1
|
Ninomiya K, Kageyama S, Shiomi H, Kotoku N, Masuda S, Revaiah PC, Garg S, O'Leary N, van Klaveren D, Kimura T, Onuma Y, Serruys PW. Can Machine Learning Aid the Selection of Percutaneous vs Surgical Revascularization? J Am Coll Cardiol 2023; 82:2113-2124. [PMID: 37993203 DOI: 10.1016/j.jacc.2023.09.818] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND In patients with 3-vessel coronary artery disease (CAD) and/or left main CAD, individual risk prediction plays a key role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). OBJECTIVES The aim of this study was to assess whether these individualized revascularization decisions can be improved by applying machine learning (ML) algorithms and integrating clinical, biological, and anatomical factors. METHODS In the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) study, ML algorithms (Lasso regression, gradient boosting) were used to develop a prognostic index for 5-year death, which was combined, in the second stage, with assigned treatment (PCI or CABG) and prespecified effect-modifiers: disease type (3-vessel or left main CAD) and anatomical SYNTAX score. The model's discriminative ability to predict the risk of 5-year death and treatment benefit between PCI and CABG was cross-validated in the SYNTAX trial (n = 1,800) and externally validated in the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome Study in Kyoto) registry (n = 7,362), and then compared with the original SYNTAX score II 2020 (SSII-2020). RESULTS The hybrid gradient boosting model performed best for predicting 5-year all-cause death with C-indexes of 0.78 (95% CI: 0.75-0.81) in cross-validation and 0.77 (95% CI: 0.76-0.79) in external validation. The ML models discriminated 5-year mortality better than the SSII-2020 in the external validation cohort and identified heterogeneity in the treatment benefit of CABG vs PCI. CONCLUSIONS An ML-based approach for identifying individuals who benefit from CABG or PCI is feasible and effective. Implementation of this model in health care systems-trained to collect large numbers of parameters-may harmonize decision making globally. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972).
Collapse
Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | | |
Collapse
|
2
|
Takeji Y, Morimoto T, Shiomi H, Kato ET, Imada K, Yoshikawa Y, Matsumura-Nakano Y, Yamamoto K, Yamaji K, Toyota T, Tada T, Tazaki J, Yamamoto E, Nakatsuma K, Suwa S, Ehara N, Taniguchi R, Tamura T, Watanabe H, Toyofuku M, Yamamoto T, Shinoda E, Mabuchi H, Inoko M, Onodera T, Sakamoto H, Inada T, Ando K, Furukawa Y, Sato Y, Kadota K, Nakagawa Y, Kimura T. Sex Differences in Clinical Outcomes After Percutaneous Coronary Intervention. Circ J 2023; 87:277-286. [PMID: 36351607 DOI: 10.1253/circj.cj-22-0517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a scarcity of studies comparing the clinical outcomes after percutaneous coronary intervention (PCI) for women and men stratified by the presentation of acute coronary syndromes (ACS) or stable coronary artery disease (CAD).Methods and Results: The study population included 26,316 patients who underwent PCI (ACS: n=11,119, stable CAD: n=15,197) from the CREDO-Kyoto PCI/CABG registry Cohort-2 and Cohort-3. The primary outcome was all-cause death. Among patients with ACS, women as compared with men were much older. Among patients with stable CAD, women were also older than men, but with smaller difference. The cumulative 5-year incidence of all-cause death was significantly higher in women than in men in the ACS group (26.2% and 17.9%, log rank P<0.001). In contrast, it was significantly lower in women than in men in the stable CAD group (14.2% and 15.8%, log rank P=0.005). After adjusting confounders, women as compared with men were associated with significantly lower long-term mortality risk with stable CAD but not with ACS (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.69-0.82, P<0.001, and HR: 0.92, 95% CI: 0.84-1.01, P=0.07, respectively). There was a significant interaction between the clinical presentation and the mortality risk of women relative to men (interaction P=0.002). CONCLUSIONS Compared with men, women had significantly lower adjusted mortality risk after PCI among patients with stable CAD, but not among those with ACS.
