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Varma PK, Radhakrishnan RM, Gopal K, Krishna N, Jose R. Selecting the appropriate patients for coronary artery bypass grafting in ischemic cardiomyopathy-importance of myocardial viability. Indian J Thorac Cardiovasc Surg 2024; 40:341-352. [PMID: 38681722 PMCID: PMC11045715 DOI: 10.1007/s12055-023-01671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 05/01/2024] Open
Abstract
Patients who undergo coronary artery bypass graft (CABG) surgery in ischemic cardiomyopathy have a survival advantage over medical therapy at 10 years. The survival advantage of CABG over medical therapy is due to its ability to reduce future myocardial infarction, and by conferring electrical stability. The presence of myocardial viability does not provide a differential survival advantage for CABG over medical therapy. Presence of angina and inducible ischemia are also less predictive of outcome. Moreover, CABG is associated with significant early mortality. Hence, careful patient selection is more important for reducing the early mortality and improving the long-term outcome than relying on results of myocardial viability. Younger patients with good exercise tolerance benefit the most, while patients who are frail and patients with renal dysfunction and dysfunctional right ventricle seem to have very high operative mortality. Elderly patients, because of poor life expectancy, do not benefit from CABG, but the age cutoff is not clear. Patients also need to have revascularizable targets, but this decision is often based on experience of the surgical team and heart team discussion. These recommendations are irrespective of the myocardial viability tests. Optimal medical treatment remains the cornerstone for management of ischemic cardiomyopathy.
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Affiliation(s)
- Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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Fremes SE, Marquis-Gravel G, Gaudino MFL, Jolicoeur EM, Bédard S, Masterson Creber R, Ruel M, Vervoort D, Wijeysundera HC, Farkouh ME, Rouleau JL. STICH3C: Rationale and Study Protocol. Circ Cardiovasc Interv 2023; 16:e012527. [PMID: 37582169 DOI: 10.1161/circinterventions.122.012527] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is the recommended mode of revascularization in patients with ischemic left ventricular dysfunction (iLVSD) and multivessel disease. However, contemporary percutaneous coronary intervention (PCI) outcomes have improved with the integration of novel technologies and refinement of revascularization strategies, and PCI is often used in clinical practice in this population. There is a lack of evidence from randomized trials comparing contemporary state-of-the-art PCI versus CABG for the treatment of iLVSD and multivessel disease. This was the impetus for the STICH3C trial (Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy), described here. METHODS The STICH3C trial is a prospective, unblinded, international, multicenter trial with an expected sample size of 754 participants from ≈45 centers. Patients with multivessel/left main coronary artery disease and iLVSD with left ventricular ejection fraction ≤40% considered by the local Heart Team appropriate for and amenable to revascularization by both modes of revascularization will be randomized in a 1:1 ratio to state-of-the-art PCI or CABG. RESULTS The primary end point is the composite of death from any cause, stroke, spontaneous myocardial infarction, urgent repeat revascularization, or heart failure readmission, summarized as a time-to-event outcome. The key hierarchical end point is time to death and frequency of hospitalizations for heart failure. The key safety outcome is a composite of major adverse events. Disease-specific quality-of-life and health economics measures will be compared between groups. Participants will be followed for a median of 5 years, with a minimum follow-up of 4 years. CONCLUSIONS STICH3C will directly inform patients, clinicians, and international practice guidelines about the efficacy and safety of CABG versus PCI in patients with iLVSD. The results will provide novel and broad evidence, including clinical events, health status, and economic assessments, to guide care for patients with iLVSD and severe coronary artery disease. REGISTRATION URL: https://clinicaltrials.gov/; Unique identifier: NCT05427370.
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Affiliation(s)
- Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - E Marc Jolicoeur
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - Sylvain Bédard
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, Quebec, Canada (S.B.)
| | | | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (M.R.)
| | - Dominique Vervoort
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Michael E Farkouh
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ontario, Canada (M.E.F.)
| | - Jean-Lucien Rouleau
- Montreal Heart Institute, University of Montreal, Quebec, Canada (G.M.-G., E.M.J., J.-L.R.)
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Taha A, Assaf O, Champsi A, Nadarajah R, Patel PA. Outcomes after transvenous defibrillator implantation in cardiac sarcoidosis: A systematic review. J Arrhythm 2022; 38:710-722. [PMID: 36237869 PMCID: PMC9535799 DOI: 10.1002/joa3.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Sarcoidosis is a systemic inflammatory disorder associated with ventricular arrhythmias (VAs) and sudden death in the context of cardiac involvement. Guidelines advocate implantable cardioverter-defibrillator (ICD) implantation in specific subcohorts, but there is a paucity of data on outcomes. Methods and Results A systematic review was performed to assess outcomes in patients with definite or probable cardiac sarcoidosis (CS) treated with ICD. Observational studies were identified from multiple databases from inception to 21st May 2021. Outcomes of interest included appropriate and inappropriate ICD therapies in addition to all-cause mortality. Study quality was assessed individually using the Newcastle Ottawa Scale (NOS).Eight studies were identified comprising 530 patients, with follow-up period of 24-66 months (weighted average 40 months). Mean age was 53.9 years with ejection fraction of 41.3%. Overall incidence of appropriate therapy was 38.1% during follow-up. Left ventricular systolic dysfunction (LVSD) with ejection fraction <40% was a predictor of appropriate therapy in the majority of studies, as were sustained VAs during electrophysiological testing (EP) in one study. There was no interaction with device indication (i.e. primary or secondary). Where documented, inappropriate therapy was primarily driven by atrial arrhythmias. All-cause mortality was 6.0% over a median follow-up period of 42 months. Only three studies achieved good quality in the comparability domain of NOS. Conclusions Appropriate ICD therapy in patients with CS is commonly associated with LVSD, which can act as a surrogate for scar burden. The utility of EP testing in this setting remains unclear.
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Affiliation(s)
- Ahmed Taha
- Department of Cardiology, Leeds General InfirmaryLeedsUK
| | - Omar Assaf
- Department of CardiologyBlackpool Victoria HospitalBlackpoolUK
| | - Asgher Champsi
- Department of CardiologyNew Cross HospitalWolverhamptonUK
| | | | - Peysh A. Patel
- Department of CardiologyQueen Elizabeth HospitalBirminghamUK
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4
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El-Gamel A. Lack of Viability Should Not Deny Surgical Revascularisation to Patients With Poor Left Ventricular Function. Heart Lung Circ 2022; 31:1051-1053. [PMID: 35870829 DOI: 10.1016/j.hlc.2022.06.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Adam El-Gamel
- Waikato University, Hamilton, New Zealand; Department of Surgery, Auckland University, Auckland, New Zealand; Wollongong Hospital, Wollongong, NSW, Australia.
