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Sheng X, Yang G, Zhang Q, Zhou Y, Pu J. Impact of risk factors on intervened and non-intervened coronary lesions. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:255-266. [PMID: 39309112 PMCID: PMC11410792 DOI: 10.62347/xtbg3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/21/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION In-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL) are two pivotal aspects of disease progression in patients with coronary artery disease (CAD). Established risk factors for both include hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking. However, there is limited research on the comparative risk factors for the progression of these two aspects of progression. The aim of this study was to analyze and compare the different impacts of identical risk factors on ISR and ANL. METHODS This study enrolled a total of 510 patients with multiple coronary artery lesions who underwent repeated coronary angiography (CAG). All patients had previously undergone percutaneous coronary intervention (PCI) and presented non-intervened coronary lesions in addition to the previously intervened vessels. RESULTS After data analysis, it was determined that HbA1c (OR 1.229, 95% CI 1.022-1.477, P=0.028) and UA (OR 1.003, 95% CI 1.000-1.005, P=0.024) were identified as independent risk factors for ISR. Furthermore, HbA1c (OR 1.215, 95% CI 1.010-1.460, P=0.039), Scr (OR 1.007, 95% CI 1.003-1.017, P=0.009), and ApoB (OR 1.017, 95% CI 1.006-1.029, P=0.004) were identified as independent risk factors for ANL. The distribution of multiple blood lipid levels differed between the ANL only group and the ISR only group. Non-HDL-C (2.17 mmol/L vs. 2.44 mmol/L, P=0.007) and ApoB (63.5 mg/dL vs. 71.0 mg/dL, P=0.011) exhibited significantly higher values in the ANL only group compared to the ISR only group. CONCLUSIONS Blood glucose levels and chronic kidney disease were identified as independent risk factors for both ISR and ANL, while elevated lipid levels were only significantly associated with ANL. In patients with non-intervened coronary lesions following PCI, it is crucial to assess the concentration of non-HDL-C and ApoB as they serve as significant risk factors.
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Affiliation(s)
- Xincheng Sheng
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China
| | - Gan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China
| | - Qing Zhang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China
| | - Yong Zhou
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China
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Ermis E, Kahraman S, Ucar H, Ozyılmaz SO, Allahverdiyev S. Triple Coronary Artery Thrombosis Presenting as Acute Anterior ST-Segment Elevation Myocardial Infarction. Int J Angiol 2018; 27:223-226. [PMID: 30410294 DOI: 10.1055/s-0037-1608959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Simultaneous multivessel epicardial coronary artery thrombosis is an uncommon finding in acute ST-segment elevation myocardial infarction (STEMI). It generally leads to cardiogenic shock and sudden cardiac death in the hospital. We report a 42-year-old male patient presenting with acute anterior STEMI with triple coronary artery thrombosis. An emergency coronary angiogram showed total occlusion of the left anterior descending artery (LAD) with thrombus formation. At the same time, thrombus formations were also seen in the circumflex artery (CXA), the second obtuse marginal (OM2) branch, and the distal right coronary artery (RCA). We unsuccessfully attempted thrombus aspiration of the LAD. Subsequently, we decided to stent the LAD, and a successful percutaneous coronary intervention (PCI) was performed for the LAD. In a second procedure, RCA thrombosis regressed with 24-hour tirofiban (glycoprotein IIb/IIIa receptor inhibitor) perfusion, although CXA thrombosis and OM thrombosis did not regress. Therefore, we performed stenting of the CXA and OM with a newer provisional technique called the flower petal technique. Thrombolysis in myocardial infarction (TIMI) flow grade III was seen after stenting. The patient was discharged from the hospital 5 days after PCI without any symptoms.
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Affiliation(s)
- Emrah Ermis
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Silivri State Hospital, Istanbul, Turkey
| | - Hakan Ucar
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Sinem Ozbay Ozyılmaz
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Samir Allahverdiyev
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
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Knudtson ML. In Search of the Optimal Strategy for Multivessel Disease Revascularization. JACC Cardiovasc Interv 2017; 10:24-26. [PMID: 28057283 DOI: 10.1016/j.jcin.2016.11.035] [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: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Merril L Knudtson
- University of Calgary, Faculty of Medicine, Calgary, Alberta, Canada.
