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Yang YS, Xi DY, Duan Y, Yu M, Liu K, Meng YK, Hu CF, Han SG, Xu K. A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features. BMC Cardiovasc Disord 2024; 24:179. [PMID: 38528469 DOI: 10.1186/s12872-024-03847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE The aim of this study is to develop a nomogram model for predicting the occurrence of intramyocardial hemorrhage (IMH) in patients with Acute Myocardial Infarction (AMI) following Percutaneous Coronary Intervention (PCI). The model is constructed utilizing clinical data and the SYNTAX Score (SS), and its predictive value is thoroughly evaluated. METHODS A retrospective study was conducted, including 216 patients with AMI who underwent Cardiac Magnetic Resonance (CMR) within a week post-PCI. Clinical data were collected for all patients, and their SS were calculated based on coronary angiography results. Based on the presence or absence of IMH as indicated by CMR, patients were categorized into two groups: the IMH group (109 patients) and the non-IMH group (107 patients). The patients were randomly divided in a 7:3 ratio into a training set (151 patients) and a validation set (65 patients). A nomogram model was constructed using univariate and multivariate logistic regression analyses. The predictive capability of the model was assessed using Receiver Operating Characteristic (ROC) curve analysis, comparing the predictive value based on the area under the ROC curve (AUC). RESULTS In the training set, IMH post-PCI was observed in 78 AMI patients on CMR, while 73 did not show IMH. Variables with a significance level of P < 0.05 were screened using univariate logistic regression analysis. Twelve indicators were selected for multivariate logistic regression analysis: heart rate, diastolic blood pressure, ST segment elevation on electrocardiogram, culprit vessel, symptom onset to reperfusion time, C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, creatine kinase-MB, high-sensitivity troponin T (HS-TnT), and SYNTAX Score. Based on multivariate logistic regression results, two independent predictive factors were identified: HS-TnT (Odds Ratio [OR] = 1.61, 95% Confidence Interval [CI]: 1.21-2.25, P = 0.003) and SS (OR = 2.54, 95% CI: 1.42-4.90, P = 0.003). Consequently, a nomogram model was constructed based on these findings. The AUC of the nomogram model in the training set was 0.893 (95% CI: 0.840-0.946), and in the validation set, it was 0.910 (95% CI: 0.823-0.970). Good consistency and accuracy of the model were demonstrated by calibration and decision curve analysis. CONCLUSION The nomogram model, constructed utilizing HS-TnT and SS, demonstrates accurate predictive capability for the risk of IMH post-PCI in patients with AMI. This model offers significant guidance and theoretical support for the clinical diagnosis and treatment of these patients.
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Affiliation(s)
| | - De-Yang Xi
- Xuzhou Medical University, Jiangsu, 221004, China
| | - Yang Duan
- Department of Cardiac Care Unit, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Miao Yu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Kai Liu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Yan-Kai Meng
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Chun-Feng Hu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Shu-Guang Han
- Xuzhou Medical University, Jiangsu, 221004, China.
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China.
| | - Kai Xu
- Xuzhou Medical University, Jiangsu, 221004, China.
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China.
