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Lee JH, Cho H, Lee SH, Lee SJ, Kang CD, Choi DH, Park JM, Nam SJ, Kim TS, Kim JH, Park SC. Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:143-149. [PMID: 38659250 DOI: 10.4166/kjg.2024.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024]
Abstract
Background/Aims Colorectal adenomas are precancerous lesions that may lead to colorectal cancer. Recent studies have shown that colorectal adenomas are associated with atherosclerosis. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) are noninvasive methods for evaluating atherosclerosis. This study examined the association between atherosclerosis and high-risk colorectal adenomas based on the CAVI and ABI. Methods The data of patients aged ≥50 years who had a colonoscopy and CAVI and ABI measurements from August 2015 to December 2021 at the Kangwon National University Hospital were analyzed retrospectively. After the colonoscopy, subjects were divided into no, overall, and high-risk (size ≥1 cm, high-grade dysplasia or villous adenoma, three or more adenomas) adenoma groups based on the pathology findings. The data were subjected to univariate and multivariate logistic regression analyses. Results Among the 1,164 subjects, adenomas and high-risk adenomas were found in 613 (52.6%) and 118 (10.1%) patients, respectively. The rate of positive ABI (<0.9) and positive CAVI (≥9.0) were significantly higher in the high-risk adenoma group (22.0% and 55.9%) than in the no adenoma (12.3% and 39.6%) and the overall adenoma group (15.7% and 44.0%) (p=0.008 and p=0.006, respectively). Multivariate analysis revealed a positive CAVI and smoking status to be significantly associated with high-risk adenoma with an odds ratio of 1.595 (95% confidence interval 1.055-2.410, p=0.027) and 1.579 (1.072-2.324, p=0.021), respectively. Conclusions In this study, a significant correlation between positive CAVI and high-risk adenomas was observed. Therefore, CAVI may be a significant predictor for high-risk colorectal adenoma.
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Affiliation(s)
- Jung Ho Lee
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Hyunseok Cho
- Department of Pediatrics, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sang Hoon Lee
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sung Joon Lee
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Dae Hee Choi
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Tae Suk Kim
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
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Fioretti V, Gerardi D, Giugliano G, Di Fazio A, Stabile E. Focus on Prevention: Peripheral Arterial Disease and the Central Role of the Cardiologist. J Clin Med 2023; 12:4338. [PMID: 37445373 PMCID: PMC10342387 DOI: 10.3390/jcm12134338] [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: 05/17/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a manifestation of systemic atherosclerotic disease. PAD patients have a poor prognosis with an increased risk of cardiovascular (CV) events, including myocardial infarction (MI), stroke, limb ischemia and CV death; therefore, it is important to detect and treat PAD early. PAD and coronary artery disease (CAD) share a common pathogenesis and risk factors for development; therefore, cardiologists are in a unique position to screen, diagnosis and treat PAD. Moreover, PAD and CAD also share some treatment goals, including an aggressive modification of risk factors to reduce the risk of CV events. However, PAD remains an underdiagnosed and undertreated disease with medico-legal implications. As the role of cardiologists is expanding, the purpose of this review was to awaken the clinicians to the significance of PAD.