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Multiple arterial conduits for multi-vessel coronary artery bypass grafting in patients with mild to moderate left ventricular systolic dysfunction: a multicenter retrospective study. J Cardiothorac Surg 2021; 16:123. [PMID: 33941221 PMCID: PMC8090915 DOI: 10.1186/s13019-021-01463-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Advantages of multiple arterial conduits for coronary artery bypass grafting (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD). Methods This multicenter study using propensity score matching took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with mild to moderate LVSD, undergoing primary, isolated multi-vessel CABG with left internal thoracic artery. The in-hospital and mid-term outcomes of MABG versus conventional left internal thoracic artery supplemented by saphenous vein grafts (single arterial CABG) were compared. The primary end points were death from all causes and death from cardiovascular causes. The secondary end points were stroke, myocardial infarction, repeat revascularization, and a composite of all mentioned outcomes, including death from all causes (major adverse events). Sternal wound infection was included with 6 months of follow-up after surgery. Results 243 and 676 patients were formed in MABG and single arterial CABG cohorts after matching in a 1:3 ratio. In-hospital death was not significantly different (MABG 1.6% versus single arterial CABG 2.2%, p = 0.78). After a mean (±SD) follow-up time of 3.3 ± 1.8 years, MABG was associated with lower rates of major adverse events (HR, 0.64; 95% CI, 0.44–0.94; p = 0.019), myocardial infarction (HR, 0.39; 95% CI, 0.16–0.99; p = 0.045) and repeat revascularization (HR, 0.42; 95% CI, 0.18–0.97; p = 0.034). There was no difference in the rates of death, stroke, and sternal wound infection. Conclusions MABG was associated with reduced mid-term rates of major adverse events and cardiovascular events and may be the procedure of choice for patients with mild to moderate LVSD requiring CABG. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01463-5.
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Küçük U, Duygu A, Kırılmaz B. Effect of Treatment Regimen on Long-Term Mortality of Geriatric Patients Diagnosed With Stable Coronary Artery Disease. Cureus 2021; 13:e13618. [PMID: 33816017 PMCID: PMC8011467 DOI: 10.7759/cureus.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Increased life expectancy across the world has resulted in an increase in the proportion of the elderly population who are lost to heart diseases. Advanced age and comorbidities are believed to change the response to treatments. In this study, we aimed to investigate the effects of surgical and medical treatments on the mortality of stable coronary diseases. Methods A total of 150 geriatric patients who underwent coronary angiography (CAG) were followed up in our cardiology clinic. Patients who decided to undergo coronary artery bypass graft (CABG) surgery after CAG and were willing to undergo the operation were assigned to group 1, whereas those who were unwilling to undergo the operation were not eligible for percutaneous coronary intervention and were followed up medically, and were assigned to group 2. Keeping the primary goal as mortality rates, both the groups were compared using medical records for three years after the treatment. Results After three years, the overall mortality rate included six patients (16%) in the CABG group versus 63 patients (55%) in the medical therapy group (p < 0.001). The CABG therapy was found to be significantly and independently associated with first- and third-year mortality (risk ratio: 0.064, 95% confidence interval: 0.009-0.467, p = 0.007; risk ratio: 0.305, 95% confidence interval: 0.151-0.615, p < 0.001, respectively). Kaplan-Meier analysis for first- and third-year all-cause mortality rates led to significant results and curves between the groups. Conclusion Our study revealed that compared to CABG surgery in the treatment of coronary artery disease in geriatric patients, medical treatment is associated with poor outcomes in terms of mortality in long-term follow-up.
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Affiliation(s)
- Uğur Küçük
- Cardiology, Canakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, TUR
| | - Ali Duygu
- Cardiology, Canakkale Onsekiz Mart University Faculty of Medicıne, Çanakkale, TUR
| | - Bahadır Kırılmaz
- Cardiology, Canakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, TUR
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8
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Zhao Y, Meng S, Liu T, Dong R. Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study. Med Sci Monit 2020; 26:e919374. [PMID: 32097388 PMCID: PMC7059453 DOI: 10.12659/msm.919374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Surgical treatment methods for patients with complex coronary artery disease (CAD) who have undergone vascular reconstruction mainly include coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). The purpose of the study aimed to compare a 1-year follow-up for the patient clinical outcomes and costs between PCI and CABG treatment. MATERIAL AND METHODS There were 840 patients enrolled in this study from July 2015 to September 2016. Among the study participants, 420 patients underwent PCI treatment and 420 patients underwent off-pump CABG. Patients costs were assessed from the perspective of the China healthcare and medical insurance system. EuroQOL 5-dimension 3 levels (EQ-5D-3L) questionnaire was used to evaluate the general health status, and the Seattle Angina Questionnaire (SAQ) was used to assess the disease-specific health status. RESULTS After a 1-year follow-up, the all-cause mortality (P=0.0337), the incidence of major adverse cardiac and cerebrovascular events (P<0.001), and additional revascularization (P<0.001) in PCI group were significantly higher than those in CABG group. Both groups have significant sustained benefits in the SAQ subscale. The CABG group had a higher score on the frequency of angina than the PCI group. In addition, the quality-adjusted life year value of PCI and CABG resulted was 0.8. The average total cost for PCI was $14 643 versus CABG cost of $13 842 (P=0.0492). CONCLUSIONS In the short-term, among the CAD patients with stable triple-vessel or left-main, costs and clinical outcomes are substantially higher for CABG than PCI. Long-term, economic, and health benefits analysis, is warranted.
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Affiliation(s)
- Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Shuai Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
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9
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DeVore AD, Yow E, Krucoff MW, Sherwood MW, Shaw LK, Chiswell K, O'Connor CM, Ohman EM, Velazquez EJ. Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic dysfunction. ESC Heart Fail 2019; 6:1233-1242. [PMID: 31560171 PMCID: PMC6989282 DOI: 10.1002/ehf2.12510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/27/2019] [Accepted: 07/30/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS We sought to better understand the role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and moderate or severe left ventricular systolic dysfunction. METHODS AND RESULTS Using data from the Duke Databank for Cardiovascular Disease, we analysed patients who underwent coronary angiography at Duke University Medical Center (1995-2012) that had stable CAD amenable to PCI and left ventricular ejection fraction ≤35%. Patients with acute coronary syndrome or Canadian Cardiovascular Society class III or IV angina were excluded. We used propensity-matched Cox proportional hazards to evaluate the association of PCI with mortality and hospitalizations. Of 901 patients, 259 were treated with PCI and 642 with medical therapy. PCI propensity scores created from 24 variables were used to assemble a matched cohort of 444 patients (222 pairs) receiving PCI or medical therapy alone. Over a median follow-up of 7 years, 128 (58%) PCI and 125 (56%) medical therapy alone patients died [hazard ratio 0.87 (95% confidence interval 0.68, 1.10)]; there was also no difference in the rate of a composite endpoint of all-cause mortality or cardiovascular hospitalization [hazard ratio 1.18 (95% confidence interval 0.96, 1.44)] between the two groups. CONCLUSIONS In this well-profiled, propensity-matched cohort of patients with stable CAD amenable to PCI and moderate or severe left ventricular systolic dysfunction, the addition of PCI to medical therapy did not improve long-term mortality, or the composite of mortality or cardiovascular hospitalization. The impact of PCI on other outcomes in these high-risk patients requires further study.