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Kheifets M, Vons SA, Bental T, Vaknin-Assa H, Greenberg G, Samara A, Codner P, Wittberg G, Talmor Barkan Y, Perl L, Kornowski R, Levi A. Temporal Trends in Complex Percutaneous Coronary Interventions. Front Cardiovasc Med 2022; 9:913588. [PMID: 35811722 PMCID: PMC9263118 DOI: 10.3389/fcvm.2022.913588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Accumulated experience combined with technological advancements in percutaneous coronary interventions (PCI) over the past four decades, has led to a gradual increase in PCI utilization and complexity. We aimed to investigate the temporal trends in PCI complexity and the outcomes of complex PCI (C-PCI) in our institution. Methods We analyzed 20,301 consecutive PCI procedures performed over a 12-year period. C-PCI was defined as a procedure involving at least one of the following: Chronic total occlusion (CTO), left main (LM), bifurcation or saphenous vein graft (SVG) PCI. Four periods of 3-year time intervals were defined (2008–10, 2011–2013, 2014–2016, 2017–2019), and temporal trends in the rate and outcomes of C-PCI within these intervals were studied. Endpoints included mortality and major adverse cardiac events [MACE: death, acute myocardial infarction (MI), and target vessel revascularization (TVR)] at 1 year. Results A total of 5,647 (27.8%) C-PCI procedures were performed. The rate of C-PCI has risen significantly since 2,017 (31.2%, p < 0.01), driven mainly by bifurcation and LM interventions (p < 0.01). At 1-year, rates of death, acute MI, TVR and MACE, were all significantly higher in the C-PCI group (8.8 vs. 5.1%, 5.6 vs. 4.5%, 5.5 vs. 4.0%, 17.2 vs. 12.2%, p < 0.001 for all, respectively), as compared to the non-complex group. C-PCI preformed in the latter half of the study period (2014–2019) were associated with improved 1-year TVR (4.4% and 4.8% vs. 6.7% and 7.1%, p = 0.01, respectively) and MACE (13.8% and 13.5% vs. 17.3% and 18.2%, p = 0.001, respectively) rates compared to the earlier period (2007–2013). Death rate had not significantly declined with time. Conclusion In the current cohort, we have detected a temporal increase in PCI complexity coupled with improved 1-year clinical outcomes in C-PCI.
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Affiliation(s)
- Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Abigail Vons
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abed Samara
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Wittberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor Barkan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhang H, Zhao Z, Yao J, Zhao J, Hou T, Wang M, Xu Y, Wang B, Niu G, Sui Y, Song G, Wu Y. Prior percutaneous coronary intervention and outcomes in patients after coronary artery bypass grafting: a meta-analysis of 308,284 patients. Ther Adv Chronic Dis 2022; 13:20406223221078755. [PMID: 35586304 PMCID: PMC9109498 DOI: 10.1177/20406223221078755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The association between prior percutaneous coronary intervention (PCI) and
prognosis after coronary artery bypass grafting (CABG) remains uncertain. We
aimed to evaluate the aforementioned association in a meta-analysis. Methods: PubMed, Cochrane’s Library, and Embase databases were searched for potential
studies. A random-effects model was used for the meta-analysis.
Meta-regression was performed to evaluate the influence of study
characteristics on the outcomes. Results: Thirty-six follow-up studies with 308,284 patients were included, and 40,892
(13.3%) patients had prior PCI. Pooled results showed that prior PCI was
associated with higher risks of early (in-hospital or within 1 month)
all-cause mortality [odds ratio (OR): 1.26, 95% confidence interval (CI):
1.11–1.44, p = 0.003; I2 = 64%]
and major adverse cardiovascular events (MACEs; OR: 1.36, 95% CI: 1.12–1.66,
p = 0.002, I2 = 79%), but
not with late (follow-up durations from 1 to 13 years) mortality (OR: 1.03,
95% CI: 0.95–1.13, p = 0.44,
I2 = 46%) or MACEs (OR: 1.03, 95% CI: 0.97–1.09,
p = 0.38, I2 = 0%).
Meta-regression showed that the study characteristics of patient number,
age, sex, diabetic status, and proportion of patients with prior PCI did not
affect the outcomes. Sensitivity analyses limited to multivariate studies
excluding patients with acute PCI failure showed similar results (early
mortality, OR: 1.25, p = 0.003; early MACE, OR: 1.50,
p = 0.001; late mortality, OR: 1.03,
p = 0.70). Conclusion: The current evidence, mostly from retrospective observational studies,
suggests that prior PCI is related to poor early clinical outcomes, but not
to late clinical outcomes, after CABG.
