause death (17.9%, p = 0.004), and cardiac death (7.7%, p = 0.004). The combination of CKD and HPR was an independent predictor of MACE (HR 3.12, 95% CI 1.46-6.68, p = 0.003). In conclusion, the combination of CKD and HPR identifies a cohort of patients with the highest risk of MACE at 5 years.
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Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
| | - Alessandro Sticchi
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Edoardo Bressi
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Roberto Mangiacapra
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Michele Mattia Viscusi
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Iginio Colaiori
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Elisabetta Ricottini
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Ilaria Cavallari
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Silvia Spoto
- Unit of Diagnostic and Therapeutic Medicine, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
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16
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Mayer O, Seidlerová J, Bruthans J, Opatrný J, Hromádka M, Jirák J, Filipovský J. The prognostic impact of renal function decline during hospitalization for myocardial infarction. J Comp Eff Res 2021; 10:219-228. [PMID: 33541131 DOI: 10.2217/cer-2020-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We analyzed the mortality risk of myocardial infarction (MI) patients according to renal function, observed during hospitalization. Materials & methods: Patients hospitalized for MI between 2006 and 2018 were followed (n = 5659). We divided the sample into four groups by estimated glomerular filtration (eGFR) [ml/min]: normal functions (lowest eGFR during hospitalization >60); transiently moderate insufficiency (lowest eGFR >30 and ≤60, highest >60); permanently moderate insufficiency (highest eGFR >30 and ≤60); severe insufficiency (highest and lowest eGFR ≤30). Results: Permanently moderate renal insufficiency indicates increased 5-years all-cause mortality (hazard risk ratio: 2.27 [95% CIs: 1.87-2.75], p < 0.0001), but a similar risk was found in patients with the only transient decline of renal functions (hazard risk ratio: 2.08 [95% CIs: 1.70-2.55], p < 0.0001). Both moderate insufficiency subgroups (transient/permanent) did not statistically differ regarding mortality risk. Conclusion: Even just fluctuation of eGFR toward moderate insufficiency during hospitalization represents an important prognostic indicator in MI patients.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic.,Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer's Hospital, Prague, Czech Republic
| | - Jan Opatrný
- Department of Cardiology, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic
| | - Milan Hromádka
- Department of Cardiology, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic
| | - Josef Jirák
- Department of Informatics, University Hospital, Pilsen, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
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17
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Jonas M, Kagan M, Sella G, Haberman D, Chernin G. Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis. BMC Nephrol 2020; 21:445. [PMID: 33097001 PMCID: PMC7583297 DOI: 10.1186/s12882-020-02089-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents. Drug-eluting balloons are used for in-stent restenosis and selected cases of de-novo coronary lesions. Little is known regarding the outcomes of individuals with CKD who undergo PCI with drug-eluting balloons. The goal of this study was to assess outcomes of PCI with drug-eluting balloons in individuals with CKD. METHODS In a retrospective analysis, outcomes of PCI with drug-eluting balloons were compared between 101 patients with CKD and 261 without CKD. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73m2. We compared demographics, procedure data and clinical outcomes in the first and second years following the procedure. RESULTS Rates of major adverse cardiac events (MACE) and myocardial infarction were higher in patients with than without CKD: 23.8% vs. 13.8%, P < 0.005 and 15.9% vs. 3.8%, P < 0.001, respectively. Rates of target lesion revascularization were similar, 14.9 and 11.5%, respectively, P = 0.4. Shorter duration of dual anti-platelet therapy was observed among patients with than without CKD (10.0 + 3.4 vs. 10.9 + 3.7 months, P < 0.05). First-year hemorrhage episodes were similar in the two groups (0.08 ± 0.4 and 0.03 ± 0.2, respectively, P = 0.2). In a multivariate regression analysis, CKD was associated with increased risks of first year MACE (OR 2.1; 95% confidence interval 1.0-4.3, P < 0.001). CONCLUSIONS PCI with drug-eluting balloons was associated with increased cardiovascular morbidity and mortality in patients with than without CKD. However, rates of target lesion revascularization were similar in the two groups. Shorter duration of dual anti-platelet therapy was observed in the CKD group.