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Affiliation(s)
- Adam D DeVore
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, 6318, Durham, NC, 27701, USA
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, 6318, Durham, NC, 27701, USA
| | - Mitchell W Krucoff
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, 6318, Durham, NC, 27701, USA
| | | | - Linda K Shaw
- Duke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, 6318, Durham, NC, 27701, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, 6318, Durham, NC, 27701, USA
| | | | - Erik Magnus Ohman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, 6318, Durham, NC, 27701, USA
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AlHabeeb W, Al-Ayoubi F, AlGhalayini K, Al Ghofaili F, Al Hebaishi Y, Al-Jazairi A, Al-Mallah MH, AlMasood A, Al Qaseer M, Al-Saif S, Chaudhary A, Elasfar A, Tash A, Arafa M, Hassan W. Saudi Heart Association (SHA) guidelines for the management of heart failure. J Saudi Heart Assoc 2019; 31:204-253. [PMID: 31371908 PMCID: PMC6660461 DOI: 10.1016/j.jsha.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
- Corresponding author at: Cardiac Sciences Department, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia.
| | - Fakhr Al-Ayoubi
- King Fahad Cardiac Center, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Kamal AlGhalayini
- King Abdulaziz University Hospital, Jeddah, Saudi ArabiaSaudi Arabia
| | - Fahad Al Ghofaili
- King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi ArabiaSaudi Arabia
| | | | - Abdulrazaq Al-Jazairi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi ArabiaSaudi Arabia
| | - Ali AlMasood
- Riyadh Care Hospital, Riyadh, Saudi ArabiaSaudi Arabia
| | - Maryam Al Qaseer
- King Fahad Specialist Hospital, Dammam, Saudi ArabiaSaudi Arabia
| | - Shukri Al-Saif
- Saud Al-Babtain Cardiac Center, Dammam, Saudi ArabiaSaudi Arabia
| | - Ammar Chaudhary
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi ArabiaSaudi Arabia
| | - Abdelfatah Elasfar
- Madina Cardiac Center, AlMadina AlMonaoarah, Saudi ArabiaSaudi Arabia
- Cardiology Department, Tanta University, EgyptEgypt
| | - Adel Tash
- Ministry of Health, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mohamed Arafa
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Walid Hassan
- International Medical Center, Jeddah, Saudi ArabiaSaudi Arabia
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11
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Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:127. [PMID: 30815422 PMCID: PMC6387802 DOI: 10.14196/mjiri.32.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
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12
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Mechanical support for high-risk coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2018; 34:287-296. [PMID: 33060951 PMCID: PMC7525900 DOI: 10.1007/s12055-018-0740-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 11/04/2022] Open
Abstract
Mechanical circulatory support devices are being used to an increasing extent. The use of these devices as an adjunct to cardiac surgery to support ventricular function has contributed to improved outcomes for the highest risk patients. In the context of patients undergoing coronary artery bypass grafting, there are several potential indications for mechanical circulatory support: preoperatively in the setting of acute cardiogenic shock, or in patients with intractable angina with or without haemodynamic compromise; at induction of anaesthesia prophylactically in patients with critical coronary anatomy and/or severely impaired left ventricular function; intraoperatively in the setting of failure to wean from cardiopulmonary bypass; or postoperatively in patients who develop an intractable low cardiac output state. The use of the intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, TandemHeart, Impella and central ventricular assist devices will be considered in the setting of high-risk patients undergoing coronary artery bypass grafting.
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13
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Cui K, Zhang D, Lyu S, Song X, Yuan F, Xu F, Zhang M. Meta-Analysis Comparing Percutaneous Coronary Revascularization Using Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients With Left Ventricular Systolic Dysfunction. Am J Cardiol 2018; 122:1670-1676. [PMID: 30220418 DOI: 10.1016/j.amjcard.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/05/2018] [Accepted: 08/09/2018] [Indexed: 01/11/2023]
Abstract
The relative safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and coronary artery bypass grafting (CABG) in patients with left ventricular (LV) systolic dysfunction remains controversial; therefore we conducted this meta-analysis to identify the optimal strategy for such cohorts. A comprehensive search of the electronic databases including PubMed, EMBASE, and Cochrane Library from January 1, 2003 to March 1, 2018 was performed to identify the eligible adjusted observational studies. The primary end point was all-cause death during the longest follow-up, and the generic inverse variance random-effect model was used to estimate the pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Eight adjusted observational studies involving 10,268 patients were included. Compared with CABG, PCI with DES was associated with higher risk of all-cause mortality (HR 1.36, 95% CI 1.16 to 1.60), cardiac mortality (HR 2.20, 95% CI 1.63 to 2.95), myocardial infarction (HR 1.69, 95% CI 1.28 to 2.24), and repeat revascularization (HR 4.95, 95% CI 3.28 to 7.46) in patients with coronary artery disease and LV systolic dysfunction. Besides, separate analysis of patients with LV ejection fraction <35% or left main and/or multivessel disease obtained similar results compared with the overall analysis. However, DES and CABG shared similar rates of stroke (HR 0.92, 95% CI 0.67 to 1.26). In conclusion, CABG appears to be superior to PCI with DES for patients with coronary artery disease and LV systolic dysfunction, particularly in patients with severe LV systolic dysfunction or those with left main and/or multivessel disease.