Collapse
Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Eri Toda Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital
| | | | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital
| | - Eiji Shinoda
- Department of Cardiovascular Medicine, Hamamatsu Rosai Hospital
| | | | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | | | - Tsukasa Inada
- Department of Cardiovascular Medicine, Osaka Red Cross Hospital
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital
| | | | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.,Department of Cardiology, Hirakata Kohsai Hospital
| |
Collapse
|
3
|
Li Y, Hou X, Liu T, Xu S, Huang Z, Xu X, Dong R. Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stent Implantation in Patients With Chronic Kidney Disease: A Propensity Score Matching Study. Front Cardiovasc Med 2022; 9:802181. [PMID: 35433853 PMCID: PMC9010548 DOI: 10.3389/fcvm.2022.802181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo compare the long-term outcomes of coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for coronary artery disease (CAD) patients with chronic kidney disease (CKD).MethodsCoronary artery disease patients with decreased kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m2) who underwent CABG (n = 533) or PCI with DES (n = 952) from 2013 to 2020 were enrolled at a single center. The baseline characteristics and clinical outcomes were compared between the CABG and PCI groups for each matched pair of patients with CKD. The primary endpoint was the occurrence of all-cause death. The secondary endpoints were major adverse cardiovascular events (MACCEs) such as death, myocardial infarction (MI), stroke, and repeat revascularization.ResultsA total of 1,485 patients underwent revascularization, such as 533 CABG and 952 patients with PCI. The median follow-up duration was 55.6 months (interquartile range 34.3–74.7 months). Multivariable Cox regression models were used for risk adjustment, and after propensity score matching (PSM), 399 patients were well matched in each group. The in-hospital mortality rate in the CABG group was higher than that in the PCI group, but the difference was not statistically significant (5.0 vs. 2.5%, p = 0.063). At the 1-year follow-up, CABG was associated with a lower survival rate than PCI (94.2 vs. 98.0%, hazard ratio [HR] of 3.72, 95% CI = 1.63–8.49, p < 0.01). At the end of the 5-year follow-up, the freedom from MI and the freedom from repeated revascularization were both better in the CABG group compared to the PCI group (89.1 vs. 81.7%, HR of 0.59, 95% CI = 0.38–0.92, p = 0.019; 86.9 vs. 73.8%, HR of 0.54, 95% CI = 0.36–0.81, p = 0.003, respectively). Furthermore, the freedom from MACCEs was also better in the patients of CABG compared with the patients of PCI (58.5 vs. 51.3%, HR of 0.71, 95% CI = 0.55–0.91, p = 0.030). CABG had a higher cumulative survival rate (68.4 vs. 66.0%) but without a statistically significant difference (HR of 0.92, 95% CI = 0.67–1.27, p = 0.602) compared with that of PCI.ConclusionsCompared to the use of PCI with a drug-eluting stent among patients with CKD, the use of CABG was associated with a lower MI rate, repeat revascularization rate, and lower number of MACCEs during the long-term follow-up. At a follow-up of 1 year, the number of MACCEs and other adverse events were comparable between the two cohorts, but CABG showed a lower survival rate than PCI.
Collapse
Affiliation(s)
- Yang Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - XueJian Hou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - TaoShuai Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shijun Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhuhui Huang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - XiaoYu Xu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Ran Dong
| |
Collapse
|
4
|
Coronary Revascularization for Patients with Diabetes Mellitus: A Contemporary Systematic Review and Meta-Analysis. Ann Surg 2022; 275:1058-1066. [PMID: 35081569 DOI: 10.1097/sla.0000000000005391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aims to review the contemporary literature comparing CABG and PCI in diabetic patients providing an up-to-date perspective on the differences between the interventions. BACKGROUND Diabetes is common and diabetic patients are at a 2-to-4-fold increased risk of developing coronary artery disease. Approximately 75% of diabetic patients die of cardiovascular disease. Previous literature has identified CABG as superior to PCI for revascularization in diabetic patients with complex coronary artery diseas. METHODS PubMed and Medline were systematically searched for articles published from January 1, 2015 to April 15, 2021. This systematic review included all retrospective, prospective, and randomized trial studies comparing CABG and PCI in diabetic patients. 1552 abstracts were reviewed and 25 studies were included in this review. The data was analyzed using the RevMan 5.4 software. RESULTS Diabetic patients undergoing CABG experienced significantly reduced rates of 5-year mortality, major adverse cardiovascular and cerebrovascular events, myocardial infarction, and required repeat revascularization. Patients who underwent PCI experienced improved rates of stroke that trended toward significance. CONCLUSIONS Previous literature regarding coronary revascularization in diabetic patients has consistently demonstrated superior outcomes for patients undergoing CABG over PCI. The development of 1st and 2nd generation DES have narrowed the gap between CABG and PCI, but CABG continues to be superior. Continued investigation with large randomized trials and retrospective studies including long term follow-up comparing CABG and 2nd generation DES is necessary to confirm the optimal intervention for diabetic patients.
Collapse
|
5
|
Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease. Gen Thorac Cardiovasc Surg 2021; 70:419-429. [PMID: 34613579 DOI: 10.1007/s11748-021-01711-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease. METHODS From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376). RESULTS The median and interquartile range of patient's age was 82 (81-84) in the CABG group and 83 (81-85) in the PCI group (P = 0.10). Patients > = 85 years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01). The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43-0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14-0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32-0.85, P = 0.009). CONCLUSIONS CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.
