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Yamamoto K, Saito Y, Hashimoto O, Nakayama T, Okino S, Sakai Y, Nakamura Y, Fukuzawa S, Himi T, Kobayashi Y. Biomarkers for Risk Stratification in Patients With Type A Acute Aortic Dissection. Am J Cardiol 2024; 212:103-108. [PMID: 38040278 DOI: 10.1016/j.amjcard.2023.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
Type A acute aortic dissection (AAD) is a fatal disease and thus, accurate and objective risk stratification is essential. In this study, we evaluated the prognostic value of readily available and assessable biomarkers in patients with type A AAD. This was a retrospective, multicenter, observational study. A total of 703 patients with type A AAD diagnosed using contrast-enhanced computed tomography were included. Therapeutic strategies were left to the physician's discretion in a real-world clinical setting. The prognostic value for in-hospital mortality was examined in 15 circulating biomarkers on admission, which are routinely available in clinical practice. Of the 703 patients, 126 (17.9%) died during the hospitalization. Of the 15 biomarkers, the multivariable analysis identified positive cardiac troponin, a low total bilirubin (T-Bil) level, and increased levels of brain natriuretic peptide (BNP) and lactate dehydrogenase (LDH) as significant predictors of in-hospital death. The receiver operating characteristics curve analysis showed that these 4 biomarkers had an independent additive prognostic value. With the cut-off values of T-Bil, BNP, and LDH, in combination with positive troponin, the increase in the number of positive biomarkers was progressively associated with higher in-hospital mortality from 1.3% to 9.8%, 20.5%, 36.4%, and 75.0% (p <0.001). In conclusion, in patients with type A AAD, positive cardiac troponin, a low T-Bil level, and increased levels of BNP and LDH on admission were related to higher in-hospital mortality, with an incremental prognostic value, suggesting that the readily available and assessable biomarkers can aid in decision-making in therapeutic strategies.
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Affiliation(s)
- Kayo Yamamoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Osamu Hashimoto
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, International University of Health and Welfare, Narita, Japan
| | - Shinichi Okino
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Yoshiaki Sakai
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Yoshitake Nakamura
- Division of Cardiology, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan
| | - Shigeru Fukuzawa
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Hashimoto O, Saito Y, Sasaki H, Yumoto K, Oshima S, Tobaru T, Kanda J, Sakai Y, Yasuda S. Treatment strategies and in-hospital mortality in patients with type A acute aortic dissection and coronary artery involvement. J Thorac Cardiovasc Surg 2024; 167:596-601.e3. [PMID: 35459537 DOI: 10.1016/j.jtcvs.2022.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Type A acute aortic dissection (AAD), especially that with coronary artery involvement and malperfusion, is a life-threatening disease. In the present study we aimed to investigate the association of surgical treatment and percutaneous coronary intervention (PCI) with in-hospital mortality in patients with type A AAD and coronary artery involvement. METHODS This retrospective multicenter registry in Japan included 225 patients with type A AAD and coronary artery involvement. Treatment strategies including surgical treatment and/or PCI were left to treating physicians. The primary end point was in-hospital death. RESULTS Of 225 patients, dissection extended into the right and left coronary arteries and both in 115 (51.1%), 105 (46.7%), and 5 (2.2%), respectively. Overall, 94 (41.8%) patients died during the hospitalization. Coronary angiography was performed in 53 (23.6%) patients, among whom 39 (73.6%) underwent PCI. Surgical repair was performed in 188 (83.6%) patients. In patients who received neither procedure, 33 of 35 (94.3%) died during the hospitalization. PCI was performed as a bridge to surgical repair in 37 of 39 (94.9%) patients, and in-hospital mortality of patients who underwent PCI and surgical procedures was 24.3%. Multivariable analysis identified PCI and surgical procedures as factors associated with lower in-hospital mortality rates. CONCLUSIONS Coronary artery involvement in type A AAD was associated with high in-hospital mortality of more than 40% in the current era. An early reperfusion strategy with PCI as a bridge to surgical repair might improve clinical outcomes in this fatal condition.