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Affiliation(s)
- Vincenzo Fioretti
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, 85100 Potenza, Italy
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Donato Gerardi
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, 85100 Potenza, Italy
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Aldo Di Fazio
- Regional Complex Intercompany Institute of Legal Medicine, Azienda Ospedaliera Regionale “San Carlo”, 85100 Potenza, Italy;
| | - Eugenio Stabile
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, 85100 Potenza, Italy
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Lin MC, Tseng VS, Lin CS, Chiu SW, Pan LK, Pan LF. Quantitative Prediction of SYNTAX Score for Cardiovascular Artery Disease Patients via the Inverse Problem Algorithm Technique as Artificial Intelligence Assessment in Diagnostics. Diagnostics (Basel) 2022; 12:diagnostics12123180. [PMID: 36553187 PMCID: PMC9777487 DOI: 10.3390/diagnostics12123180] [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: 11/24/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The quantitative prediction of the SYNTAX score for cardiovascular artery disease patients using the inverse problem algorithm (IPA) technique in artificial intelligence was explored in this study. A 29-term semi-empirical formula was defined according to seven risk factors: (1) age, (2) mean arterial pressure, (3) body surface area, (4) pre-prandial blood glucose, (5) low-density-lipoprotein cholesterol, (6) Troponin I, and (7) C-reactive protein. Then, the formula was computed via the STATISTICA 7.0 program to obtain a compromised solution for a 405-patient dataset with a specific loss function [actual-predicted]2 as low as 3.177, whereas 0.0 implies a 100% match between the prediction and observation via "the lower, the better" principle. The IPA technique first created a data matrix [405 × 29] from the included patients' data and then attempted to derive a compromised solution of the column matrix of 29-term coefficients [29 × 1]. The correlation coefficient, r2, of the regression line for the actual versus predicted SYNTAX score was 0.8958, showing a high coincidence among the dataset. The follow-up verification based on another 105 patients' data from the same group also had a high correlation coefficient of r2 = 0.8304. Nevertheless, the verified group's low derived average AT (agreement) (ATavg = 0.308 ± 0.193) also revealed a slight deviation between the theoretical prediction from the STATISTICA 7.0 program and the grades assigned by clinical cardiologists or interventionists. The predicted SYNTAX scores were compared with earlier reported findings based on a single-factor statistical analysis or scanned images obtained by sonography or cardiac catheterization. Cardiologists can obtain the SYNTAX score from the semi-empirical formula for an instant referral before performing a cardiac examination.
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Affiliation(s)
- Meng-Chiung Lin
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 10041, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 40044, Taiwan
| | - Vincent S. Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu 10041, Taiwan
| | - Chih-Sheng Lin
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing 210000, China
| | - Shao-Wen Chiu
- Department of Pet Business Management, Taipei University of Marine Technology, Taipei 10001, Taiwan
| | - Lung-Kwang Pan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung 40044, Taiwan
| | - Lung-Fa Pan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung 40044, Taiwan
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 40044, Taiwan
- Correspondence:
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Grachev VG, Vedenskaya SS, Smolenskaya OG. Features of Antithrombotic Therapy in Patients with Multifocal Arterial Disease. ACTA ACUST UNITED AC 2021; 61:87-95. [PMID: 33849424 DOI: 10.18087/cardio.2021.3.n1498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
Multifocal arterial injury is common in patients with atherosclerotic cardiovascular diseases and is associated with increased risk of cardiovascular complications and death. Administration of more intensive antithrombotic therapy, particularly combinations of acetylsalicylic acid and a "vascular" dose of rivaroxaban, in patients with multifocal arterial injury is characterized by a beneficial ratio of efficiency and safety due to a pronounced decrease in the risk of cardiovascular complications. Detection of peripheral artery diseases in patients with ischemic heart disease and atherosclerotic cerebrovascular pathology makes it possible to improve the risk stratification, optimize the diagnostic tactics and clarify indications for more intensive antithrombotic therapy.
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Affiliation(s)
- V G Grachev
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
| | - S S Vedenskaya
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
| | - O G Smolenskaya
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
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Grachev VG, Vedenskaya SS, Smolenskaya OG. Features of Risk Stratification, Diagnosis and Secondary Prevention in Patients with Multifocal Arterial Disease. Part 1: Risk Stratification and Diagnosis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Multifocal arterial disease is common in patients with atherosclerotic cardiovascular disease and is associated with an increased risk of cardiovascular complications and death. The possibility of improving the prognosis of patients with multifocal arterial disease is associated with a more efficient diagnosis of both the underlying disease and obstructive atherosclerotic lesions of other localizations and with a more intensive secondary prevention. According to observational studies, the presence of significant stenoses of the carotid arteries and, especially, lower extremities arterial disease can be predictorы of similar lesions in other vascular beds and their detection with screening methods available in clinical practice allows improvement of the diagnosis in patients with suspected coronary artery disease. On the other hand, screening of lower extremities artery diseases in patients with acute coronary syndrome can clarify indications for the use of invasive diagnostic and treatment strategy, in patients with chronic coronary artery disease it can justify more aggressive approaches to secondary prevention.