Collapse
|
6
|
Hara H, Shiomi H, van Klaveren D, Kent DM, Steyerberg EW, Garg S, Onuma Y, Kimura T, Serruys PW. External Validation of the SYNTAX Score II 2020. J Am Coll Cardiol 2021; 78:1227-1238. [PMID: 34531023 DOI: 10.1016/j.jacc.2021.07.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The SYNTAX score II 2020 (SSII-2020) was derived from cross correlation and externally validated in randomized trials to predict death and major adverse cardiac and cerebrovascular events (MACE) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). OBJECTIVES The authors aimed to investigate the SSII-2020's value in identifying the safest modality of revascularization in a non-randomized setting. METHODS Five-year mortality and MACE were assessed in 7,362 patients with 3VD and/or LMCAD enrolled in a Japanese PCI/CABG registry. The discriminative abilities of the SSII-2020 were assessed using Harrell's C statistic. Agreement between observed and predicted event rates following PCI or CABG and treatment benefit (absolute risk difference [ARD]) for these outcomes were assessed by calibration plots. RESULTS The SSII-2020 for 5-year mortality well predicted the prognosis after PCI and CABG (C-index = 0.72, intercept = -0.11, slope = 0.92). When patients were grouped according to the predicted 5-year mortality ARD, <4.5% (equipoise of PCI and CABG) and ≥4.5% (CABG better), the observed mortality rates after PCI and CABG were not significantly different in patients with lower predicted ARD (observed ARD: 2.1% [95% CI: -0.4% to 4.4%]), and the significant difference in survival in favor of CABG was observed in patients with higher predicted ARD (observed ARD: 9.7% [95% CI: 6.1%-13.3%]). For MACE, the SSII-2020 could not recommend a specific treatment with sufficient accuracy. CONCLUSIONS The SSII-2020 for predicting 5-year death has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD.
Collapse
Affiliation(s)
- Hironori Hara
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - David van Klaveren
- Department of Public Health, Center for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands; Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| |
Collapse
|
7
|
Coronary Revascularization in the Past Two Decades in Japan (From the CREDO-Kyoto PCI/CABG Registries Cohort-1, -2, and -3). Am J Cardiol 2021; 153:20-29. [PMID: 34238444 DOI: 10.1016/j.amjcard.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023]
Abstract
The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081). From Cohort-1 to Cohort-3, the patients got progressively older across subsequent cohorts (67.0 ± 10.0, 68.4 ± 9.9, and 69.8 ± 10.2 years, ptrend < 0.001). There was increased use of PCI over CABG (73.5%, 81.9%, and 85.2%, ptrend < 0.001) and increased prevalence of evidence-based medications use over time. The cumulative 3-year incidence of all-cause death was similar across the 3 cohorts (9.0%, 9.0%, and 9.3%, p = 0.74), while cardiovascular death decreased over time (5.7%, 5.1%, and 4.8%, p = 0.03). The adjusted risk for all-cause death and for cardiovascular death progressively decreased from Cohort-1 to Cohort-2 (HR:0.89, 95%CI:0.80 to 0.99, p = 0.03, and HR:0.80, 95%CI:0.70 to 0.92, p = 0.002, respectively), and from Cohort-2 to Cohort-3 (HR:0.86, 95%CI:0.78 to 0.95, p = 0.004, and HR:0.77, 95%CI:0.67-0.89, p < 0.001, respectively). The risks for stroke and repeated coronary revascularization also improved over time. In conclusions, we found a progressive and substantial reduction of adjusted risk for all-cause death, cardiovascular death, stroke, and repeated coronary revascularization over the past two decades in Japan.
Collapse
|
8
|
Matsumura-Nakano Y, Shiomi H, Morimoto T, Yamaji K, Ehara N, Sakamoto H, Takeji Y, Yoshikawa Y, Yamamoto K, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3). Am J Cardiol 2021; 145:25-36. [PMID: 33454340 DOI: 10.1016/j.amjcard.2020.12.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 01/14/2023]
Abstract
There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.
Collapse
Affiliation(s)
- Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital; Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital; Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
9
|
Guha A, Dey AK, Kalra A, Gumina R, Lustberg M, Lavie CJ, Sabik JF, Addison D. Coronary Artery Bypass Grafting in Cancer Patients: Prevalence and Outcomes in the United States. Mayo Clin Proc 2020; 95:1865-1876. [PMID: 32861331 PMCID: PMC7860624 DOI: 10.1016/j.mayocp.2020.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To characterize the contemporary efficacy and utilization patterns of coronary artery bypass grafting (CABG) in specific cancer types. METHODS We leveraged the data from the National Inpatient Sample and plotted trends of utilization and outcomes of isolated CABG (with no other additional surgeries during the same hospitalization) procedures from January 1, 2003, through September 1, 2015. Propensity score matching was used to assess for potential differences in outcomes by type of cancer status among contemporary (2012-2015) patients. RESULTS Overall, the utilization of CABG decreased over time (250,677 in 2003 vs 134,534 in 2015, P<.001). However, the proportion of those with comorbid cancer increased (7.0% vs 12.6%, P<.001). Over time, in-hospital mortality associated with CABG use in cancer remained unchanged (.9% vs 1.0%, P=.72); yet, cancer patients saw an increase in associated major bleeding (4.5% vs 15.3%, P<.001) and rate of stroke (.9% vs 1.5%, P<.001) over time. In-hospital cost-of-care associated with CABG-use in cancer also increased over time ($29,963 vs $33,636, P<.001). When stratified by cancer types, in-hospital mortality was not higher in breast, lung, prostate, colon cancer, or lymphoma versus non-cancer CABG patients (all P>.05). However, there was a significantly higher prevalence of major bleeding but not stroke in patients with breast and prostate cancer only compared with non-cancer CABG patients (P<.01). Discharge dispositions were not found to be different between cancer sub-groups and non-cancer patients (P>.05), except for breast cancer patients who had lower home care, but higher skilled care disposition (P<.001). CONCLUSION Among those undergoing CABG, the prevalence of comorbid cancer has steadily increased. Outside of major bleeding, these patients appear to share similar outcomes to those without cancer indicating that CABG utilization should be not be declined in cancer patients when otherwise indicated. Further research into the factors underlying the decision to pursue CABG in specific cancer sub-groups is needed.