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Association of syntax score with short-term outcomes among acute ST-elevation myocardial infarction patients undergoing primary PCI. Indian Heart J 2016; 69 Suppl 1:S20-S23. [PMID: 28400034 PMCID: PMC5388013 DOI: 10.1016/j.ihj.2016.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/25/2016] [Accepted: 08/08/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Syntax score (SX) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on location and complexity of each lesion. It has been shown to predict long-term clinical outcomes in patients with left main or multi-vessel disease and recently also in ST-segment elevation myocardial infarction undergoing primary PCI. The aim of this study was to evaluate whether the syntax score is associated with short-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods Syntax score was determined in 90 consecutive patients (mean age 54.2 ± 11.6) of STEMI undergoing primary PCI. Outcomes were stratified according to syntax score groups: SX low ≤15 (n = 33), SX mid 16–22 (n = 30), and SX high ≥23 (n = 27). The primary endpoint was all-cause mortality at 30 days. Secondary endpoints were nonfatal major adverse cardiac and cerebrovascular events (MACE) defined as a composite of any repeat revascularization, acute coronary syndrome, and stroke at 30 days in patients discharged alive. Results Mortality at 30 days was higher in the SX high group compared to the SX mid and SX low group (18.5% vs 3.3% p = 0.011), MACE at 30 days was higher in SX high group compared to SX mid and SX low group (48.1% vs 16.6% vs 9.1%, p = 0.001). Conclusions The syntax score is associated with 30-day mortality in patients with STEMI undergoing primary PCI. In those discharged, it is associated with risk of MACE at 30 days.
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Weissler-Snir A, Gurevitz C, Assali A, Vaknin-Assa H, Bental T, Lador A, Yavin H, Perl L, Kornowski R, Lev E. Prognosis of STEMI Patients with Multi-Vessel Disease Undergoing Culprit-Only PCI without Significant Residual Ischemia on Non-Invasive Stress Testing. PLoS One 2015; 10:e0138474. [PMID: 26406235 PMCID: PMC4583296 DOI: 10.1371/journal.pone.0138474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/31/2015] [Indexed: 12/28/2022] Open
Abstract
Aims In about 50–80% of ST-segment elevation myocardial infarction (STEMI) patients there is significant atherosclerotic disease in other coronary arteries in addition to the culprit vessel. There is substantial controversy as to the optimal revascularization approach in these patients. We sought to compare the outcomes of STEMI patients with multi-vessel disease (MVD) treated with culprit-only primary percutaneous coronary intervention (PPCI) without significant ischemia on subsequent non-invasive testing, to those of STEMI patients with single-vessel disease (SVD). Methods and Results Between 2001–2010, 1,540 consecutive patients treated with primary PCI for STEMI were prospectively observed and entered into a comprehensive clinical database. The primary end point was a composite of major adverse cardiac events (MACE), consisting of mortality, re-infarction and revascularization within 1 and 3 years following PPCI (excluding events occurring during the first 30 days). Patients with cardiogenic shock were excluded. The study included 720 patients with SVD and 185 patients with MVD who underwent culprit-only PPCI and had no residual ischemia on subsequent non-invasive stress testing. Patients with MVD were older, more likely to have hypertension or previous MI and less likely to be smokers and present with anterior MI than patients with SVD. One and 3-year MACE rates were similar between the groups. On cox proportional-hazards regression MVD without residual ischemia was not independently associated with MACE and its components. Conclusions STEMI patients with MVD treated with culprit only-PCI without significant residual ischemia on non-invasive stress testing appear to have similar prognosis to STEMI patients with SVD.