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Affiliation(s)
- Michael Jonas
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Maayan Kagan
- Department of Nephrology and Hypertension, Kaplan Medical Center, Hebrew University School of Medicine, Pasternak St. POB1, 76100, Rehovot, Israel
| | - Gal Sella
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Dan Haberman
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Gil Chernin
- Department of Nephrology and Hypertension, Kaplan Medical Center, Hebrew University School of Medicine, Pasternak St. POB1, 76100, Rehovot, Israel.
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18
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Wybraniec MT, Bańka P, Bochenek T, Roleder T, Mizia-Stec K. Small vessel coronary artery disease: How small can we go with myocardial revascularization? Cardiol J 2020; 28:767-778. [PMID: 32986235 DOI: 10.5603/cj.a2020.0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
The issue of small coronary artery atherosclerosis represents an intriguing aspect of coronary artery disease, which is related with higher rates of peri- and post-procedural complications and impaired long-term outcome. This problem is further complicated by the unclear definition of small coronary vessel. Recent randomized controlled trials have provided new data on possible novel interventional treatment of small coronary vessels with drug-coated balloons instead of traditional new-generation drug-eluting stent implantation. Also, the conservative management represents a therapeutic option in light of the results of the recent ISCHEMIA trial. The current article provides an overview of the most appropriate definition, interventional management, and prognosis of small coronary artery atherosclerosis.
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Affiliation(s)
- Maciej T Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. .,Upper Silesia Medical Center, Katowice, Poland.
| | - Paweł Bańka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
| | - Tomasz Bochenek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
| | - Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
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19
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Hell MM, Gilg MD, Röther J, Blachutzik F, Achenbach S, Schlundt C. Dual-axis rotational coronary angiography versus conventional coronary angiography: a randomized comparison. Clin Res Cardiol 2020; 110:258-269. [PMID: 32936322 DOI: 10.1007/s00392-020-01743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dual-axis of rotational coronary angiography (RA), with one single cine acquisition during continuous C-arm motion along a pre-described path, is an alternative to conventional coronary angiography (CA). We assessed the performance of RA versus CA in a modern, experienced cath lab setting. METHODS Sixty-seven patients with suspected coronary artery disease undergoing invasive coronary angiography were randomized to CA (n = 35) or dual-axis RA (n = 32). CA was performed with four left and two right coronary artery acquisitions with manual contrast medium injection. In RA, one cine acquisition each was performed for the left (5 projections) and right coronary artery (3 projections) with a fixed amount of contrast medium applied by a power injector. In both groups, single cine acquisitions in additional angulations were performed to fully interpret the coronary system, if necessary. Procedural parameters and outcome were compared. RESULTS Mean age was 63 ± 12 years (64% males). Six additional projections were required in the RA group compared to 13 in the CA group (p = 0.173). Fluoroscopy duration (CA: 3 ± 3 min, RA: 3 ± 2 min, p = 0.748) and dose area product (CA: 1291 ± 761 µGym2, RA: 1476 ± 679 µGym2, p = 0.235) did not differ significantly between both groups. For CA, the amount of contrast medium (42 ± 13 vs. 46 ± 8 ml, p = 0.022) and procedure time (8 ± 5 vs. 11 ± 3 min, p < 0.001) were significantly lower. No major adverse event occurred during hospital stay. CONCLUSIONS Dual-axis RA represents a feasible and safe alternative method to CA for obtaining coronary angiograms. However, no superiority was observed when performed by an experienced interventionalist with a modern system.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. .,Department of Cardiology, University Medical Center Mainz, Johannes-Gutenberg University, Mainz, Germany.