Collapse
Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Amit K Dey
- Division of Cardiology, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Gumina
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH
| | - Maryam Lustberg
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Carl J Lavie
- Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| | - Joseph F Sabik
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH.
| |
Collapse
|
10
|
Quality of life in patients after coronary artery bypass grafting with bilateral internal thoracic artery versus single internal thoracic artery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:24-28. [PMID: 32728359 PMCID: PMC7379207 DOI: 10.5114/kitp.2020.94187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/12/2020] [Indexed: 11/20/2022]
Abstract
Introduction The left internal thoracic artery to the left anterior descending artery graft is recognized as the gold standard for coronary revascularization. We compared quality of life (QoL) in patients who received bilateral internal thoracic arteries (BITA) and those with a single internal thoracic artery (SITA) graft. Aim To assess QoL during a 10-year follow-up in patients who underwent coronary artery bypass grafting (CABG) with BITA vs. SITA. Material and methods We recruited 300 patients with multivessel coronary artery disease who underwent CABG from January 2005 to October 2010. Mean duration (standard deviation – SD) of follow-up was 3568 ±409 days. QoL was measured subjectively using a Likert scale and objectively by the WHOQOL-BREF questionnaire. Patients were interviewed by telephone. Results BITA patients reported marked improvement and improvement more often than SITA patients (58% vs. 43.3%, p = 0.02). Marked deterioration was noted by 2% of BITA patients and 3.3% of SITA patients (p = 0.03). Summarized results of the WHOQOL-BREF questionnaire showed significantly better QoL in the BITA group (median: 15.0) vs. SITA group (median: 14.75) (p = 0.02). There were more angina-free patients in the BITA group (84%) compared to SITA patients (72.7%) (p = 0.006). QoL did not correlate with patients’ body mass index (p = 0.10) or residence status (p = 0.51), but there was a weak negative correlation between QoL and patients’ age (r = –0.14, p = 0.01). Conclusions Surgical coronary revascularization using BITA improves QoL, particularly when measured by a Likert scale.
Collapse
|
11
|
Tani H, Sawano M, Numasawa Y, Kobayashi Y, Suzuki M, Noma S, Shiraishi Y, Ueda I, Fukuda K, Kohsaka S. In-hospital outcome in patients presenting with acute coronary syndrome with left main coronary artery disease: A report from Japanese prospective multicenter percutaneous coronary intervention registry. J Cardiol 2019; 75:635-640. [PMID: 31899113 DOI: 10.1016/j.jjcc.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/03/2019] [Accepted: 11/20/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients presenting with acute coronary syndrome (ACS) from left main (LM) disease are at a high risk for mortality despite recent advancement in devices and techniques during percutaneous coronary interventions (PCI). We aimed to evaluate patient characteristics, clinical presentations, and key clinical characteristics associated with adverse in-hospital outcomes among ACS patients undergoing LM-PCI. METHODS We retrospectively identified 280 LM-ACS patients (3.7 %) from 7608 ACS patients in the prospective multicenter Japan Cardiovascular Database-Keio Inter-Hospital Cardiovascular Studies registry from March 2009 to May 2016 and divided them into those with/without PCI/coronary artery bypass grafting. We compared baseline demographics, coronary lesion characteristics, PCI details, and short-term outcomes, including in-hospital mortality and periprocedural complications, between the two groups. RESULTS Among LM-ACS patients, 38.6 % presented with ST elevation myocardial infarction, 29.6 % with cardiogenic shock (CS), and 15.4 % with cardiac arrest. The observed in-hospital mortality rate was 18.9 % with presence of CS [odds ratio (OR): 10.16, 95 % confidence interval (CI): 4.51-22.91, p<0.001] and absence of prior revascularization (de novo patients; OR: 4.31, 95 % CI: 1.43-12.94, p=0.009) was independently associated with higher incidence of in-hospital mortality. Notably, the observed mortality rate was substantially higher among de novo patients than the predicted mortality rate with a contemporary risk model (observed: 25.1 %; predicted: 11.6 %). CONCLUSIONS Prior revascularization act as a protective factor among LM-ACS patients in the contemporary era of PCI. Further studies to detect those at higher risk for LM coronary lesion progression are needed to fully implement these findings into clinical practice.