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Affiliation(s)
| | - Chen Gurevitz
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Tamir Bental
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Adi Lador
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Hagai Yavin
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Leor Perl
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eli Lev
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Su MI, Tsai CT, Yeh HI, Chen CY. The impact of SYNTAX score of non-infarct-related artery on long- term outcome among patients with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. PLoS One 2014; 9:e109828. [PMID: 25303079 PMCID: PMC4193833 DOI: 10.1371/journal.pone.0109828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022] Open
Abstract
Objective We investigated the impact of the severity of stenosis in a non-infarct-related artery (IRA) on the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods Three hundred one consecutive patients (age: 59.7 ± 13.2 years, 85.5% men) underwent primary PCI during 2009–2012. Receiver operating characteristic curve analysis found the optimal cutoff for non-IRA SYNTAX score (SS) to be 2.5. We divided the patients into two groups according to this cutoff value. Results By multivariable analysis, non-IRA SS (≥2.5) was an independent predictor of major adverse cardiac events (hazard ratio [HR]: 2.15, 95% confidence interval [CI]: 1.21–3.79, P = 0.008) and all-cause mortality (HR: 3.49, 95% CI: 1.13–10.8, P = 0.03). However, the prediction of cardiovascular mortality had only borderline significance (HR: 3.29, 95% CI: 0.90–12.08, P = 0.07). Conclusion STEMI patients treated with primary PCI and moderate to severe non-IRA stenosis (SS ≥2.5) have more subsequent cardiac events. Those populations should be treated with more aggressive preventive and medical management.
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Affiliation(s)
- Min-I Su
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Ting Tsai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, New Taipei City, Taiwan
| | - Chun-Yen Chen
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, New Taipei City, Taiwan
- * E-mail:
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Kim MC, Jeong MH, Kim SH, Hong YJ, Kim JH, Ahn Y. Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. Korean Circ J 2014; 44:131-8. [PMID: 24876852 PMCID: PMC4037633 DOI: 10.4070/kcj.2014.44.3.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Primary percutaneous coronary intervention (PCI) is a standard interventional treatment modality for ST-segment elevation myocardial infarction (STEMI). Diagnostic coronary angiogram during PCI reveals multivessel coronary artery disease in about half of patients with STEMI, and it is difficult to make decision on the extent of intervention in these patients. Although revascularization for the infarct-related artery only is still effective for STEMI patients, several studies have reported the efficacy of multivessel revascularization during primary PCI, as well as in a staged PCI procedure. Clinicians should consider clinical aspects such as initial cardiogenic shock and myocardial viability when performing primary multivessel intervention, including the risks and benefits of multivessel revascularization in patients undergoing primary PCI. This review describes the current status of performing multivessel PCI in patients with STEMI and proposes an optimal revascularization strategy based on the previous literature.
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Affiliation(s)
- Min Chul Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Hyung Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
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Zhao W, Bai J, Zhang F, Guo L, Gao W. Impact of completeness of revascularization by coronary intervention on exercise capacity early after acute ST-elevation myocardial infarction. J Cardiothorac Surg 2014; 9:50. [PMID: 24641986 PMCID: PMC3995092 DOI: 10.1186/1749-8090-9-50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 03/11/2014] [Indexed: 11/29/2022] Open
Abstract
Background The importance of achieving complete revascularization by percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI) on exercise capacity remains unclear. Objective To compare exercise capacity early after acute ST-elevation myocardial infarction (STEMI), in patients receiving PCI with stenting, between those completely revascularized (CR) and those incompletely revascularized (IR). Methods We retrospectively reviewed 326 patients [single-vessel disease (SVD) group, 118 patients; multivessel disease (MVD) with CR group, 112 patients; MVD with IR group, 96 patients] who underwent cardiopulmonary exercise testing 7–30 days after STEMI to measure peak oxygen uptake (VO2peak), oxygen uptake at anaerobic threshold (VO2AT), and peak oxygen pulse. Demographic data, presence of concomitant diseases, STEMI characteristics, and echocardiography and angiography findings were evaluated. Results Most patients were male (89.0%) and mean age was 55.6 ± 11.2 years. Ischemic ST deviation occurred in 7.1%, with no significant difference between groups. VO2peak and VO2AT did not differ significantly between groups, despite a trend to be lower in the CR and IR groups compared with the SVD group. Peak oxygen pulse was significantly higher in the SVD group than in the IR group (p = 0.005). After adjustment for age, gender, body mass index, cardiovascular risk factors, MI characteristics and echocardiography parameters, CR was not an independent predictor of VO2peak (OR = −0.123, 95% confidence interval [CI] -2.986 to 0.232, p = 0.093), VO2AT (OR = 0.002, 95% CI 1.735 to 1.773, p = 0.983), or peak oxygen pulse (OR = −0.102, 95% CI −1.435 to 0.105, p = 0.090). Conclusion CR in patients with STEMI treated with PCI for multivessel disease might show no benefit on short-term exercise tolerance over IR.
