1
|
Salinas P, García-Camarero T, Jimenez-Kockar M, Regueiro A, García-Blas S, Gomez-Menchero AE, Ojeda S, Vilchez-Tschischke JP, Amat-Santos I, Díez-Gil JL, Rondán J, Lozano Ruiz-Poveda F, de Miguel Castro A, Manzano MC, Pascual-Tejerina V, Cruz-González I, García Perez-Velasco J, Fernández-Diaz JA, Escaned J. Myocardial revascularization failure among patients requiring cardiac catheterization and secondary revascularization in contemporary clinical practice: Results of the REVASEC multicenter registry. Catheter Cardiovasc Interv 2023; 102:608-619. [PMID: 37582340 DOI: 10.1002/ccd.30804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Myocardial revascularization failure (MRF) and Secondary revascularization (SR) are contemporary interventional cardiology challenges. AIM To investigate the characteristics, management, and prognosis of patients with myocardial revascularization failure (MRF) and need for secondary revascularization (SR) in contemporary practice. METHODS The REVASEC study is a prospective registry (NCT03349385), which recruited patients with prior revascularization referred for coronary angiography at 19 centers. The primary endpoint is a patient-oriented composite (POCE) at 1 year, including death, myocardial infarction, or repeat revascularization. RESULTS A total of 869 patients previously revascularized by percutaneous intervention (83%) or surgery (17%) were recruited. MRF was found in 83.7% (41.1% stent/graft failure, 32.1% progression of coronary disease, and 10.5% residual disease). SR was performed in 70.1%, preferably by percutaneous intervention (95%). The POCE rate at 1 year was 14% in the overall cohort, with 6.4% all-cause death. In the multivariate analysis, lower POCE rates were found in the groups without MRF (9.4%) and with disease progression (11%) compared with graft/stent failure (17%) and residual disease (18%), hazard ratio 0.67 (95% confidence interval: 0.45-0.99), p = 0.043. At 1 year, the SR group had less chronic persistent angina (19% vs. 34%, p < 0.001), but a higher rate of repeat revascularization (9% vs. 2.9%, p < 0.001). CONCLUSION MRF was found in 84% of patients with prior revascularization referred for coronary angiography. Stent/graft failure and residual coronary disease were associated with a worse prognosis. SR provided better symptom control at the expense of a higher rate of new revascularization.
Collapse
Affiliation(s)
- Pablo Salinas
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | - Sergio García-Blas
- Instituto de Investigación Sanitaria INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
2
|
de Winter RW, Walsh SJ, Hanratty CG, Spratt JC, Sprengers RW, Twisk JWR, Vegting I, Schumacher SP, Bom MJ, Hoek R, Verouden NJ, Delewi R, Nap A, Knaapen P. Percutaneous coronary intervention of native coronary artery versus saphenous vein graft in patients with prior coronary artery bypass graft surgery: Rationale and design of the multicenter, randomized PROCTOR trial. Am Heart J 2023; 257:20-29. [PMID: 36410442 DOI: 10.1016/j.ahj.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Patients with prior coronary artery bypass grafting (CABG) frequently require repeat percutaneous revascularization due to advanced age, progressive coronary artery disease and bypass graft failure. Percutaneous coronary intervention (PCI) of either the bypass graft or the native coronary artery may be performed. Randomized trials comparing native vessel PCI with bypass graft PCI are lacking and long-term outcomes have not been reported. METHODS PROCTOR (NCT03805048) is a prospective, multicenter, randomized controlled trial, that will include 584 patients presenting with saphenous vein graft (SVG) failure and a clinical indication for revascularization, as determined by the local Heart Team. The trial is designed to compare the clinical and angiographic outcomes in patients randomly allocated in a 1:1 fashion to either a strategy of native vessel PCI or SVG PCI. The primary study endpoint is a 3-year composite of major adverse cardiac events (MACE: all-cause mortality, non-fatal target coronary territory myocardial infarction [MI], or clinically driven target coronary territory revascularization). At 3-years, after evaluation of the primary endpoint, follow-up invasive coronary angiography will be performed. Secondary endpoints comprise individual components of MACE at 1, 3 and 5 years follow-up, PCI-related MI, MI >48 hours after index PCI, target vessel failure, target lesion revascularization, renal failure requiring renal-replacement therapy, angiographic outcomes at 3-years and quality of life (delta Seattle Angina Questionnaire, Canadian Cardiovascular Society Grading Scale and Rose Dyspnea Scale). CONCLUSION PROCTOR is the first randomized trial comparing an invasive strategy of native coronary artery PCI with SVG PCI in post-CABG patients presenting with SVG failure.