Collapse
Affiliation(s)
- Hidenori Tani
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University Medical Center and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| |
Collapse
|
12
|
Matsumura-Nakano Y, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Yamaji K, Shizuta S, Sakata R, Hanyu M, Shimamoto M, Komiya T, Kimura T. Surgical Ineligibility and Long-Term Outcomes in Patients With Severe Coronary Artery Disease. Circ J 2019; 83:2061-2069. [PMID: 31434812 DOI: 10.1253/circj.cj-19-0440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In patients with severe coronary artery disease (CAD) requiring coronary revascularization, the prevalence of surgical ineligibility and its clinical effect on long-term outcomes remain unclear.Methods and Results:Among 15,939 patients with first coronary revascularization in the CREDO-Kyoto percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2, we identified 3,982 patients with triple-vessel or left main disease (PCI: n=2,188, and CABG: n=1,794). Surgical ineligibility as documented in hospital charts was present in 142 (6.5%) of 2,188 PCI-patients, which was mainly related to comorbidities and advanced age. The cumulative 5-year incidence of the primary outcome measure (all-cause death/myocardial infarction/stroke) was much higher in PCI-patients with surgical ineligibility than in PCI-patients without surgical ineligibility and in CABG-patients (52.5%, 27.6%, and 24.0%, respectively, log-rank P<0.001). After adjusting for confounders, the excess risk of PCI-patients with surgical ineligibility relative to CABG-patients was substantial (hazard ratio [HR] 1.97, 95% CI 1.51-2.58, P<0.001), while the excess risk of PCI-patients without surgical ineligibility relative to CABG-patients was modest, but remained significant (HR 1.37, 95% CI 1.19-1.59, P<0.001). CONCLUSIONS Among patients with severe CAD, PCI-patients with surgical ineligibility had worse long-term outcomes as compared with those without surgical ineligibility and CABG-patients.
Collapse
Affiliation(s)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | | | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital
| | | | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | |
Collapse
|
13
|
Watanabe H, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Tazaki J, Watanabe H, Natsuaki M, Minatoya K, Hanyu M, Komiya T, Kimura T. Percutaneous coronary intervention versus coronary arterial bypass grafting in patients with multi-vessel coronary revascularization (from the CREDO-Kyoto PCI/CABG registry/cohort-2). Catheter Cardiovasc Interv 2019; 96:42-51. [PMID: 31389659 DOI: 10.1002/ccd.28420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess long-term outcomes after percutaneous coronary intervention (PCI) with drug-eluting stent only compared with coronary artery bypass grafting (CABG) in patients with triple-vessel disease. BACKGROUND Selection between PCI and CABG is still a clinically relevant issue in the management of patients with multi-vessel coronary artery disease. METHODS Among 15,939 patients enrolled in the CREDO-Kyoto PCI/CABG registry/cohort-2, the current study population consisted of 2,193 patients who underwent elective multi-vessel coronary revascularization including left anterior descending coronary artery (LAD) either by PCI with sirolimus-eluting stent (SES) only (N = 945) or CABG (N = 1,248). RESULTS The cumulative 5-year incidence of and the adjusted risk for the primary outcome measure (a composite of all-cause death, myocardial infarction [MI], or stroke) were not significantly different between PCI and CABG groups (22.6% vs. 23.0%, p = .40, and HR: 1.13, 95%CI: 0.91-1.40, p = .26). The risk of PCI relative to CABG for all-cause death and stroke was also insignificant (HR: 1.19, 95%CI: 0.92-1.53, p = .19; HR: 0.89, 95%CI: 0.62-1.27, p = .51). The adjusted 5-year risk for MI, hospitalization for heart failure (HF), any coronary revascularization and major bleeding was significantly different between the groups (HR: 1.59, 95%CI: 1.10-2.30, p = .01; HR: 1.49, 95%CI: 1.05-2.11, p = .02; HR: 3.70, 95%CI: 2.91-4.70, p < .0001; HR: 0.18, 95%CI: 0.14-0.22, p < .0001). CONCLUSIONS In patients who underwent coronary revascularization for multiple vessels including LAD, PCI using SES as compared with CABG was associated with a comparable 5-year risk for death/MI/stroke as well as for mortality, but with a markedly higher risk for any coronary revascularization.