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Cardiac rehabilitation in people with peripheral arterial disease: A higher risk population that benefits from completion. Int J Cardiol 2019; 285:108-114. [DOI: 10.1016/j.ijcard.2019.02.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/27/2019] [Indexed: 01/12/2023]
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Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:52-58. [PMID: 29743904 PMCID: PMC5939545 DOI: 10.5114/aic.2018.74355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/02/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction The extent of peripheral artery disease (PAD) measured by the ankle-brachial index (ABI) and intima-media thickness (IMT) is correlated with the complexity of coronary artery disease (CAD) in stable angina patients. However, data regarding patients with acute coronary syndromes are still lacking. Aim To compare coronary complexity measured by the SYNTAX score in patients with and without PAD presenting with myocardial infarction (MI). Material and methods Both ABI and IMT were measured in 101 consecutive patients who underwent primary diagnostic due to MI. Patients were divided into three tertile groups depending on the SYNTAX score (0-4; 5-11; 12 and more points). Results Mean ABI in the general population was 0.9 ±0.26, mean IMT was 0.8 ±0.3 mm and mean SYNTAX score was 7.8 ±5.4 points. We found significant correlations between ABI and SYNTAX score (p = 0.01), IMT and SYNTAX score (p < 0.001), and IMT and ABI (p < 0.001). The highest mean values of IMT (p < 0.001) and lowest mean values of ABI (p = 0.015) were found in patients in the highest SYNTAX score group. When analyzing receiver operating characteristics (ROC) curves, IMT had greater specificity and sensitivity than ABI. Conclusions Both IMT and ABI are correlated with SYNTAX score (positively for IMT and negatively for ABI values). In our study, IMT was a better predictor of SYNTAX score than ABI. Our study suggests that the higher rate of cardiovascular events in patients with PAD presenting with MI may be partially explained by greater coronary lesion complexity.
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Bryniarski KL, Yamamoto E, Takumi H, Xing L, Zanchin T, Sugiyama T, Lee H, Jang IK. Differences in coronary plaque characteristics between patients with and those without peripheral arterial disease. Coron Artery Dis 2017; 28:658-663. [DOI: 10.1097/mca.0000000000000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hashizume N, Miura T, Miyashita Y, Motoki H, Ebisawa S, Izawa A, Koyama J, Ikeda U, Kuwahara K. Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry. Angiology 2017; 68:884-892. [PMID: 28956475 DOI: 10.1177/0003319717697883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle-brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups-low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.
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Affiliation(s)
- Naoto Hashizume
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- 2 Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hirohiko Motoki
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Izawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Koyama
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Liu J, Liu H, Zhao H, Shang G, Zhou Y, Li L, Wang H. Descriptive study of relationship between cardio-ankle vascular index and biomarkers in vascular-related diseases. Clin Exp Hypertens 2017; 39:468-472. [PMID: 28544855 DOI: 10.1080/10641963.2016.1273946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jinbo Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Huan Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Hongwei Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Guangyun Shang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Yingyan Zhou
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Lihong Li
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Hongyu Wang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
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Minamisawa M, Miura T, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Aso S, Uchikawa S, Senda K, Morita T, Hashizume N, Abe N, Ebisawa S, Izawa A, Miyashita Y, Koyama J, Ikeda U. Prediction of 1-year clinical outcomes using the SYNTAX score in patients with prior heart failure undergoing percutaneous coronary intervention: sub-analysis of the SHINANO registry. Heart Vessels 2016; 32:399-407. [PMID: 27709325 PMCID: PMC5371627 DOI: 10.1007/s00380-016-0896-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/30/2016] [Indexed: 01/06/2023]
Abstract
Although coronary artery disease (CAD) is common in patients with heart failure (HF), little is known about the prognostic significance of coronary lesion complexity in patients with prior HF undergoing percutaneous coronary intervention (PCI). The aim of this study was to investigate whether the coronary Synergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score could improve risk stratification in HF patients with CAD. Two hundred patients (mean age 73 ± 11 years, left ventricular ejection fraction 49 ± 15 %) with prior HF who underwent PCI were divided into two groups stratified by SYNTAX score (median value 12) and tracked prospectively for 1 year. The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for worsening HF. Adverse events were observed in 39 patients (19.5 %). Patients with high SYNTAX scores (n = 100) showed worse prognoses than those with low scores (n = 100) (26.0 vs. 13.0 %, respectively, P = 0.021). In multivariate Cox-regression analysis, SYNTAX score ≥12 was significantly associated with MACE (hazard ratio: 1.99, 95 % confidence interval: 1.02–3.97; P = 0.045). In patients with prior HF and CAD, high SYNTAX scores predicted a high incidence of MACE. These results suggest that the SYNTAX score might be a useful parameter for improving risk stratification in these patients.