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Affiliation(s)
- Kongyong Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shuzheng Lyu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fei Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Feng Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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14
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Sun LY, Tu JV, Lee DS, Beanlands RS, Ruel M, Austin PC, Eddeen AB, Liu PP. Disability-free survival after coronary artery bypass grafting in women and men with heart failure. Open Heart 2018; 5:e000911. [PMID: 30487983 PMCID: PMC6242014 DOI: 10.1136/openhrt-2018-000911] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/02/2018] [Accepted: 09/26/2018] [Indexed: 01/01/2023] Open
Abstract
Objective Heart failure (HF) impairs survival post coronary artery bypass grafting (CABG), but little is known about the postoperative quality of life (QoL) in patients with HF. We derived a patient-centred QoL surrogate and assessed the impact of different HF subtypes on this surrogate in the year post-CABG. Methods We surveyed 3112 cardiovascular patients to derive a patient-centred disability outcome and studied this outcome in a population-based cohort. We defined preserved ejection fraction as ≥50% and reduced ejection fraction as <50%. The primary outcome was disability, defined according to compiled patient-derived values. The secondary outcomes consisted of each individual component of disability, and death. The incidence of disability was calculated using cumulative incidence functions, with death as a competing risk. We identified predictors of disability using cause-specific hazard models. Results Patient-derived disability outcome consisted of stroke, nursing home admission and recurrent hospitalisations. When applied to 40 083 CABG patients (20.6% women), the incidence of disability was 5.4% while the incidence of death was 3.7% in the year post-CABG. Female sex was associated with an adjusted HR of 1.25 (95% CI 1.13 to 1.37) for disability. Women with HF with preserved ejection fraction had an adjusted HR of 1.73 (95% CI 1.52 to 1.98) for disability. Conclusions Disability was a more frequent complication than death in the year post-CABG. Women experienced higher burden of disability than men, and female sex and the presence of HF were important disability risk factors. Efforts should be dedicated to disability risk prediction to enable patient-centred operative decision-making and to developing sex-specific treatment strategies to improve outcomes.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Jack V Tu
- Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ontario, Canada.,Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada
| | - Douglas S Lee
- Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ontario, Canada.,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rob S Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Peter C Austin
- Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Anan Bader Eddeen
- Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Peter P Liu
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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15
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Sun LY, Tu JV, Bader Eddeen A, Liu PP. Prevalence and Long-Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction. J Am Heart Assoc 2018; 7:e008902. [PMID: 29909401 PMCID: PMC6220539 DOI: 10.1161/jaha.118.008902] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting. METHODS AND RESULTS We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population-based database of all Ontarians with physician-diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all-cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan-Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age-standardized HFpEF mortality rates at 4±2 years of follow-up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men. CONCLUSIONS We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow-up should be focused on women and men with HF rather than on rEF alone.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Jack V Tu
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Sunnybrook Schulich Heart Centre, University of Toronto, Ontario, Canada
| | | | - Peter P Liu
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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16
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Perera D, Clayton T, Petrie MC, Greenwood JP, O'Kane PD, Evans R, Sculpher M, Mcdonagh T, Gershlick A, de Belder M, Redwood S, Carr-White G, Marber M. Percutaneous Revascularization for Ischemic Ventricular Dysfunction: Rationale and Design of the REVIVED-BCIS2 Trial: Percutaneous Coronary Intervention for Ischemic Cardiomyopathy. JACC. HEART FAILURE 2018; 6:517-526. [PMID: 29852933 DOI: 10.1016/j.jchf.2018.01.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Evaluate whether PCI in combination with optimal medical therapy (OMT) will reduce all-cause death and hospitalization for HF compared to a strategy of OMT alone. BACKGROUND Ischemic cardiomyopathy (ICM) is the most common cause of heart failure (HF) and is associated with significant mortality and morbidity. Surgical revascularization has been shown to improve long-term outcomes in some patients, but surgery itself carries a major early hazard. Percutaneous coronary intervention (PCI) may allow a better balance between risk and benefit. METHODS REVIVED-BCIS2 is a prospective, multi-center, open-label, randomized controlled trial, funded by the National Institute for Health Research in the United Kingdom. Follow-up will be for at least 2 years from randomization. Secondary outcomes include left ventricular ejection fraction (LVEF), quality of life scores, appropriate implantable cardioverter defibrillator therapy and acute myocardial infarction. Patients with LVEF ≤35%, extensive coronary disease and demonstrable myocardial viability are eligible for inclusion and those with a myocardial infarction within 4 weeks, decompensated HF or sustained ventricular arrhythmias within 72 h are excluded. A trial of 700 patients has more than 85% power to detect a 30% relative reduction in hazard. RESULTS A total of 400 patients have been enrolled to date. CONCLUSIONS International guidelines do not provide firm recommendations on the role of PCI in managing severe ICM, because of a lack of robust evidence. REVIVED-BCIS2 will provide the first randomized data on the efficacy and safety of PCI in ICM and has the potential to inform guidelines pertaining to both revascularization and HF. (Study of Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival in Heart Failure [REVIVED-BCIS2]; NCT01920048) (REVascularisation for Ischaemic VEntricular Dysfunction; ISRCTN45979711).
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Affiliation(s)
- Divaka Perera
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom.
| | - Tim Clayton
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Peter D O'Kane
- Royal Bournemouth and Christchurch Hospital, United Kingdom
| | - Richard Evans
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, United Kingdom
| | | | - Anthony Gershlick
- Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Simon Redwood
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Gerald Carr-White
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
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17
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Ellis AG, Trikalinos TA, Wessler BS, Wong JB, Dahabreh IJ. Propensity Score-Based Methods in Comparative Effectiveness Research on Coronary Artery Disease. Am J Epidemiol 2018; 187:1064-1078. [PMID: 28992207 DOI: 10.1093/aje/kwx214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022] Open
Abstract
This review examines the conduct and reporting of observational studies using propensity score-based methods to compare coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy for patients with coronary artery disease. A systematic selection process identified 48 studies: 20 addressing CABG versus PCI; 21 addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG versus medical therapy; 1 addressing PCI versus medical therapy; and 1 addressing drug-eluting stents versus balloon angioplasty. Of 32 studies reporting information on variable selection, 7 relied exclusively on statistical criteria for the association of covariates with treatment, and 5 used such criteria to determine whether product or nonlinear terms should be included in the propensity score model. Twenty-five (52%) studies reported assessing covariate balance using the estimated propensity score, but only 1 described modifications to the propensity score model based on this assessment. The over 400 variables used in the 48 propensity score models were classified into 12 categories and 60 subcategories; only 17 subcategories were represented in at least half of the propensity score models. Overall, reporting of propensity score-based methods in observational studies comparing CABG, PCI, and medical therapy was incomplete; when adequately described, the methods used were often inconsistent with current methodological standards.