Collapse
Affiliation(s)
- Hiroki Watanabe
- Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | |
Collapse
|
14
|
Hata R, Kubo S, Tsuneyoshi H, Shimamoto T, Kuwayama A, Ohya M, Shimada T, Miura K, Amano H, Otsuru S, Habara S, Tada T, Tanaka H, Fuku Y, Goto T, Komiya T, Kadota K. Long-term outcomes of three-vessel coronary artery disease after coronary revascularization by percutaneous coronary intervention using second-generation drug-eluting stents versus coronary artery bypass graft surgery. Cardiovasc Interv Ther 2019; 35:194-202. [DOI: 10.1007/s12928-019-00599-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
|
15
|
De Palo M, Quagliara T, Dachille A, Carrozzo A, Giardinelli F, Mureddu S, Mastro F, Rotunno C, Paparella D. Trials Comparing Percutaneous And Surgical Myocardial Revascularization: A Review. Rev Recent Clin Trials 2019; 14:95-105. [PMID: 30706789 DOI: 10.2174/1574887114666190201102353] [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: 05/04/2017] [Revised: 06/10/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Ischemic heart diseases are the major leading cause of death worldwide. Revascularization procedures dramatically reduced the overall risk for death related to acute coronary syndromes. Two kinds of myocardial revascularization can grossly be outlined: percutaneous coronary intervention (PCI) and surgical coronary artery bypass graft intervention (CABG). The net clinical benefit coming from these two kinds of procedures is still under debate. METHODS We have traced the state-of-the-art background about myocardial revascularization procedures by comparing the most important trials dealing with the evaluation of percutaneous interventions versus a surgical approach to coronary artery diseases. RESULTS Both PCI and CABG have become effective treatments for revascularization of patients suffering from advanced CAD. The advance in technology and procedural techniques made PCI an attractive and, to some extent, more reliable procedure in the context of CAD. However, there are still patients that cannot undergo PCI and have to be rather directed towards CABG. CONCLUSION CABG still remains the best strategy for the treatment of multiple vessel CAD due to improved results in term of survival and freedom from reintervention. Anyway, a systematic, multidisciplinary approach to revascularization is the fundamental behaviour to be chased in order to effectively help the patients in overcoming its diseases. The creation of the "heart team" seems to be a good option for the correct treatment of patients suffering from stable and unstable CAD.
Collapse
Affiliation(s)
- Micaela De Palo
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.,Department of Cardiovascular Diseases, Mater Dei Hospital, Bari, Italy
| | - Teresa Quagliara
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Annamaria Dachille
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Carrozzo
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giardinelli
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Simone Mureddu
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Florinda Mastro
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | | | - Domenico Paparella
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.,Department of Cardiovascular Surgery, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| |
Collapse
|
16
|
Gao XQ, Li Y, Jiang ZL. Comparison of Secondary Prevention Status between Percutaneous Coronary Intervention and Coronary Artery Bypass Patients. Arq Bras Cardiol 2017; 109:466-474. [PMID: 29267627 PMCID: PMC5729783 DOI: 10.5935/abc.20170153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Data are scarce regarding disparities in cardiovascular risk factor
management between patients treated with percutaneous coronary intervention
(PCI) and those treated with coronary artery bypass grafting (CABG). Objective Whether the goal achievement rates of cardiovascular risk factors were
different between PCI and CABG patients. Methods We retrospectively reviewed the data retrieved from a clinical record
database of patients admitted to Beijing Anzhen Hospital between January 1,
2014, and December 31, 2014, who underwent PCI or CABG. Results Compared with the CABG group, low-density lipoprotein cholesterol (LDL-C)
< 1.8 mmol/L (28.6% vs. 24.7%; p < 0.01), LDL-C < 2.07 mmol/L
(43.5% vs. 39.4%; p < 0.01) and blood pressure (BP) < 140/90 mm Hg
(85.6% vs. 77.7%; p < 0.01) goal achievement rates were significantly
higher in the PCI group. Compared with patients ≥ 60 years old:
patients < 60 years old had better BP < 140/90 mm Hg goal achievement
rates (87.7% vs. 84.4%; p < 0.01) in the PCI group, and better fasting
blood-glucose (FBG) < 7 mmol/L (79.4% vs.72.0%; p < 0.01) and HbA1c
< 7% (79.4% vs. 70.1%; p < 0.01) goal achievement rates in the CABG
group. Compared with females: males had better LDL-C < 2.07 mmol/L (24.7%
vs. 28.5%; p < 0.01), FBG < 7 mmol/L (71.8% vs.75.2%; p < 0.01) and
HbA1c < 7% (70.4% vs. 74.1%; p < 0.01) goal achievement rates in the
PCI group. Conclusion Patients in the PCI group were generally more likely than those in the CABG
group to achieve LDL-C < 1.8 mmol/L and BP goals. The control of
cardiovascular risk factors differed between patients ≥ 60 years old
and < 60 years old. Female patients were less likely to achieve LDL-C,
FBG and HbA1c goals.