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Affiliation(s)
- Osamu Hashimoto
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Keita Yumoto
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Department of Aortic Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Yoshiaki Sakai
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Shojima T, Takagi K, Saku K, Fukuda T, Tayama E. Preoperative management using Impella support for acute aortic dissection with left coronary malperfusion: a case report. Egypt Heart J 2024; 76:11. [PMID: 38285313 PMCID: PMC10825086 DOI: 10.1186/s43044-024-00439-9] [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: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Acute aortic dissection (AAD) with impaired perfusion of the left coronary artery has a poor prognosis, even after urgent radical aortic surgery, due to extensive myocardial damage. Although Impella, a microaxial-flow catheter pump, is useful in managing acute myocardial infarction, it is generally contraindicated in patients with AAD because it is an intra-aortic device and the aortic structure is compromised in these cases. Here, we introduce a novel intervention that allowed a planned aortic repair after managing circulation using Impella and venoarterial extracorporeal membrane oxygenation in a case of AAD with left main trunk malperfusion. CASE PRESENTATION A 40-year-old man presented with cardiogenic shock. Percutaneous coronary intervention was performed to address left main trunk obstruction using an intra-aortic balloon pump; however, circulatory instability persisted. The patient was transferred to our hospital after venoarterial extracorporeal membrane oxygenation. Impella CP™ was used to improve his circulatory status. However, a subsequent CT scan confirmed an AAD diagnosis. After 5 days of stable circulatory support, the patient underwent aortic root replacement and coronary artery bypass grafting. CONCLUSIONS In patients with AAD and coronary malperfusion, adjunctive circulatory management with Impella may be a valuable therapeutic option.
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Affiliation(s)
- Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomofumi Fukuda
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
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Saito Y, Ichihara S, Hashimoto O, Nakayama T, Sasaki H, Yumoto K, Oshima S, Tobaru T, Kushida S, Kanda J, Sakai Y, Okino S, Fukuzawa S, Abiko A, Itoh T, Nakamura Y, Nakashima T, Yasuda S, Goto K, Takebayashi H, Oshitomi T, Sakamoto T, Kojima S, Otsuka Y, Himi T, Inagaki Y, Yamaguchi J, Hagiya K, Nanasato M, Kobayashi Y. Timing of Recognition of Type A Acute Aortic Dissection in Acute Myocardial Infarction. Am J Cardiol 2023; 207:428-430. [PMID: 37797549 DOI: 10.1016/j.amjcard.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Shinya Ichihara
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Osamu Hashimoto
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, International University of Health and Welfare, Narita, Japan
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Departments of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Keita Yumoto
- Cardiovascular Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Aortic Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Tetsuya Tobaru
- Departments of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shunichi Kushida
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Yoshiaki Sakai
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Shinichi Okino
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Shigeru Fukuzawa
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Akihiko Abiko
- Divisions of Cardiology, Iwate Medical University Hospital, Yahaba, Japan
| | - Tomonori Itoh
- Divisions of Cardiology, Iwate Medical University Hospital, Yahaba, Japan; Department of Internal Medicine and Community Medicine, Department of Medical Education, Iwate Medical University Hospital, Yahaba, Japan
| | - Yoshitake Nakamura
- Division of Cardiology, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan
| | - Takahiro Nakashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Goto
- Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
| | - Hideo Takebayashi
- Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
| | - Takashi Oshitomi
- Divisions of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamato, Japan
| | - Tomohiro Sakamoto
- Divisions of Cardiology, Saiseikai Kumamoto Hospital, Kumamato, Japan
| | - Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yoritaka Otsuka
- Department of Cardiovascular Medicine, Fukuoka Kieikai Hospital, Fukuoka, Japan
| | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yusuke Inagaki
- Department of Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP. J Atheroscler Thromb 2023; 30:1229-1241. [PMID: 36529503 PMCID: PMC10499455 DOI: 10.5551/jat.63956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 09/05/2023] Open
Abstract
AIMS Complex and high-risk intervention in indicated patients (CHIP) is an emerging concept in the contemporary percutaneous coronary intervention (PCI). CHIP is known to consist three factors, namely, (1) patient factors, (2) complicated heart disease, and (3) complex PCI. However, it remains unclear whether additional CHIP factors further increase the incidence of complications in complex PCI. Thus, in this study, we aim to compare the incidence of complications among definite CHIP, possible CHIP, and non-CHIP in terms of complex PCI and to further investigate the association between CHIP and complications. METHODS The primary aim of this study was to determine the major complications in PCI. We included 989 PCI lesions and divided those into definite CHIP (n=140), possible CHIP (n=397), and the non-CHIP groups (n=452). RESULTS The incidence of major complications was noted to be the highest in the definite CHIP, followed by the possible CHIP, and lowest in the non-CHIP (p=0.001). The multivariate logistic regression analysis using a generalized estimating equation revealed definite CHIP (versus non-CHIP: odds ratio (OR) 2.099, 95% confidence interval (CI) 1.062-4.150, p=0.033) was significantly associated with major complications after controlling for confounding factors. Another multivariate logistic regression analysis revealed immunosuppressive drugs (OR 3.040, 95% CI 1.251-7.386, p=0.014), unstable hemodynamics (OR 5.753, 95% CI 1.217-27.201, p=0.027), and frailty (OR 2.039, 95% CI 1.108-3.751, p=0.022) were significantly associated with major complications among CHIP factors. CONCLUSIONS The incidence of major complications in complex PCI was determined to be the highest in the definite CHIP, followed by the possible CHIP and lowest in the non-CHIP. Thus, more attention should be given to the three components of CHIP to prevent major complications in complex PCI.