Collapse
Affiliation(s)
- Ruben W de Winter
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Simon J Walsh
- Department of Cardiology, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colm G Hanratty
- Heart & Vascular Centre, Mater Private Day Hospital, Dublin, Ireland
| | - James C Spratt
- Department of Cardiology, St George's University Hospital NHS Trust, London, United Kingdom
| | - Ralf W Sprengers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | - Iris Vegting
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Roel Hoek
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J Verouden
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ronak Delewi
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Heart Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
| |
Collapse
|
3
|
Hamilton GW, Dinh D, Yeoh J, Brennan AL, Fulcher J, Koshy AN, Yudi MB, Reid CM, Hare DL, Freeman M, Stub D, Chan W, Duffy SJ, Ajani A, Raman J, Farouque O, Clark DJ. Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:457-467. [PMID: 36858666 DOI: 10.1016/j.jcin.2022.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND When patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft. OBJECTIVES The aim of this study was to report the characteristics of arterial graft stenoses and evaluate the feasibility of RA PCI. METHODS This study included 2,780 consecutive patients with prior CABG undergoing PCI between 2005 and 2018 who were prospectively enrolled in the MIG (Melbourne Interventional Group) registry. Data were stratified by PCI target vessel. RA graft PCI was compared with both native vessel (native PCI) and SVG PCI. Internal mammary graft PCI data were reported. The primary outcome was 3-year mortality. RESULTS Overall, 1,928 patients (69.4%) underwent native PCI, 716 (25.6%) SVG PCI, 86 (3.1%) RA PCI, and 50 (1.8%) internal mammary graft PCI. Compared with SVG PCI, the RA PCI cohort presented earlier after CABG, less frequently had acute coronary syndrome, and more commonly had ostial or distal anastomosis intervention (P < 0.005 for all). Compared with patients who underwent native PCI, those who underwent RA PCI were more likely to have diabetes and peripheral vascular disease (P < 0.001 for both) and to present with non-ST-segment elevation myocardial infarction (P = 0.010). The RA PCI group had no perforations or in-hospital myocardial infarctions, though no significant difference was found in periprocedural outcomes compared with either native or SVG PCI. No differences were found between RA PCI and either native or SVG PCI in 30-day outcomes or 3-year mortality. CONCLUSIONS Presenting and lesion characteristics differed between patients undergoing arterial compared with SVG PCI, implying a varied pathogenesis of graft stenosis. RA PCI appears feasible, safe, and where anatomically suitable, may be a viable alternative to native PCI.