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Affiliation(s)
- Alexandra G Ellis
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, Massachusetts
- Department of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Issa J Dahabreh
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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18
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Ujueta F, Weiss EN, Shah B, Sedlis SP. Effect of Percutaneous Coronary Intervention on Survival in Patients with Stable Ischemic Heart Disease. Curr Cardiol Rep 2017; 19:17. [PMID: 28213668 DOI: 10.1007/s11886-017-0821-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW This study aims to determine if percutaneous coronary intervention (PCI) does improve survival in stable ischemic heart disease (SIHD). RECENT FINDINGS The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial will evaluate patients with moderate to severe ischemia and will be the largest randomized trial of an initial management strategy of coronary revascularization (percutaneous or surgical) versus optimal medical therapy alone for SIHD. Although the ISCHEMIA trial may show a benefit with upfront coronary revascularization in this high-risk population, cardiac events after PCI are largely caused by plaque rupture in segments outside of the original stented segment. Furthermore, given the robust data from prior randomized trials, which showed no survival benefit with PCI, and the likelihood that the highest risk patients in ISCHEMIA will be treated with surgery, it is unlikely that the ISCHEMIA trial will show a survival benefit particular to PCI. RECENT FINDINGS Although PCI relieves symptoms, the evidence base indicates that it does not prolong survival in SIHD.
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Affiliation(s)
- Francisco Ujueta
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA
| | - Ephraim N Weiss
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA
| | - Binita Shah
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA
| | - Steven P Sedlis
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA.
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19
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Álvarez-Cabo R, Meana B, Díaz R, Hernández-Vaquero D, Mencía P, Martín M, Llosa JC, Morales C, Silva J. Cirugía coronaria en pacientes con disfunción ventricular severa. Resultados a medio plazo. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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The Racial Paradox in Multiarterial Conduit Utilization for Coronary Artery Bypass Grafting. Ann Thorac Surg 2017; 103:1214-1221. [DOI: 10.1016/j.athoracsur.2016.07.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/17/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022]
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21
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Thompson A, Crilley J, Wilson D, Hungin A, Fuat A, Murphy J. Reliable exclusion of prognostically significant coronary disease in left ventricular dysfunction by cardiac MRI. Clin Radiol 2017; 72:159-164. [DOI: 10.1016/j.crad.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 12/12/2022]
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22
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Wolff G, Dimitroulis D, Andreotti F, Kołodziejczak M, Jung C, Scicchitano P, Devito F, Zito A, Occhipinti M, Castiglioni B, Calveri G, Maisano F, Ciccone MM, De Servi S, Navarese EP. Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003255. [PMID: 28087687 DOI: 10.1161/circheartfailure.116.003255] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/05/2016] [Indexed: 01/06/2023]
Abstract
Background—
Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment.
Methods and Results—
We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61–0.72;
P
<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62–0.85;
P
<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75–0.90;
P
<0.001).
Conclusions—
The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.
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Affiliation(s)
- Georg Wolff
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Dimitrios Dimitroulis
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Felicita Andreotti
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Michalina Kołodziejczak
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Christian Jung
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Pietro Scicchitano
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Fiorella Devito
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Annapaola Zito
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Michele Occhipinti
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Battistina Castiglioni
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Giuseppe Calveri
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Francesco Maisano
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Marco M. Ciccone
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Stefano De Servi
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
| | - Eliano P. Navarese
- From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń,
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Buzzatti N, Alfieri O. When the cardiac surgeon says no: anatomical and clinical reasons for declining coronary artery bypass grafting. J Cardiovasc Med (Hagerstown) 2016; 18 Suppl 1:e58-e63. [PMID: 27922927 DOI: 10.2459/jcm.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
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Ramakrishna H, Gutsche JT, Patel PA, Evans AS, Weiner M, Morozowich ST, Gordon EK, Riha H, Bracker J, Ghadimi K, Murphy S, Spitz W, MacKay E, Cios TJ, Malhotra AK, Baron E, Shaefi S, Fassl J, Weiss SJ, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2016; 31:1-13. [PMID: 28041810 DOI: 10.1053/j.jvca.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Menachem Weiner
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Joseph Bracker
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Sunberri Murphy
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Spitz
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Elvera Baron
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Shahzad Shaefi
- Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Harvard Medical School, Boston, MA
| | - Jens Fassl
- Cardiovascular and Thoracic Section, Department of Anesthesia and Intensive Care Medicine, University of Basel, Basel, Switzerland
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Borghi C, Omboni S, Novo S, Vinereanu D, Ambrosio G, Ambrosioni E. Zofenopril and ramipril in patients with left ventricular systolic dysfunction after acute myocardial infarction: A propensity analysis of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) 4 study. J Renin Angiotensin Aldosterone Syst 2016; 17:17/4/1470320316656480. [PMID: 27708111 PMCID: PMC5843868 DOI: 10.1177/1470320316656480] [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] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/30/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction: This was a propensity score analysis of the prospective, randomized, double-blind Survival of Myocardial Infarction Long-term Evaluation (SMILE) 4 study in which one-year treatment with zofenopril 60 mg plus acetylsalicylic acid (ASA) 100 mg gave superior results compared to ramipril 10 mg plus ASA in terms of death or hospitalization for cardiovascular causes in patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction (LVD). Materials and methods: A total of 716 patients of the intention-to-treat population were divided into homogeneous propensity quintiles (Q) using a logistic regression model (QI: best risk profile; QV: worst risk profile). Results: Treatment was associated with a similar low rate of major cardiovascular events in any Q. However, the efficacy of zofenopril was better than that of ramipril in QII, QV, and particularly QIII (odds ratio (OR) and 95% confidence interval: 0.43 (0.21–0.87), p<0.05]. This result was primarily attributed to a decrease in the risk of cardiovascular hospitalization, particularly striking in the QIII (OR: 0.40, 0.19-0.85; p<0.05). Mortality rate did not significantly differ between the two treatments in any Q. Conclusions: In the SMILE-4 study the propensity analysis confirmed the efficacy of zofenopril in the prevention of long-term cardiovascular outcomes irrespective of the cardiovascular risk profile of post-AMI patients.