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Affiliation(s)
- Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hideki Kobayashi
- Department of Cardiology, Shinshu Ueda Medical Center, Ueda, Japan
| | | | - Hiroyuki Nakajima
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Hikaru Kimura
- Department of Cardiology, Saku Central Hospital, Saku, Japan
| | - Hiroshi Akanuma
- Department of Cardiology, Iida Municipal Hospital, Iida, Japan
| | | | - Toshio Sato
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Shoji Hotta
- Department of Cardiology, Ina Central Hospital, Ina, Japan
| | | | - Takuya Maruyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Noboru Watanabe
- Department of Cardiology, Hokushin General Hospital, Nakano, Japan
| | - Takayuki Eisawa
- Department of Cardiology, Komoro Kosei General Hospital, Komoro, Japan
| | - Shinichi Aso
- Department of Cardiology, Aizawa Hospital, Matsumoto, Japan
| | | | - Keisuke Senda
- Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan
| | - Takehiro Morita
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Naoyuki Abe
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Atsushi Izawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Koyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Nakahashi T, Sakata K, Nomura A, Yakuta Y, Gamou T, Terai H, Horita Y, Ikeda M, Namura M, Takamura M, Kawashiri MA, Yamagishi M, Hayashi K. Impact of Baseline Angiographic Complexities Determined by Coronary Artery Bypass Grafting SYNTAX Score on the Prediction of Outcome After Percutaneous Coronary Intervention. Am J Cardiol 2016; 118:974-9. [PMID: 27521219 DOI: 10.1016/j.amjcard.2016.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Abstract
Although Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score based on angiographic scoring system was developed in patients with previous coronary artery bypass grafting (CABG), few data exist regarding its prognostic utility in patients undergoing percutaneous coronary intervention (PCI). We examined 272 patients with previous CABG (217 men; mean age, 70.4 ± 9.7 years) undergoing PCI. Severity of the coronary anatomy was evaluated using CABG-SYNTAX score. The primary end point of this study was cardiovascular death. The baseline CABG-SYNTAX score ranged from 2 to 53.5, with an average of 26.0 ± 10.2. In the index procedures, PCI for the native coronary accounted for nearly all patients (88%). During follow-up (median 4.1 years), 40 cardiovascular deaths had occurred. In multivariate analysis, age >75 years (hazard ratio [HR] 2.82, 95% CI 1.45 to 5.52), left ventricular ejection fraction <40% (HR 2.99, 95% CI 1.39 to 6.07), end-stage renal disease (HR 2.90, 95% CI 1.15 to 6.75), peripheral artery disease (HR 2.20, 95% CI 1.10 to 4.64), and CABG-SYNTAX score >25 (HR 2.37, 95% CI 1.19 to 5.05) were independent predictors of cardiovascular death. After creating a composite risk score in consideration of identified predictors, the freedom from cardiovascular death at 5 years was 98%, 86%, and 58% in the low (0 to 1), medium (2), and high (3 to 5) scores, respectively (p <0.001). The area under the receiver-operating characteristic curve for cardiovascular death for the CABG-SYNTAX and composite risk scores were 0.66 and 0.77, respectively (p <0.05). In conclusion, the combination of angiographic and clinical characteristics is useful for risk stratification in patients with previous CABG undergoing PCI.