Collapse
Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. https://twitter.com/GarryHamilton6
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Jordan Fulcher
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; School of Population Health, Curtin University, Perth, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - William Chan
- Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Jaishankar Raman
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
| | | |
Collapse
|
4
|
Yamaguchi S, Uemura Y, Tanaka A, Takagi K, Ohashi T, Tanaka M, Umemoto N, Yoshida R, Negishi Y, Iwama M, Takemoto K, Watarai M, Kudo N, Morishima I, Tatami Y, Takada Y, Shimizu K, Yoshida Y, Tanaka T, Noda T, Ishii H, Murohara T. Long-term outcomes of percutaneous revascularization for internal mammary artery-left anterior descending artery bypass failure. Heart Vessels 2023; 38:157-163. [PMID: 35948801 DOI: 10.1007/s00380-022-02150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023]
Abstract
Despite the excellent long-term results of internal mammary artery (IMA)-left anterior descending (LAD) bypass, percutaneous revascularization of IMA is sometimes required for IMA-LAD bypass failure. However, its clinical outcomes have not been fully elucidated. The aim of this study was to investigate the long-term clinical outcomes, including target lesion revascularization (TLR) following contemporary percutaneous revascularization of failed IMA bypass graft. We examined data of 59 patients who had undergone percutaneous revascularization of IMA due to IMA-LAD bypass failure at nine hospitals. Patients with IMA graft used for Y-composite graft or sequential bypass graft were excluded. The incidence of TLR was primarily examined, whereas other clinical outcomes including cardiac death, myocardial infarction, and target vessel revascularization were also evaluated. Mean age of the enrolled patients was 67.4 ± 11.3 years, and 74.6% were men. Forty patients (67.8%) had anastomotic lesions, and 17 (28.8%) underwent revascularization within three months after bypass surgery. Procedural success was achieved in 55 (93.2%) patients. Stent implantation was performed in 13 patients (22.0%). During a median follow-up of 1401 days (interquartile range, 282-2521 days), TLR was required in six patients (8.5% at 1, 3, and 5 years). Patients who underwent percutaneous revascularization within 3 months after surgery tended to have a higher incidence of TLR. Clinical outcomes of IMA revascularization for IMA-LAD bypass failure were acceptable.
Collapse
Affiliation(s)
- Shogo Yamaguchi
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan.
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.,Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Ruka Yoshida
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kenji Takemoto
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan
| | - Masato Watarai
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan
| | - Nobutaka Kudo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Toshikazu Tanaka
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | |
Collapse
|
5
|
Donisan T, Madanat L, Balanescu DV, Mertens A, Dixon S. Drug-Eluting Stent Restenosis: Modern Approach to a Classic Challenge. Curr Cardiol Rev 2023; 19:e030123212355. [PMID: 36597603 PMCID: PMC10280993 DOI: 10.2174/1573403x19666230103154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
In-stent restenosis (ISR) is a recognized complication following percutaneous coronary intervention in which the luminal diameter is narrowed through neointimal hyperplasia and vessel remodeling. Although rates of ISR have decreased in most recent years owing to newer generation drug-eluting stents, thinner struts, and better intravascular imaging modalities, ISR remains a prevalent dilemma that proves to be challenging to manage. Several factors have been proposed to contribute to ISR formation, including mechanical stent characteristics, technical factors during the coronary intervention, and biological aspects of drug-eluting stents. Presentation of ISR can range from asymptomatic to late myocardial infarction and could be difficult to differentiate from acute thrombus formation. No definite guidelines are present on the management of ISR. In this review, we will discuss the mechanisms underlying ISR and provide insight into patient-related and procedural risk factors contributing to ISR, in addition to highlighting common treatment approaches utilized in the management of ISR.
Collapse
Affiliation(s)
- Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Dinu V. Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| |
Collapse
|
6
|
Guo L, Lv H, Yin X. Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives. Front Cardiovasc Med 2022; 9:753250. [PMID: 35479272 PMCID: PMC9037955 DOI: 10.3389/fcvm.2022.753250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary chronic total occlusion (CTO), which occurs in 18. 4–52% of all patients referred for coronary angiography, represents one of the last barriers in coronary intervention. Approximately half of all patients with prior coronary artery bypass graft (CABG), who undergo coronary angiography, are diagnosed with coronary CTO. In fact, these patients often develop recurrent symptoms and events, necessitating revascularization. Currently, there is neither a consensus nor developed guidelines for the treatment of CTO patients with prior CABG, and the prognosis of these patients remains unknown. In this review, we discuss current evidence and future perspectives on CTO revascularization in patients with prior CABG, with special emphasis on clinical and lesion characteristics, procedural success rates, periprocedural complications, and long-term outcomes.