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Affiliation(s)
| | | | | | | | - Wei Gao
- Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory peptides, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China.
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Akgun T, Oduncu V, Bitigen A, Karabay CY, Erkol A, Kocabay G, Ozveren O, Yildiz A, Cimen AO, Kirma C. Baseline SYNTAX Score and Long-Term Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2014; 21:712-9. [DOI: 10.1177/1076029614521281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion ( P < .001), multivessel disease ( P < .001), chronic total occlusion ( P < .001), and proximal lesion localization ( P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.
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Affiliation(s)
- Taylan Akgun
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Vecih Oduncu
- Department of Cardiology, Medical Park Fatih Hospital, Istanbul, Turkey
| | | | - Can Yucel Karabay
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Ayhan Erkol
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Gonenc Kocabay
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Olcay Ozveren
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Abdulmelik Yildiz
- Department of Cardiology, Medical Park Fatih Hospital, Istanbul, Turkey
| | | | - Cevat Kirma
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
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Chen SH, Chakrabarti AK. Percutaneous coronary intervention of culprit and non-culprit coronary arteries in acute ST-elevation MI may improve outcomes. EVIDENCE-BASED MEDICINE 2014; 19:96. [PMID: 24453086 DOI: 10.1136/eb-2013-101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Stuart H Chen
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anjan K Chakrabarti
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Brown AJ, McCormick LM, Gajendragadkar PR, Hoole SP, West NE. Initial SYNTAX Score Predicts Major Adverse Cardiac Events After Primary Percutaneous Coronary Intervention. Angiology 2013; 65:408-12. [DOI: 10.1177/0003319713483542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We assessed whether interventional complexity in patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) predicted long-term outcome. Consecutive patients undergoing PPCI for STEMI underwent SYNTAX scoring, based on angiographic images obtained at coronary intervention. Patients were classified as SYNTAX score (SS) ≤22 (low, L), 23 to 32 [intermediate (IM)], and ≥33 (high, H). The median SS for the cohort was 19 [Interquartile range (IQR), 11.0-25.5] with median tertile scores of L 14 (IQR 9.0-18.5, n = 437), IM 26 (IQR 24.0-28.5, n = 170), and H 36 (IQR 34.5-40.5, n = 67). Two-year freedom from major adverse cardiac events (MACE) was L 88.1%, IM 78.8%, and H 68.7% ( P < .001). Multivariate analysis confirmed that increasing SS tertile was an independent predictor of MACE [IM hazard ratio (HR) 1.61, confidence interval (CI) 1.05-2.47; P = .03, H HR 1.99, CI 1.16-3.41; P = .01]. The SS, when applied to patients undergoing PPCI for STEMI, provides prognostic information.
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Affiliation(s)
- Adam J. Brown
- Department of Interventional Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Liam M. McCormick
- Department of Interventional Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
| | | | - Stephen P. Hoole
- Department of Interventional Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Nick E.J. West
- Department of Interventional Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
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Biondi Zoccai G, Abbate A, D'Ascenzo F, Presutti D, Peruzzi M, Cavarretta E, Marullo AGM, Lotrionte M, Frati G. Percutaneous coronary intervention in nonagenarians: pros and cons. J Geriatr Cardiol 2013; 10:82-90. [PMID: 23610578 PMCID: PMC3627716 DOI: 10.3969/j.issn.1671-5411.2013.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/15/2013] [Accepted: 02/28/2013] [Indexed: 02/05/2023] Open
Abstract
Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.