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Affiliation(s)
- Yudai Fujimoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Yu J, Yu W, Zeng H, Gao J, Xiong J. Case report: Surgery combined with extracorporeal membrane oxygenation for a patient with type A aortic dissection complicated with myocardial infarction after percutaneous coronary intervention. Front Cardiovasc Med 2023; 10:1205373. [PMID: 37485265 PMCID: PMC10360360 DOI: 10.3389/fcvm.2023.1205373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Background Aortic dissection (AD) is a severe cardiovascular disease characterized by aortic rupture, aortic valve insufficiency, aortic branch lumen stenosis, and occlusion. Acute ST-segment elevation myocardial infarction may be the primary manifestation when aortic dissection affects the coronary artery, leading to delayed or missed diagnosis of aortic dissection, and preventing patients from receiving timely and comprehensive treatment. Simultaneous aortic repair and coronary artery bypass grafting surgery are controversial because of their high mortality rates. Personalized and optimal treatment plans for patients should be taken seriously based on their different conditions and treatment options. Case presentation A 42-year-old man who experienced 1 h of persistent precordialgia was admitted to a local second-level hospital for emergency treatment. Electrocardiogram (ECG) showed evidence of ST-segment elevation, and myocardial enzyme levels were CK-MB 18.35 ng/ml and troponin 0.42 ng/ml. The patient was treated for acute myocardial infarction (AMI) and urgently sent to the interventional catheter room. Coronary angiography showed stenosis of the starting part of the right coronary artery trunk. Thus, stent implantation was performed, and the stenosis section recovered patency; however, postoperative precordialgia was not alleviated. Computed tomography angiography (CTA) revealed a type A AD. The patient was immediately transferred to a higher-level hospital, underwent emergency surgery with cardiopulmonary bypass (CPB) ascending aorta replacement, SUN's procedure (total arch replacement and stented elephant trunk implantation), and simultaneous implantation of extracorporeal membrane oxygenation (ECMO), and regained consciousness within intensive care unit care. ECMO was discontinued when hemodynamics stabilized. The patient ultimately recovered well and was discharged. Conclusion This case demonstrated that precordialgia is not limited to myocardial infarction but may also be accompanied by aortic dissection. Percutaneous coronary intervention (PCI) can timely and effectively restore coronary artery perfusion, strive for the opportunity of aortic repair surgery, and can overcome pump failure caused by myocardial infarction, cardiopulmonary bypass, heart block time, and myocardial ischemia-reperfusion injury. Personalized treatment is crucial for patients with complex type A aortic dissection.
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Affiliation(s)
- Junjian Yu
- Department of Cardiac and Vascular Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wenbo Yu
- The First Clinical Medical College of Gannan Medical University, Ganzhou, China
| | - Hui Zeng
- Department of Thoracic and Cardiac Surgery, Ningdu County People's Hospital, Ganzhou, China
| | - Jianfeng Gao
- The First Clinical Medical College of Gannan Medical University, Ganzhou, China
| | - Jianxian Xiong
- Department of Cardiac and Vascular Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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7
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Fujimoto Y, Sakakura K, Fujita H. Complex and high-risk intervention in indicated patients (CHIP) in contemporary clinical practice. Cardiovasc Interv Ther 2023:10.1007/s12928-023-00930-1. [DOI: 10.1007/s12928-023-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
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8
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Saito Y, Oyama K, Tsujita K, Yasuda S, Kobayashi Y. Treatment strategies of acute myocardial infarction: updates on revascularization, pharmacological therapy, and beyond. J Cardiol 2023; 81:168-178. [PMID: 35882613 DOI: 10.1016/j.jjcc.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 10/16/2022]
Abstract
Owing to recent advances in early reperfusion strategies, pharmacological therapy, standardized care, and the identification of vulnerable patient subsets, the prognosis of acute myocardial infarction has improved. However, there is still considerable room for improvement. This review article summarizes the latest evidence concerning clinical diagnosis and treatment of acute myocardial infarction.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Kazuma Oyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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9
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Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention. J Clin Med 2023; 12:jcm12030840. [PMID: 36769488 PMCID: PMC9917385 DOI: 10.3390/jcm12030840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is a rare but critical complication following ST-elevation myocardial infarction (STEMI). The risk of AIS or transient ischemic attack (TIA) may be amplified by invasive procedures, including primary percutaneous coronary intervention (PCI). This study aimed to investigate the factors associated with in-hospital AIS/TIA in patients with STEMI who required primary PCI. METHODS We included 941 STEMI patients who underwent primary PCI and divided them into an AIS/TIA group (n = 39) and a non-AIS/TIA group (n = 902), according to new-onset AIS/TIA. The primary interest was to find the factors associated with AIS/TIA by multivariate logistic regression analysis. We also compared clinical outcomes between the AIS/TIA and non-AIS/TIA groups. RESULTS The incidence of in-hospital deaths was significantly higher in the AIS/TIA group (46.2%) than in the non-AIS/TIA group (6.3%) (p < 0.001). Multivariate analysis revealed that cardiogenic shock (OR 3.228, 95% CI 1.492-6.986, p = 0.003), new-onset atrial fibrillation (AF) (OR 2.280, 95% CI 1.033-5.031, p = 0.041), trans-femoral approach (OR 2.336, 95% CI 1.093-4.992, p = 0.029), use of ≥4 catheters (OR 3.715, 95% CI 1.831-7.537, p < 0.001), and bleeding academic research consortium (BARC) type 3 or 5 bleeding (OR 2.932, 95% CI 1.256-6.846, p = 0.013) were significantly associated with AIS/TIA. CONCLUSION In STEMI patients with primary PCI, new-onset AIS/TIA was significantly associated with cardiogenic shock, new-onset AF, trans-femoral approach, the use of ≥4 catheters, and BARC type 3 or 5 bleeding. We should recognize these modifiable and unmodifiable risk factors for AIS/TIA in the treatment of STEMI.