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Hong Y, Sebastianski M, Makowsky M, Tsuyuki R, McMurtry MS. Administrative data are not sensitive for the detection of peripheral artery disease in the community. Vasc Med 2016; 21:331-6. [PMID: 27114456 DOI: 10.1177/1358863x16631041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to evaluate whether case ascertainment using administrative health data would be a feasible way to identify peripheral artery disease (PAD) patients from the community. Subjects' ankle-brachial index (ABI) scores from two previous prospective observational studies were linked with International Classification of Diseases (ICD) and Canadian Classification of Interventions (CCI) codes from three administrative databases from April 2002 to March 2012, including the Alberta Inpatient Hospital Database (ICD-10-CA/CCI), Ambulatory Care Database (ICD-10-CA/CCI), and the Practitioner Payments Database (ICD-9-CM). We calculated diagnostic statistics for putative case definitions of PAD consisting of individual code or sets of codes, using an ABI score ⩽ 0.90 as the gold standard. Multivariate logistic regression was performed to investigate additional predictive factors for PAD. Different combinations of diagnostic codes and predictive factors were explored to find out the best algorithms for identifying a PAD study cohort. A total of 1459 patients were included in our analysis. The average age was 63.5 years, 66% were male, and the prevalence of PAD was 8.1%. The highest sensitivity of 34.7% was obtained using the algorithm of at least one ICD diagnostic or procedure code, with specificity 91.9%, positive predictive value (PPV) 27.5% and negative predictive value (NPV) 94.1%. The algorithm achieving the highest PPV of 65% was age ⩾ 70 years and at least one code within 443.9 (ICD-9-CM), I73.9, I79.2 (ICD-10-CA/CCI), or all procedure codes, validated with ABI < 1.0 (sensitivity 5.56%, specificity 99.4% and NPV 84.6%). In conclusion, ascertaining PAD using administrative data scores was insensitive compared with the ABI, limiting the use of administrative data in the community setting.
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Affiliation(s)
- Yongzhe Hong
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Epidemiology Coordinating and Research (EPICORE) Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Makowsky
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ross Tsuyuki
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Epidemiology Coordinating and Research (EPICORE) Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M Sean McMurtry
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Predictive Value of Combining the Ankle-Brachial Index and SYNTAX Score for the Prediction of Outcome After Percutaneous Coronary Intervention (from the SHINANO Registry). Am J Cardiol 2016; 117:179-85. [PMID: 26684515 DOI: 10.1016/j.amjcard.2015.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/23/2022]
Abstract
The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospective Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤ 0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤ 22 was defined as 0, 23 to 32 as 1, and ≥ 33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.
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15
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Duman H, Çetin M, Durakoğlugil ME, Değirmenci H, Hamur H, Bostan M, Karadağ Z, Çiçek Y. Relation of Angiographic Thrombus Burden with Severity of Coronary Artery Disease in Patients with ST Segment Elevation Myocardial Infarction. Med Sci Monit 2015; 21:3540-6. [PMID: 26573108 PMCID: PMC4655613 DOI: 10.12659/msm.895157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background We planned to investigate the relationship of thrombus burden with SYNTAX score in patients with ST elevation myocardial infarction (STEMI). Material/Methods We retrospectively enrolled 780 patients who underwent PPCI in our clinic due to STEMI. Clinical, laboratory, and demographic properties of the patients were recorded. Angiographic coronary thrombus burden was classified using thrombolysis in myocardial infarction (TIMI) thrombus grades. Results Patients with high thrombus burden were older, with higher diabetes prevalence longer pain to balloon time, higher leukocyte count, higher admission troponin, and admission CK-MB concentrations. SYNTAX score was higher and myocardial perfusion grades were lower in patients with high thrombus burden. Multivariate logistic regression analysis revealed SYNTAX score as the strongest predictor of thrombus burden. ROC analysis demonstrated a sensitivity of 75.5%, specificity of 61.2%, and cut-off value of >14 (area under the curve (AUC): 0.702; 95% confidence interval [CI]: 0.773–0.874;P<0.001) for high thrombus burden. Conclusions SYNTAX score may have additional value in predicting higher thrombus burden besides being a marker of coronary artery disease severity and complexity.
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Affiliation(s)
- Hakan Duman
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Hüsnü Değirmenci
- Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hikmet Hamur
- Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Mehmet Bostan
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Zakir Karadağ
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Yüksel Çiçek
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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