Collapse
Affiliation(s)
- Xia-Qing Gao
- Beijing Anzhen Hospital - Capital Medical University, Beijing - China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing - China
| | - Yanfang Li
- Beijing Anzhen Hospital - Capital Medical University, Beijing - China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing - China
| | - Zhi-Li Jiang
- Beijing Anzhen Hospital - Capital Medical University, Beijing - China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing - China
| |
Collapse
|
17
|
Nijs K, Vandenbrande J, Vaqueriza F, Ory JP, Yilmaz A, Starinieri P, Dubois J, Jamaer L, Arijs I, Stessel B. Neurological outcome after minimal invasive coronary artery surgery (NOMICS): protocol for an observational prospective cohort study. BMJ Open 2017; 7:e017823. [PMID: 28988183 PMCID: PMC5640084 DOI: 10.1136/bmjopen-2017-017823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Adverse neurocognitive outcomes are still an important cause of morbidity and mortality after cardiac surgery. The most common neurocognitive disorders after conventional cardiac surgery are postoperative cognitive dysfunction (POCD), stroke and delirium. Minimal invasive cardiac procedures have recently been introduced into practice. Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimal invasive cardiac procedure based on the conventional CABG procedure. Neurocognitive outcome after minimal invasive cardiac surgery, including Endo-CABG, has never been studied. Therefore, the main objective of this study is to examine neurocognitive outcome after Endo-CABG. METHODS AND ANALYSIS We will perform a prospective observational cohort study including 150 patients. Patients are categorised into three groups: (1) patients undergoing Endo-CABG, (2) patients undergoing a percutaneous coronary intervention and (3) a healthy volunteer group. All patients in the Endo-CABG group will be treated following a uniform, standardised protocol. To assess neurocognitive outcome after surgery, a battery of six neurocognitive tests will be administered at baseline and at 3-month follow-up. In the Endo-CABG group, a neurological examination will be performed at baseline and postoperatively and delirium will be scored at the intensive care unit. Quality of life (QOL), anxiety and depression will be assessed at baseline and at 3-month follow-up. Satisfaction with Endo-CABG will be assessed at 3-month follow-up. Primary endpoints are the incidence of POCD, stroke and delirium after Endo-CABG. Secondary endpoints are QOL after Endo-CABG, patient satisfaction with Endo-CABG and the incidence of anxiety and depression after Endo-CABG. ETHICS AND DISSEMINATION The neurological outcome after minimal invasive coronary artery surgery study has received approval of the Jessa Hospital ethics board. It is estimated that the trial will be executed from December 2016 to January 2018, including enrolment and follow-up. Analysis of data, followed by publication of the results, is expected in 2018. TRIAL REGISTRATION NUMBER NCT02979782.
Collapse
Affiliation(s)
- Kristof Nijs
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Vandenbrande
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Hasselt University, Hasselt, Belgium
| | - Fidel Vaqueriza
- Faculty of Medicine and Health Sciences, Hasselt University, Hasselt, Belgium
| | - Jean-Paul Ory
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Pascal Starinieri
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Jasperina Dubois
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Luc Jamaer
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Ingrid Arijs
- Faculty of Medicine and Health Sciences, Hasselt University, Hasselt, Belgium
- Limburg Clinical Research Program, Hasselt University and Jessa Hospital, Hasselt, Belgium
| | - Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Hasselt University, Hasselt, Belgium
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
18
|
Roberts JK, Rao SV, Shaw LK, Gallup DS, Marroquin OC, Patel UD. Comparative Efficacy of Coronary Revascularization Procedures for Multivessel Coronary Artery Disease in Patients With Chronic Kidney Disease. Am J Cardiol 2017; 119:1344-1351. [PMID: 28318510 DOI: 10.1016/j.amjcard.2017.01.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 12/18/2022]
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and death, yet little data exist regarding the comparative efficacy of coronary revascularization procedures in CKD patients with multivessel disease. We created a cohort of 4,687 adults who underwent cardiac catheterization, had a serum creatinine value measured within 30 days, and had more than one vessel with ≥50% stenosis. We used Cox proportional hazard regression modeling weighted by the inverse probability of treatment to examine the association between 4 treatment strategies (medical management, percutaneous coronary intervention [PCI] with bare metal stent, PCI with drug-eluting stent, and coronary artery bypass grafting [CABG]) and mortality among patients across categories of estimated glomerular filtration rate; secondary outcome was a composite of mortality, myocardial infarction, or revascularization. Compared with medical management, CABG was associated with a reduced risk of death for patients of any nondialysis CKD severity (hazard ratio [HR] range 0.43 to 0.59). There were no significant mortality differences between CABG and PCI, except a decreased death risk in CABG-treated CKD patients (HR range 0.54 to 0.55). Compared with medical management and PCI, CABG was associated with a lower risk of death, myocardial infarction, or revascularization in nondialysis CKD patients (HR range 0.41 to 0.64). There were similar associations between decreased estimated glomerular filtration rate and increased mortality across all multivessel coronary artery disease patient treatment groups. When accounting for treatment propensity, surgical revascularization was associated with improved outcomes in patients of all CKD severities. A prospective randomized trial in CKD patients is required to confirm our findings.
Collapse
|
19
|
Mølstad P, Moer R, Rødevand O. Long-term survival after coronary bypass surgery and percutaneous coronary intervention. Open Heart 2016; 3:e000489. [PMID: 27843567 PMCID: PMC5093374 DOI: 10.1136/openhrt-2016-000489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/09/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
Objectives To assess whether there exists a long-term difference in survival after treatment with coronary bypass surgery or percutaneous coronary intervention in patients with coronary disease as judged by all-cause mortality. Methods Retrospective study from the Feiring Heart Clinic database of survival in 22 880 patients—15 078 treated with percutaneous coronary intervention and 7802 with bypass surgery followed up to 16 years. Results Cox regression and propensity score analysis showed no difference in survival for one-vessel and two-vessel disease during the whole study period. In three-vessel disease, however, the analysis revealed a consistent and highly significant survival benefit in the first 8 years with an HR of 0.76 (95% CI 0.69 to 0.84, p<0.001) in favour of bypass surgery with similar survival rates in the two treatment strategies after that time period. Conclusions Treatment strategy did not affect survival in one-vessel and two-vessel disease, but bypass surgery offered an improved survival in the first 8 years in patients with three-vessel disease. These results are consistent with most previous reports and the survival benefit should be taken into account when selecting a strategy for this patient group.