| | - Melanie D Gilg
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Röther
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Medizinische Klinik, St. Theresien Krankenhaus, Nürnberg, Germany
| | - Florian Blachutzik
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Schlundt
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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20
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Chandrasekhar J, Kalkman DN, Sartori S, Baber U, Blum M, Aquino MB, Woudstra P, Beijk MA, Tijssen JG, Koch KT, Dangas GD, Colombo A, de Winter RJ, Mehran R. One-year clinical outcomes in patients with chronic kidney disease treated with COMBO stents: From the COMBO collaboration. Catheter Cardiovasc Interv 2020; 98:1095-1101. [PMID: 32964556 DOI: 10.1002/ccd.29270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/28/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) patients undergoing percutaneous coronary intervention (PCI) experience greater ischemic events including clinically driven target lesion revascularization (CD-TLR). Whether the COMBO biodegradable-polymer sirolimus-eluting stent promotes better outcomes in these patients by virtue of endothelial progenitor cell capture technology is unknown. OBJECTIVE We examined one-year outcomes by CKD status from the COMBO collaboration. METHODS The COMBO collaboration was a patient-level pooled dataset from the REMEDEE and MASCOT registries (3,614 patients) of all-comers undergoing attempted COMBO stent PCI. The primary endpoint was one-year target lesion failure (TLF), composite of cardiac death, target-vessel myocardial infarction (TV-MI) or CD-TLR. Secondary endpoints included stent thrombosis (ST). RESULTS The study included 6.4% (n = 231) CKD and 93.6% (n = 3,361) non-CKD patients. CKD patients were older and included more women with greater prevalence of several comorbidities but similar rate of acute coronary syndrome (50.6% vs. 54.5%, p = .26). CKD patients underwent radial PCI less often (56.1% vs. 70.3%, p < .001) and received clopidogrel (78.6% vs. 68.3%) more often (p = .004). One-year TLF occurred in 7.9% CKD vs. 3.7% non-CKD patients, p = .001. CKD patients also demonstrated greater incidence of cardiac death (6.2% vs. 1.2%, p < .0001), TV-MI (2.7% vs. 1.1%, p = .04) but similar CD-TLR (2.7% vs 2.2%, p = .61) and definite/probable ST (1.4% vs. 0.8%, p = .42), compared to non-CKD patients. CONCLUSIONS CKD patients treated with COMBO stents had significantly greater incidence of one-year TLF compared to non-CKD patients driven by cardiac death and to a lesser extent TV-MI but not CD-TLR. They had similar rates of definite/probable ST.
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Affiliation(s)
- Jaya Chandrasekhar
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Deborah N Kalkman
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Moritz Blum
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Melissa B Aquino
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Pier Woudstra
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Marcel A Beijk
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Jan G Tijssen
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Karel T Koch
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Antonio Colombo
- Department of cardiology, San Raffaele Hospital, Milan, Italy
| | - Robbert J de Winter
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
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21
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Chakafana G, Mutithu D, Hoevelmann J, Ntusi N, Sliwa K. Interplay of COVID-19 and cardiovascular diseases in Africa: an observational snapshot. Clin Res Cardiol 2020; 109:1460-1468. [PMID: 32809116 PMCID: PMC7433683 DOI: 10.1007/s00392-020-01720-y] [Citation(s) in RCA: 11] [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: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic, which started around December 2019 has, at present, resulted in over 450,000 deaths globally, and approximately 1% of these deaths have been reported in Africa. Despite the high prevalence of COVID-19 risk factors, namely: hypertension, diabetes, chronic pulmonary disease, cardiovascular diseases (CVDs) such as rheumatic heart disease, compromised immunity and obesity, low case fatality rates have been recorded in many parts of Africa so far. COVID-19 severity has previously been shown to be worse in patients with CVD and hypertension. We observed the severity of COVID-19 and mortality rates in Africa, and compared outcomes with prevalence of established risk factors (hypertension and CVD). We stratified data as per the United Nations’ 5 African subregions. North African countries show a positive association between the risk factors and the mortality rates from COVID-19. However, we observed discordant patterns in the relationship between COVID-19, and either CVD or hypertension, in sub-Saharan African countries. In this paper, we also review the pathogenesis of SARS-CoV-2 infection and how it worsens CVD and postulate that the differences in modulation of the renin–angiotensin–aldosterone system (RAAS) axis which controls angiotensin-converting enzyme (ACE)/ACE2 balance may be an important determinant of COVID-19 outcomes in Africa.
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Affiliation(s)
- Graham Chakafana
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA
| | - Daniel Mutithu
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA
| | - Julian Hoevelmann
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Klinik für Innere Medizin III - Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Homburg (Saar), Deutschland
| | - Ntobeko Ntusi
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA. .,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.
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