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Affiliation(s)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Italy
| | | | - Dragos Vinereanu
- Cardiology, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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26
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Johansson I, Dahlström U, Edner M, Näsman P, Rydén L, Norhammar A. Prognostic Implications of Type 2 Diabetes Mellitus in Ischemic and Nonischemic Heart Failure. J Am Coll Cardiol 2016; 68:1404-1416. [DOI: 10.1016/j.jacc.2016.06.061] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 12/20/2022]
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Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure. J Am Coll Cardiol 2016; 68:450-458. [DOI: 10.1016/j.jacc.2016.05.060] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/03/2016] [Indexed: 01/22/2023]
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Kancharla K, Weissman G, Elagha AA, Kancherla K, Samineni S, Hill PC, Boyce S, Fuisz AR. Scar quantification by cardiovascular magnetic resonance as an independent predictor of long-term survival in patients with ischemic heart failure treated by coronary artery bypass graft surgery. J Cardiovasc Magn Reson 2016; 18:45. [PMID: 27430331 PMCID: PMC4950709 DOI: 10.1186/s12968-016-0265-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/01/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Scar burden by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is associated with functional recovery after coronary artery bypass surgery (CABG). There is limited data on long-term mortality after CABG based on left ventricular (LV) scar burden. METHODS Patients who underwent LGE CMR between January 2003 and February 2010 within 1 month prior to CABG were included. A standard 16 segment model was used for scar quantification. A score of 1 for no scar, 2 for ≤ 50 % and 3 for > 50 % transmurality was assigned for each segment. LV scar score (LVSS) defined as the sum of segment scores divided by 16. All-cause mortality was ascertained by social security death index. RESULTS One hundred ninety-six patients met the inclusion criteria. 185 CMR studies were available. History of prior MI was present in 64 % and prior CABG in 5.4 % of patients. Scar was present in 72 % of patients and median LVEF was 38 %. Over a median follow up of 8.3 years, there were 64 deaths (34.6 %). There was no statistically significant difference in mortality between Scar and No-scar groups (37 % versus 29 %). In the group with scar, a lower scar burden (defined either < 4 segments with scar or based on LVSS) was independently associated with increased survival. CONCLUSION In patients undergoing surgical revascularization, scar burden is negatively associated with survival in patients with scar. However, there is no difference in survival based on presence or absence of scar alone. CMR prior to CABG adds additional prognostic information.
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Affiliation(s)
| | - Gaby Weissman
- />Division of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC USA
- />Georgetown University, Washington, DC USA
| | - Abdalla A. Elagha
- />Department of cardiology, Cairo University Hospitals, Cairo, Egypt
- />Translational Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, MD USA
| | - Kalyan Kancherla
- />MedStar Health Research Institute, Washington, DC USA
- />Howard University Hospital, Washington, DC USA
| | | | - Peter C. Hill
- />Department of Cardiac Surgery, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Steven Boyce
- />Georgetown University, Washington, DC USA
- />Department of Cardiac Surgery, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Anthon R. Fuisz
- />Division of Cardiology, Westchester Medical Center, Valhalla, New York, USA
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Alizadehasl A, Sohrabi B, Panjavi L, Sadeghpour A, Azarfarin R, Ghadrdoost B, Zolfaghari R, Habibzadeh A. Comparison of the Effects of Coronary Artery Bypass Grafting Versus Medical Therapy on Short and Long Term Outcomes in Octogenarian Patients With Multi-Vessel Coronary Artery Disease. Res Cardiovasc Med 2016; 5:e30590. [PMID: 26889460 PMCID: PMC4752697 DOI: 10.5812/cardiovascmed.30590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/17/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Appropriate treatment methods lead to a reduced rate of mortality and morbidity, and an improved quality of life, in patients with multi-vessel coronary artery disease. Objectives: In this study, we compared short and long-term outcomes of coronary artery bypass grafting (CABG) versus medical therapy in patients 80 years of age and older with multi-vessel coronary artery disease (MVCAD). Patients and Methods: In this retrospective study, 50 octogenarian patients with MVCAD who underwent CABG were compared with 50 patients in the same condition who were treated with medical therapy during the same time. The primary objective was to compare mortality and morbidity rates, as well as other factors such as the occurrence of chest pain, deterioration of the NYHA functional class, and re-hospitalization, between the two groups. The comparison was made using medical records from the five years post-treatment. Results: After five years, the overall mortality rate included 11 patients (22%) in the CABG group versus 18 patients (36%) in the medical therapy group; this difference was not significant between the two groups (P = 0.186). Regarding short-term outcomes, in the CABG group, cardiogenic shock occurred in 9 patients (18%), renal failure in 13 patients (26%), pulmonary complications in 9 patients (18%) and neurologic complications in 3 patients (6%); in the medical therapy group, these same complications occurred, respectively, in 6 patients (12%), 7 patients (14%), 10 patients (20%) and 1 patient (2%). In addition to these factors, freedom from chest pain and improvement in the functional class among the CABG group was significantly higher than among the medical therapy group (P = <0.001). Conclusions: CABG may be the superior form of treatment for long-term outcomes in terms of the relief of chest pain, improvement of the functional class, reduced need for re-admission, and later death for octogenarians. However, short-term morbidity may be higher among the CABG group, but the mortality rate after 30 days is quite similar.
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Affiliation(s)
- Azin Alizadehasl
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Bahram Sohrabi
- Madani Cardiovascular Medical and Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Bahram Sohrabi, Madani Cardiovascular Medical and Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4133357767, Fax: +98-2122663293, E-mail:
| | - Laleh Panjavi
- Madani Cardiovascular Medical and Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Anita Sadeghpour
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Rasoul Azarfarin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Reza Zolfaghari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Afshin Habibzadeh
- Madani Cardiovascular Medical and Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Wrobel K, Stevens SR, Jones RH, Selzman CH, Lamy A, Beaver TM, Djokovic LT, Wang N, Velazquez EJ, Sopko G, Kron IL, DiMaio JM, Michler RE, Lee KL, Yii M, Leng CY, Zembala M, Rouleau JL, Daly RC, Al-Khalidi HR. Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction: Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Circulation 2015; 132:720-30. [PMID: 26304663 DOI: 10.1161/circulationaha.114.014932] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. METHODS AND RESULTS In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. CONCLUSIONS CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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Affiliation(s)
- Krzysztof Wrobel
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Susanna R Stevens
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Robert H Jones
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Craig H Selzman
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Andre Lamy
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Thomas M Beaver
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Ljubomir T Djokovic
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Nan Wang
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Eric J Velazquez
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - George Sopko
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Irving L Kron
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - J Michael DiMaio
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Robert E Michler
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Kerry L Lee
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Michael Yii
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Chua Yeow Leng
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Marian Zembala
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Jean L Rouleau
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Richard C Daly
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Hussein R Al-Khalidi
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.).