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Affiliation(s)
- Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy
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Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial. Neth Heart J 2012; 20:347-53. [PMID: 22622701 DOI: 10.1007/s12471-012-0281-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There are conflicting data regarding optimal treatment of non-culprit lesions detected during primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). We aimed to investigate whether ischaemia-driven early invasive treatment improves the long-term outcome and prevents major adverse cardiac events (MACE). METHODS 121 patients with at least one non-culprit lesion were randomised in a 2:1 manner, 80 were randomised to early fractional flow reserve (FFR)-guided PCI (invasive group), and 41 to medical treatment (conservative group). The primary endpoint was MACE at 3 years. RESULTS Three-year follow-up was available in 119 patients (98.3 %). There was no significant difference in all-cause mortality between the invasive and conservative strategy, 4 patients (3.4 %) died, all in the invasive group (P = 0.29). Re-infarction occurred in 14 patients (11.8 %) in the invasive group versus none in the conservative group (p = 0.002). Re-PCI was performed in 7 patients (8.9 %) in the invasive group and in 13 patients (32.5 %) in the conservative group (P = 0.001). There was no difference in MACE between these two strategies (35.4 vs 35.0 %, p = 0.96). CONCLUSIONS In STEMI patients with MVD, early FFR-guided additional revascularisation of the non-culprit lesion did not reduce MACE at three-year follow-up compared with a more conservative strategy. The rate of MACE in the invasive group was predominantly driven by death and re-infarction, whereas in the conservative group the rate of MACE was only driven by repeat interventions.
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Luo Y, Pan YZ, Zeng C, Li GL, Lei XM, Liu Z, Zhou SF. Altered serum creatine kinase level and cardiac function in ischemia-reperfusion injury during percutaneous coronary intervention. Med Sci Monit 2011; 17:CR474-9. [PMID: 21873942 PMCID: PMC3560508 DOI: 10.12659/msm.881932] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Myocardial ischemia-reperfusion injury (MIRI) resulting from primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is considered harmful to the patient, but its clinical significance remains unclear. This study explored the relationship of cardiac function examined by echocardiography and serum creatine kinase (CK) and CK-MB levels with MIRI in a cohort of Chinese AMI patients. Material/Methods We retrospectively analysed the clinical and angiographic data in 228 AMI patients in whom the infarct-related artery (IRA) was successfully recanalized by primary PCI. Cardiac function was evaluated by use of echocardiography before discharge from hospital. Results The in-hospital mortality rate in the MIRI group was 13.4% (16/119), which was significantly higher than the 4.6% (5/109) mortality rate in the non-MIRI group (P=0.021). The median of peak serum CK level was remarkably lower in the suppression-type MIRI group than in the non-MIRI group. There were no significant differences in the peak serum CK or CK-MB levels between the irritation-type MIRI group and the non-MIRI group. The peak CK and CK-MB levels were significantly higher in the no-reflow-type MIRI group than in the non-MIRI group. Left ventricular ejection fraction in the no-reflow-type MIRI group was significantly lower than in the non-MIRI group; left ventricular end-diastolic volume was significantly higher than in the irritation-type MIRI subgroup; and left ventricular end-systolic volume was greater than that in non-MIRI group and suppression-type MIRI group. Conclusions MIRI (especially the no-reflow type) may lead to acute hemodynamic disorders and increase the mortality rate. However, suppression- and irritation-type MIRI may imply the existence of surviving myocardium.
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Affiliation(s)
- Yi Luo
- Department of Cardiology, Guangzhou 1st People's Hospital Affiliated to Guangzhou Medical College, Guangzhou, Guangdong, China.
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Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J 2011; 32:2125-34. [PMID: 21697170 DOI: 10.1093/eurheartj/ehr213] [Citation(s) in RCA: 371] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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