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Affiliation(s)
- Hongliang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Hou
- Department of Cardiology, Cixian People's Hospital, Han Dan City, China
| | - Moyang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanlu Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bincheng Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guannan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yonggang Sui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Anzhen road 2, Chaoyang District, Beijing 100029, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China
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Shekhar S, Mohananey D, Villablanca P, Tyagi S, Crestanello JA, Gil IJN, Ramakrishna H. Revascularization Strategies for Stable Left Main Coronary Artery Disease: Analysis of Current Evidence. J Cardiothorac Vasc Anesth 2021; 36:3370-3378. [PMID: 35115224 DOI: 10.1053/j.jvca.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sudhi Tyagi
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Iván J Núñez Gil
- Interventional Cardiology Consultant, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Chang C, Pan Y, Du H, Wang X, Li X. Serum amyloid A1 can be a novel biomarker for evaluating the presence and severity of acute coronary syndrome. Clin Biochem 2020; 85:27-32. [PMID: 32805223 DOI: 10.1016/j.clinbiochem.2020.08.005] [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: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serum amyloid A (SAA) is an acute phase protein and a novel inflammatory biomarker of cardiovascular diseases. Of the four subtypes, SAA1 is the most representative biomarker. In this study, we aimed to assess the value of SAA1 as a novel biomarker for evaluating the presence and severity of acute coronary syndrome (ACS) in Chinese patients. METHODS AND RESULTS A total of 140 ACS patients and 88 non-ACS patients (including 36 stable coronary artery disease (SCAD) patients and 52 healthy controls) who underwent coronary angiography were enrolled. The SAA1 level was significantly higher in ACS patients compared with the SCAD and healthy control subgroups (P < 0.001, respectively), and was significantly higher in the high SYNTAX Score II (SS II) group compared with the medium SS II group and low SS II group (P < 0.001, respectively) in ACS patients. The cutoff level of SAA1 for indicating the presence of ACS was 324.65 ng/mL (sensitivity of 77.9%, specificity of 60.2% and an area under the curve of 0.717). The increased SAA1 levels were positively associated with the presence (OR = 1.013, P < 0.001) and severity (OR = 1.023, P < 0.001) of ACS. Furthermore, there was a positive correlation between SAA1 levels and SS II (r = 0.467, P < 0.001). CONCLUSIONS Our results suggest that elevated SAA1 levels may be a novel biomarker for evaluating the presence of ACS and the severity of CAD in ACS patients. Measuring SAA1 levels makes it possible to evaluate the presence of ACS and severity of CAD in ACS patients.
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Affiliation(s)
- Cheng Chang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Yilong Pan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Hongjiao Du
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Xiao Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Xiaodong Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China.
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Three-year clinical outcome of unprotected left main coronary artery disease patients complicated with chronic kidney disease treated by coronary artery bypass graft versus percutaneous coronary intervention. Ir J Med Sci 2020; 190:89-96. [PMID: 32529544 DOI: 10.1007/s11845-020-02257-9] [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: 03/18/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) or after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in unprotected left main coronary artery disease (ULMCAD) patients complicated with chronic kidney disease (CKD). METHODS Three hundred sixty-eight ULMCAD patients complicated with CKD who underwent first ever CABG (n = 207) or PCI with DES (n = 161) were recruited in this prospective cohort study. Patients were followed up to MACCE occurrence or 36 months after operations, and accumulating MACCE occurrence was calculated. RESULTS Accumulating MACCE occurrence was decreased in CABG group compared with PCI group (P = 0.007). Subgroup analysis showed that CKD stage positively correlated with accumulating MACCE occurrence in total patients (P = 0.006) and in PCI-treated patients (P = 0.018), but not in CABG-treated patients (P = 0.217). Further univariate Cox's regression model displayed that CABG (versus (vs.) PCI) (P = 0.008) was associated with lower accumulating MACCE occurrence, while age (≥ 65 years) (P = 0.048), hyperlipidemia (P = 0.013), diabetes (P = 0.012), previous heart failure (P = 0.011), previous stroke (P = 0.030), LVEF < 50% (P = 0.048), higher CKD stage (P = 0.002), and more diseased vessels (P = 0.022) were associated with increased accumulating MACCE occurrence. Forward stepwise multivariate Cox's regression model disclosed that CABG (vs. PCI) (P = 0.002) independently predicted decreased accumulating MACCE occurrence, whereas hyperlipidemia (P = 0.033), diabetes (P = 0.002), higher CKD stage (P = 0.001), and more diseased vessels (P = 0.009) independently predicted elevated accumulating MACCE occurrence. CONCLUSION CABG could be considered as the preferred treatment strategy compared with PCI with DES in ULMCAD patients complicated with CKD.
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