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Ammirati E, Guida V, Latib A, Moroni F, Arioli F, Scotti I, Rimoldi OE, Colombo A, Camici PG. Determinants of outcome in patients with chronic ischemic left ventricular dysfunction undergone percutaneous coronary interventions. BMC Cardiovasc Disord 2015; 15:137. [PMID: 26503520 PMCID: PMC4624381 DOI: 10.1186/s12872-015-0126-x] [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: 07/06/2015] [Accepted: 10/16/2015] [Indexed: 11/22/2022] Open
Abstract
Background Percutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear. Methods We retrospectively evaluated 385 consecutive patients (76 % male, 66 ± 9 years) with SLVD (left ventricular ejection fraction [LVEF] ≤40 %) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF). Results The median follow-up was 28 months (inter-quartile range 14–46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21 %) and 109 (28 %) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF < 35 %, symptoms of heart failure (HF) emerged both as independent predictors of death (adjusted hazard ratios [HR] 2.64; 1.92, 1.88 and 1.67 respectively) and composite outcome of death and hospitalization for ADHF (adjusted HR 2.22, 1.92, 1.79 and 1.94 respectively). Furthermore advanced age (HR = 1.03) emerged as independent predictors of death and having performed a stress test before PCI correlated with reduced number of deaths and ADHF hospitalizations (HR = 0.60). Of note, PCI significantly reduced the symptom of angina from 63.2 % at baseline to 16.3 % at the last follow up (p < 0.0001). Conclusions IDDM, symptoms of HF, multivessel disease and LVEF < 35 % appear to be associated with worse outcome patients with ischemic SLVD undergoing PCI, and may be taken into account for optimal risk stratification. On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome.
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Affiliation(s)
- Enrico Ammirati
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy. .,Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy. .,Cardiothoracic Department, San Raffaele Scientific Institute and University, Via Olgettina 60, 20132, Milan,, Italy.
| | - Valentina Guida
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Azeem Latib
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Moroni
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Arioli
- A.O. Ospedale di Circolo di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Isabella Scotti
- Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | | | - Antonio Colombo
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Paolo G Camici
- IRCCS Ospedale San Raffaele and Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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New Insights in the Diagnosis and Treatment of Heart Failure. BIOMED RESEARCH INTERNATIONAL 2015; 2015:265260. [PMID: 26634204 PMCID: PMC4637457 DOI: 10.1155/2015/265260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/21/2015] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists.
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Johansson I, Edner M, Dahlström U, Näsman P, Rydén L, Norhammar A. Is the prognosis in patients with diabetes and heart failure a matter of unsatisfactory management? An observational study from the Swedish Heart Failure Registry. Eur J Heart Fail 2015; 16:409-18. [PMID: 24464683 DOI: 10.1002/ejhf.44] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 11/08/2022] Open
Abstract
AIMS To analyse the long-term outcome, risk factor panorama, and treatment pattern in patients with heart failure (HF) with and without type 2 diabetes (T2DM) from a daily healthcare perspective. METHODS AND RESULTS Patients with (n=8809) and without (n=27,465) T2DM included in the Swedish Heart Failure Registry (S-HFR) 2003–2011 due to a physician-based HF diagnosis were prospectively followed for long-term mortality (median follow-up time: 1.9 years, range 0–8.7 years). Left ventricular function expressed as EF did not differ between patients with and without T2DM. Survival was significantly shorter in patients with T2DM, who had a median survival time of 3.5 years compared with 4.6 years (P<0.0001). In subjects with T2DM. unadjusted and adjusted odds ratios (ORs) for mortality were 1.37 [95% confidence interval (CI) 1.30–1.44) and 1.60 (95% CI 1.50–1.71), and T2DM predicted mortality in all age groups. Ischaemic heart disease was an important predictor for mortality (OR 1.68, 95% CI 1.47–1.94), more abundant in patients with T2DM (59% vs. 45%) among whom only 35% had been subjected to coronary angiography and 32% to revascularization. Evidence-based pharmacological HF treatment was somewhat more extensive in patients with T2DM. CONCLUSION The combination of T2DM and HF seriously compromises long-term prognosis. Ischaemic heart disease was identified as one major contributor; however, underutilization of available diagnostic and therapeutic facilities for ischaemic heart disease was obvious and may be an important area for future improvement in patients with T2DM and HF.
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Nef H, Renker M, Hamm CW. [ESC/EACTS guidelines on myocardial revascularization : Amendments 2014]. Herz 2015; 39:913-8. [PMID: 25406330 DOI: 10.1007/s00059-014-4180-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
One of the most important treatment principles in interventional cardiology relies on myocardial revascularization by percutaneous coronary intervention (PCI) or surgical placement of coronary artery bypass grafts (CABG). However, in order to apply these principles effectively, it is important to identify patients who require revascularization. Consequently, the appropriate method has to be selected to effectively restore blood flow. Patients will only benefit from the interventional or surgical procedures when those revascularization measures that can cause more harm than good are avoided. In the new European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization some new aspects will be addressed.
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Affiliation(s)
- H Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen, Klinikstr. 33, 35392, Gießen, Deutschland,
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Velazquez EJ, Bonow RO. Revascularization in Severe Left Ventricular Dysfunction. J Am Coll Cardiol 2015; 65:615-24. [DOI: 10.1016/j.jacc.2014.10.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/07/2014] [Indexed: 01/04/2023]
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3323] [Impact Index Per Article: 332.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery. Int Psychogeriatr 2014; 26:845-55. [PMID: 24345656 DOI: 10.1017/s1041610213002378] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The knowledge base regarding the pathogenesis of postoperative delirium is limited. The primary aim of this study is to investigate whether increased levels of IL-2 and TNF-α are associated with delirium in patients who underwent coronary-artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). The secondary aim is to establish whether any association between raised cytokine levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing conditions associated with raised cytokine levels, such as major depressive disorder (MDD), cognitive impairment, or aging. METHODS Patients were examined and screened for MDD and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Montreal Cognitive Assessment and Trail Making Test Part B. Blood samples were collected postoperatively for cytokine levels. RESULTS Postoperative delirium screening was found positive in 36% (41 of 113) of patients. A multivariate logistic regression revealed that an increased concentration of pro-inflammatory cytokines is associated with delirium, and related to advancing age, preoperative cognitive decline of participants, and duration of CPB. According to receiver operating characteristic analysis, the most optimal cut-off for IL-2 and TNF-α concentrations in predicting the development of delirium were 907.5 U/ml and 10.95 pg/ml, respectively. CONCLUSIONS The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group.