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10
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Right versus left coronary artery involvement in patients with type A acute aortic dissection. Int J Cardiol 2023; 371:49-53. [PMID: 36257475 DOI: 10.1016/j.ijcard.2022.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Type A acute aortic dissection (AAD) complicated by coronary malperfusion is a life-threatening disease. In the present study, we compared the clinical characteristics and prognostic impact of treatment strategies including surgical treatment and percutaneous coronary intervention (PCI) in type A AAD patients with RCA and LCA involvement. METHODS This multicenter registry included 220 patients with type A AAD and either RCA or LCA involvement. Treatment strategies were left to treating physicians. The primary endpoint was in-hospital death. RESULTS Of 220 patients, 115 (52.3%) and 105 (47.7%) had RCA and LCA involvement. Patients with LCA involvement were more1 likely to present with Killip class IV on admission than those with RCA involvement. Coronary angiography was performed in 52 of 220 (23.6%) patients, among whom 39 (75.0%) underwent subsequent PCI. During the hospitalization, 93 (42.3%) patients died. Patients with LCA involvement had an increased risk of in-hospital mortality compared to those with RCA involvement (54.3% vs. 31.3%, p < 0.001). In patients with RCA involvement, multivariable analysis identified Killip class IV and no surgical treatment as predictors of in-hospital death, while PCI and surgical treatment were indicated as factors associated with lower in-hospital mortality in patients with LCA involvement. CONCLUSIONS The rates of RCA and LCA involvement were similar in type A AAD. Immediate PCI as a bridge to subsequent surgical treatment might improve survival in patients with type A AAD complicated by coronary malperfusion, especially in those with LCA involvement.
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11
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Qin W, Fan R, Wang J, Li J, Huang F, Chen X. Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement. Front Surg 2022; 9:950264. [PMID: 36225217 PMCID: PMC9549406 DOI: 10.3389/fsurg.2022.950264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coronary artery (CA) involvement due to acute aortic dissection (AAD) is a catastrophic cardiovascular disease with high mortality. Two main surgery strategies, local coronary repair and coronary artery bypass grafting (CABG) can be applied to reestablish the blood flow in the aortic repair. This study was to evaluate the operative and long-term outcomes of type A AAD patients, who received aortic dissection repair plus CABG or local coronary repair. Method We reviewed our database and screened 148 type A AAD patients with CA involvement from January 2001 to December 2021. Local coronary repair or CABG was performed concomitantly on these enrolled patients. Results At the time of aortic repair, there were 58 patients with concomitant CABG (Group I) and 90 patients with local coronary repair (Group II). The basal characteristics of these two groups had no difference, except for acute myocardial ischemia (AMI) and CA involvement type. 45 patients with AMI in Group I, but none in Group II (P < 0.001). There was a higher frequency of type B and C lesions of CA involvement in Group I than that in Group II (P < 0.001). There was no difference in surgical procedures and complications, except for postoperative acute kidney injury (AKI) (34.5% vs. 8.9%, P < 0.001). Hospital mortality in Group I was higher than that in Group II, but without statistical difference (20.7% vs. 11.1%, P = 0.155). No significant difference was obtained in long-term survival rate between the two groups (82.5 ± 4.8% vs. 81.2 ± 6.9%, P = 0.19). Conclusion CABG and local coronary repair suits different types of CA involvement, and their effects on perioperative results and long-term survival for type A AAD patients with CA involvement are equal.
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Affiliation(s)
- Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Fan
- School of Medicine, Southeast University, Nanjing, China
| | - Jiankai Wang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Correspondence: Fuhua Huang Xin Chen
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Correspondence: Fuhua Huang Xin Chen
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