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Alfonso F, Marschall A. Left Main Coronary Artery Revascularization: Looking for Vascular Disease Beyond the Coronary Tree. Am J Cardiol 2024; 223:186-188. [PMID: 38772501 DOI: 10.1016/j.amjcard.2024.05.009] [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: 05/04/2024] [Accepted: 05/11/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain.
| | - Alexander Marschall
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
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Sugimoto K, Takahashi K, Okune M, Ueno M, Fujita T, Doi H, Tobaru T, Takanashi S, Kinoshita Y, Okawa Y, Fuku Y, Komiya T, Tsujita K, Fukui T, Shimokawa T, Watanabe Y, Kozuma K, Sakaguchi G, Nakazawa G. Impact of quantitative flow ratio on graft function in patients undergoing coronary artery bypass grafting. Cardiovasc Interv Ther 2023; 38:406-413. [PMID: 37017900 DOI: 10.1007/s12928-023-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Recent studies showed that preoperative functional assessment with fractional flow reserve (FFR) could predict a long-term patency of arterial bypass grafts in patients with coronary artery bypass grafting (CABG). Quantitative flow ratio (QFR) is a novel angiography-based approach to estimate FFR. This study aimed to investigate whether preoperative QFR could discriminate arterial bypass function at 1 year after surgery. The PRIDE-METAL registry was a prospective, multicenter observational study that enrolled 54 patients with multivessel coronary artery disease. By protocol, left coronary stenoses were revascularized by CABG with arterial grafts, whereas right coronary stenoses were treated with coronary stenting. Follow-up angiography at 1 year after surgery was scheduled to assess arterial graft patency. QFR was performed using index angiography by certified analysts, blinded to bypass graft function. The primary end point of this sub-study was the discriminative ability of QFR for arterial graft function, as assessed by receiver-operating characteristic curve. Among 54 patients enrolled in the PRIDE-METAL registry, index and follow-up angiography was available in 41 patients with 97 anastomoses. QFR were analyzed in 35 patients (71 anastomoses) with an analyzability of 85.5% (71/83). Five bypass grafts were found to be non-functional at 1 year. The diagnostic performance of QFR was substantial (area under the curve: 0.89; 95% confidence interval: 0.83 to 0.96) with an optimal cutoff of 0.76 to predict functionality of bypass grafts. Preoperative QFR is highly discriminative for predicting postoperative arterial graft function.Trial registration: Clinical.gov reference: NCT02894255.
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Affiliation(s)
- Keishiro Sugimoto
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kuniaki Takahashi
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Mana Okune
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masafumi Ueno
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Insutitute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medicine Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
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Serruys PW, Revaiah PC, Ninomiya K, Masuda S, Kotoku N, Kageyama S, Onuma Y, Morel MA, Garg S, Feldman T, Kappetein AP, Holmes DR, Mack MJ, Mohr FW. 10 Years of SYNTAX: Closing an Era of Clinical Research After Identifying New Outcome Determinants. JACC. ASIA 2023; 3:409-430. [PMID: 37396431 PMCID: PMC10308124 DOI: 10.1016/j.jacasi.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/21/2023] [Accepted: 03/24/2023] [Indexed: 07/04/2023]
Abstract
The SYNTAX trial randomized patients equally eligible for coronary artery bypass grafting or percutaneous coronary intervention using the Heart Team approach. The SYNTAXES study achieved a follow-up rate of 93.8% and reported the 10-year vital status. Factors associated with increased mortality at 10 years were pharmacologically treated diabetes mellitus, increased waist circumference, reduced left ventricular function, prior cerebrovascular and peripheral vascular disease, western Europe and North American descent, current smoking, chronic obstructive pulmonary disease, elevated C-reactive protein, anemia, and an increase in HbA1c. Procedural factors associated with higher 10 years mortality include periprocedural myocardial infarction, extensive stenting, small stents, ≥1 heavily calcified lesion, ≥1 bifurcation lesion, residual SYNTAX score >8, and staged percutaneous coronary intervention. Optimal medical therapy at 5 years, use of statins, on-pump coronary artery bypass grafting, multiple arterial grafts, and higher physical component score and mental component score were associated with lower mortality at 10 years. Numerous scores and prediction models were developed to help individualize risk assessment. Machine learning has emerged as a novel approach for developing risk models.