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ten Kate GJR, Caliskan K, Dedic A, Meijboom WB, Neefjes LA, Manintveld OC, Krenning BJ, Ouhlous M, Nieman K, Krestin GP, de Feyter PJ. Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. Eur J Heart Fail 2014; 15:1028-34. [DOI: 10.1093/eurjhf/hft090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gert-Jan R. ten Kate
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Kadir Caliskan
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
| | - Admir Dedic
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - W. Bob Meijboom
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
| | - Lisan A. Neefjes
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | | | - Mohammed Ouhlous
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Koen Nieman
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Gabriel P. Krestin
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Pim J. de Feyter
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
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Abstract
PURPOSE OF REVIEW Recent results from prospective randomized controlled trials examining the management of patients with ischemic cardiomyopathy (ICM) have questioned both the added value of revascularization over contemporary optimal medical therapy (OMT) and the use of viability testing as a gate-keeper to revascularization. The purpose of this review is to summarize recent trial evidence before discussing future perspectives in the field. RECENT FINDINGS The Surgical Treatment of Ischemic Heart Failure (STICH) trial, PPAR-2 trial and Heart Failure Revascularisation Trial have all reported their results within the past 5 years. None of these trials found revascularization superior to OMT in improving survival of ICM patients. Additionally, the STICH trial's viability substudy suggested that pretreatment viability testing was not beneficial. SUMMARY ICM patients remain a clinical conundrum. The numerous limitations of the recent RCTs have led to uncertainty about optimal management. Revascularization continues to be offered to patients with evidence of myocardial viability. Further studies are required to answer the outstanding questions in the management of patients with ICM.
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Ferguson TB, Chen C. FREEDOM, SYNTAX, FAME and FUNCTIONALITY: the future of surgical revascularization in stable ischemic heart disease. Future Cardiol 2014; 10:63-79. [DOI: 10.2217/fca.13.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
ABSTRACT: At the age of nearly 50 years, the procedure of coronary artery bypass grafting (CABG) now has the most solid evidence supporting its role in revascularization for stable ischemic heart disease in its history. In what is a relatively infrequent occurrence in medicine, the results from large-scale observational database analyses are now aligned with and supported by data from recent randomized trials, providing important contemporary evidence in support of CABG. However, even with strong evidence, the changing landscape of revascularization for stable ischemic heart disease threatens to make this evidence irrelevant in deciding which patients should be referred for CABG in the future. How the procedure of CABG could be modified and optimized for incorporation into this new landscape is discussed in this article.
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Affiliation(s)
- T Bruce Ferguson
- East Carolina Heart Institute, Brody School of Medicine at ECU, Greenville, NC, USA
| | - Cheng Chen
- East Carolina Heart Institute, Brody School of Medicine at ECU, Greenville, NC, USA
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Effects of wenxin keli on the action potential and L-type calcium current in rats with transverse aortic constriction-induced heart failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:572078. [PMID: 24319478 PMCID: PMC3844239 DOI: 10.1155/2013/572078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022]
Abstract
Objective. We investigated the effects of WXKL on the action potential (AP) and the L-type calcium current (ICa-L) in normal and hypertrophied myocytes. Methods. Forty male rats were randomly divided into two groups: the control group and the transverse aortic constriction- (TAC-) induced heart failure group. Cardiac hypertrophy was induced by TAC surgery, whereas the control group underwent a sham operation. Eight weeks after surgery, single cardiac ventricular myocytes were isolated from the hearts of the rats. The APs and ICa-L were recorded using the whole-cell patch clamp technique. Results. The action potential duration (APD) of the TAC group was prolonged compared with the control group and was markedly shortened by WXKL treatment in a dose-dependent manner. The current densities of the ICa-L in the TAC group treated with 5 g/L WXKL were significantly decreased compared with the TAC group. We also determined the effect of WXKL on the gating mechanism of the ICa-L in the TAC group. We found that WXKL decreased the ICa-L by accelerating the inactivation of the channels and delaying the recovery time from inactivation. Conclusions. The results suggest that WXKL affects the AP and blocked the ICa-L, which ultimately resulted in the treatment of arrhythmias.
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Yang JH, Choi SH, Song YB, Hahn JY, Choi JH, Jeong DS, Sung K, Kim WS, Lee YT, Gwon HC. Long-term outcomes of drug-eluting stent implantation versus coronary artery bypass grafting for patients with coronary artery disease and chronic left ventricular systolic dysfunction. Am J Cardiol 2013; 112:623-9. [PMID: 23711811 DOI: 10.1016/j.amjcard.2013.04.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 11/30/2022]
Abstract
Limited data are available on comparing the clinical outcomes of coronary artery bypass grafting (CABG) and drug-eluting stent (DES) implantation in patients with reduced left ventricular systolic function in the DES era. From January 2003 to December 2010, 953 patients with reduced left ventricular systolic function, defined as a left ventricular ejection fraction <50%, who had undergone percutaneous coronary intervention with DESs (n = 402) or CABG (n = 551) were enrolled in a retrospective, observational registry. Patients with acute myocardial infarction were excluded. Propensity score-matching analysis was also performed in 141 patient pairs. The primary outcome was all-cause death. The median follow-up duration was 32 months (interquartile range 15 to 61). All-cause death occurred in 81 patients (20.1%) in the DES group and 98 patient (17.8%) in the CABG group (p = 0.524). After propensity score matching, the long-term cumulative rate of death was not significantly different between the 2 groups (DES vs CABG 21.3% vs 19.1%; adjusted hazard ratio 1.23, 95% confidence interval 0.57 to 2.66, p = 0.603). However, the rate of major adverse cardiac and cerebrovascular events (35.5% vs 24.1%, adjusted hazard ratio 1.69, 95% confidence interval 1.04 to 2.77, p = 0.036) was higher in the DES group than the CABG group. This was driven by the higher incidence of repeat revascularization in the DES group (11.3% vs 4.3%, adjusted hazard ratio 3.65, 95% confidence interval 1.01 to 10.37, p = 0.018). In conclusion, DES implantation provides comparable long-term clinical outcomes, except for repeat revascularization, to CABG in patients with coronary artery disease and chronic left ventricular systolic dysfunction.
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Affiliation(s)
- Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Low preoperative hepcidin concentration as a risk factor for mortality after cardiac surgery: A pilot study. J Thorac Cardiovasc Surg 2013; 145:1380-6. [DOI: 10.1016/j.jtcvs.2012.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/26/2012] [Accepted: 09/12/2012] [Indexed: 11/21/2022]
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Bridgewater B. Almanac 2012: Adult cardiac surgery. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:64-71. [PMID: 23453923 DOI: 10.1016/j.acmx.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ben Bridgewater
- University Hospital of South Manchester, Manchester, United Kingdom.
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Bridgewater B. Almanac 2012 adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bridgewater B. Almanac 2012: adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2013; 32:173-80. [PMID: 23369506 DOI: 10.1016/j.repc.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022] Open
Abstract
This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation.
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Bridgewater B. Almanac 2012: Adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Velazquez EJ. Does imaging-guided selection of patients with ischemic heart failure for high risk revascularization improve identification of those with the highest clinical benefit?: Myocardial imaging should not exclude patients with ischemic heart failure from coronary revascularization. Circ Cardiovasc Imaging 2012; 5:271-9; discussion 279. [PMID: 22438425 DOI: 10.1161/circimaging.111.964650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric J Velazquez
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA.
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