Collapse
Affiliation(s)
- Per Mølstad
- Department of cardiology , LHL Clinics Feiring , Feiring , Norway
| | - Rasmus Moer
- Department of cardiology , LHL Clinics Feiring , Feiring , Norway
| | - Olaf Rødevand
- Department of cardiology , LHL Clinics Feiring , Feiring , Norway
| |
Collapse
|
20
|
Yamaji K, Shiomi H, Morimoto T, Nakatsuma K, Toyota T, Ono K, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Shirai S, Onodera T, Watanabe H, Natsuaki M, Sakata R, Hanyu M, Nishiwaki N, Komiya T, Kimura T. Effects of Age and Sex on Clinical Outcomes After Percutaneous Coronary Intervention Relative to Coronary Artery Bypass Grafting in Patients With Triple-Vessel Coronary Artery Disease. Circulation 2016; 133:1878-91. [PMID: 27009629 DOI: 10.1161/circulationaha.115.020955] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age and sex are important considerations in the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice. METHODS AND RESULTS Of 25 816 patients enrolled in the multicenter Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto; Cohort-1, n=9877; Cohort-2, n=15 939), the present study population consisted of 5651 patients (men, n=3998; women, n=1653) with triple-vessel coronary artery disease who were considered to be pertinent in comparisons of PCI with CABG (PCI, n=3165; CABG, n=2486). Patients were divided into 3 groups according to the tertiles of age: ≤65 years (n=1972), 66 to 73 years (n=1820), and ≥74 years (n=1859). The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.10-1.79; P=0.006), whereas the risks were neutral in patients ≤65 years of age (HR, 1.05; 95% CI, 0.73-1.53; P=0.78) and in patients 66 to 73 years of age (HR, 1.03; 95% CI, 0.78-1.36; P=0.85; interaction P=0.003). The excess mortality risk of PCI relative to CABG was significant in men (HR, 1.24; 95% CI, 1.03-1.50; P=0.02) and trended to be significant in women (HR, 1.34; 95% CI, 0.98-1.84; P=0.07) without significant interaction between sex and the mortality risk of PCI relative to CABG (interaction P=0.40). CONCLUSIONS There was a significant association between age and the mortality risk of PCI relative to CABG with excess risk in patients ≥74 years of age and neutral risk in younger patients. There was no significant sex-related difference in the mortality risk of PCI relative to CABG.
Collapse
Affiliation(s)
- Kyohei Yamaji
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Hiroki Shiomi
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Takeshi Morimoto
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Kenji Nakatsuma
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Toshiaki Toyota
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Koh Ono
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Yutaka Furukawa
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Yoshihisa Nakagawa
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Kazushige Kadota
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Kenji Ando
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Shinichi Shirai
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Tomoya Onodera
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Hirotoshi Watanabe
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Masahiro Natsuaki
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Ryuzo Sakata
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Michiya Hanyu
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Noboru Nishiwaki
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Tatsuhiko Komiya
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Takeshi Kimura
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.).
| |
Collapse
|
21
|
Sigwart U. Treatment of coronary artery disease from the inside: Light at the end of the tunnel? Glob Cardiol Sci Pract 2015; 2015:53. [PMID: 26779525 PMCID: PMC4710871 DOI: 10.5339/gcsp.2015.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/27/2015] [Indexed: 11/04/2022] Open
Abstract
Surgical treatment of coronary heart disease has shown its life saving benefits in millions of patients for more than half a century. Attempts to create less invasive ways to achieve similar results have attracted great attention since the introduction of balloon angioplasty in 1977. The fascination with such techniques was hampered by a 30% recurrence rate and a 5% rate of abrupt closure, requiring emergency bypass surgery in most instances. Angioplasty lost much of its unpredictability with the introduction of stents in 1986. The use of potent anti-platelet regimes added further safety, but recurrence remained a definite thread until the introduction of anti-mitotic coatings during the early years of this century. Very late thrombosis, however, continues to haunt interventionist and patients. Vanishing poly-lactic acid stents time still fail to exhibit comparable mechanical properties at present. So far bypass surgery has not yet lost its attraction in complicated and diffuse disease, despite its much higher patient discomfort.
Collapse
Affiliation(s)
- Ulrich Sigwart
- Professor and Chairman Emeritus, Department of Cardiology, University of Geneva, 1 av. de Miremont, CH-1206 Geneva, Switzerland
| |
Collapse
|