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Affiliation(s)
- Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Pruthvi C. Revaiah
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Marie Angele Morel
- Department of Cardiology, National University of Ireland, Galway (NUIG), and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - David R. Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, Texas, USA
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XU N, ZHANG C, JIANG L, XU JJ, LIU R, SONG Y, ZHAO XY, XU LJ, GAO RL, XU B, YUAN JQ, SONG L. Long-term outcome of percutaneous or surgical revascularization with and without prior stroke in patients with three-vessel disease. J Geriatr Cardiol 2022; 19:583-593. [PMID: 36339466 PMCID: PMC9629998 DOI: 10.11909/j.issn.1671-5411.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To determine whether high-risk patients with three-vessel disease (TVD) with and without prior stroke preferentially benefit from three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT)]. METHODS A total of 8943 patients with TVD were included in the study. Patients enrolled were stratified into two categories according to the presence or absence of prior stroke history. The primary endpoint was all-cause death. Secondary endpoints included stroke and major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction (MI), unplanned revascularization and stroke. RESULTS Prior stroke was present in 888 patients (9.9%). These patients were older and had higher rates of comorbidities. During a median follow-up of 7.5 years, patients with prior stroke were strongly associated with increased risks of all-cause death, cardiac death, stroke and MACCE, even after adjusting for confounding variables and results been consistent across either treatment subgroup (PCI, CABG and MT) (all adjusted P < 0.01). Notably, there was a significant interaction between prior stroke history and treatment strategies. Revascularization strategy (PCI or CABG) was associated with a lower incidence of all-cause death and MACCE compared with MT alone, and favorable rates of MACCE, MI and unplanned revascularization in the CABG group compared with the PCI group, but with similar rate of all-cause death regardless of prior stroke history. The prevalence of stroke was significantly higher after CABG when compared with PCI or MT in no prior stroke patients [hazard ratio (HR) = 1.429, 95% CI: 1.132-1.805 for CABG vs. MT; HR = 1.703, 95% CI: 1.371-2.116 for CABG vs. PCI]. CONCLUSIONS Patients with TVD and prior stroke have poor clinical outcomes. It is essential to balance benefit and risk when determining the optimal treatment strategy for TVD with and without prior stroke.
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Affiliation(s)
- Na XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ce ZHANG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin JIANG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Jing XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ru LIU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying SONG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan ZHAO
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian-Jun XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin GAO
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Qing YUAN
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei SONG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kageyama S, Serruys PW, Garg S, Ninomiya K, Masuda S, Kotoku N, Colombo A, Mack MJ, Banning AP, Morice MC, Witkowski A, Curzen N, Burzotta F, James S, van Geuns RJ, Davierwala PM, Holmes DR, Wood DA, McEvoy JW, Onuma Y. Geographic disparity in 10-year mortality after coronary artery revascularization in the SYNTAXES trial. Int J Cardiol 2022; 368:28-38. [DOI: 10.1016/j.ijcard.2022.08.013] [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: 06/18/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022]
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LaPiano JB, Arnott SM, Napolitano MA, Holleran TJ, Sparks AD, Antevil JL, Trachiotis GD. Risk factors for cerebrovascular accident after isolated coronary artery bypass grafting in Veterans. J Card Surg 2022; 37:3084-3090. [PMID: 35822719 DOI: 10.1111/jocs.16751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/20/2022] [Accepted: 06/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cerebrovascular accident (CVA) after coronary artery bypass grafting (CABG) is a devastating complication. Patient comorbidities and intraoperative elements contribute to the risk of CVA. The aim of this study is to identify risk factors for CVA in Veterans undergoing CABG. METHODS Veterans undergoing isolated CABG from 2008 to 2019 were retrospectively identified using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Thirty-day postoperative outcomes were observed. Univariate analysis followed by multivariable logistic regression identified independent risk factors for postoperative CVA. Receiver operating characteristic diagnostics identified optimal inflection points between continuous risk factors and odds of CVA. RESULTS Twenty-eight thousand seven hundred fifty-seven patients met inclusion criteria. Incidence of CVA was 1.1% (310 cases). In multivariate analysis, preoperative cerebrovascular disease had the strongest association with postoperative CVA (adjusted odds ratio = 2.29; p < .001). There was an inverse relationship between CVA incidence and ejection fraction (EF), with EF of 35%-39% conferring a 2.11 times higher risk compared to EF >55% (p < .001). CVA incidence was not different in on-pump versus off-pump cases; however, after 104 min or more on bypass patients had a 55% greater adjusted odds of CVA (p < .001). Other risk factors included poor kidney function, prior myocardial infarction, and intra-aortic balloon pump use. CONCLUSION The risk of CVA after CABG is multifactorial and involves multiple organ systems, including cardiac disease, poor renal function, and cerebrovascular disease, which was the strongest contributing risk factor. Optimization of these comorbidities and time on bypass may help improve clinical outcomes and lower the risk of this devastating complication.
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Affiliation(s)
- Jessica B LaPiano
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Suzanne M Arnott
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, George Washington University, Washington, District of Columbia, USA
| | - Michael A Napolitano
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, George Washington University, Washington, District of Columbia, USA
| | - Timothy J Holleran
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Andrew D Sparks
- Department of Statistics, George Washington University, Washington, District of Columbia, USA
| | - Jared L Antevil
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, George Washington University, Washington, District of Columbia, USA
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