Collapse
|
7
|
Salinas P, Vilchez-Tschischke JP, Noriega F, Macaya F, Rosillo S, García-Camarero T, de la Torre-Hernández JM, de Tapia B, Jiménez-Kockar M, Regueiro A, Flores-Umanzor E, García-Blas S, González-D'Gregorio J, Gómez-Menchero AE, Díaz-Fernandez JF, Rondán J, Amat-Santos I, Ojeda S, Diez-Gil JL, de Miguel Castro A, Lozano Ruiz-Poveda F, Fernández-Diaz JA, Manzano MC, Cruz-González I, Pascual Tejerina V, García Pérez-Velasco J, Serra A, Poveda-Andrés JL, Macaya C, Escaned J. Design and rationale for a real-world prospective, multicenter registry of myocardial revascularization failure and secondary revascularization: The REVASEC study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:50-56. [PMID: 34857473 DOI: 10.1016/j.carrev.2021.11.015] [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: 08/27/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/03/2022]
Abstract
AIM To investigate key aspects of the problem of myocardial revascularization failure (MRF) and repeat or secondary myocardial revascularization (SR) in contemporary practice. METHODS The registry of secondary revascularization (REVASEC) is an investigator-initiated, multicenter, prospective registry enhanced with data monitoring and independent event adjudication (ClinicalTrials.govNCT03349385). It includes patients with prior revascularization referred to coronary angiography for suspected MRF with broad inclusion criteria. The main objectives are to describe the characteristics of patients with prior revascularization referred for repeat angiography, to describe and the rate and mechanisms of MRF (stent or graft failure, coronary artery disease progression or residual coronary artery disease); to evaluate the management including medical treatment and SR of these patients; and to assess the prognosis according to the outlined causative mechanisms. The registry has one year follow up for the primary endpoint (Patient-oriented composite endpoint including all-cause death, any myocardial infarction or any new unplanned revascularization according to subsets of MRF), but extended follow-up will be carried out up to 5 years. CONCLUSION The REVASEC Registry will provide updated data on the characteristics, patterns of treatment, and 1-year outcomes of patients with MRF and SR in contemporary clinical practice.
Collapse
Affiliation(s)
- Pablo Salinas
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Jean Paul Vilchez-Tschischke
- Hospital Universitario y Politécnico La Fe, Valencia, Spain; Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
| | - Francisco Noriega
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Fernando Macaya
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Juan Rondán
- Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimonides de Investigación Biomédica (IMIBIC), Universidad de Cordoba, Spain
| | | | | | | | | | | | | | | | | | - Antonio Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Carlos Macaya
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
8
|
Lim M, Dinh DT, Brennan A, Liew D, Reid C, Lefkovits J, Duffy SJ, Andrianopoulos N, Stub D. Clinical Outcomes in Older Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Elevation Acute Coronary Syndromes. Heart Lung Circ 2020; 30:275-281. [PMID: 32622913 DOI: 10.1016/j.hlc.2020.05.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/26/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Distinguishing the subgroup of older, comorbid patients presenting with non-ST-elevation acute coronary syndromes (NSTEACS) who will benefit from percutaneous coronary intervention (PCI) remains challenging. Identifying risk factors for major adverse cardiac or cerebrovascular events (MACCE) post PCI may help define this cohort. The objective of this study was to describe contemporary outcomes of older patients with NSTEACS undergoing PCI and identify pre-procedural risk factors for MACCE. METHODS We retrospectively reviewed data for 1,875 patients aged ≥80 years entered in the Victorian Cardiac Outcomes Registry (VCOR) who underwent PCI for NSTEACS between 1 January 2013 and 31 December 2017. MACCE was a composite outcome comprising 30-day mortality, myocardial infarction, stroke, major bleeding, target lesion revascularisation or target vessel revascularisation; in-hospital cardiogenic shock or stent thrombosis; and new requirement for dialysis. Patient demographic data and pre-procedural comorbidities were compared between the groups with and without a MACCE. RESULTS The rate of MACCE at 30 days was 8.0% (n=150). Thirty-day (30-day) mortality was 3.0% (n=57). Pre-procedural left ventricular ejection fraction (LVEF)<45% (OR 2.32; 95% CI 1.47-3.68; p<0.001) and eGFR≤30 mL/min/1.73m2 or renal replacement therapy (OR 2.10; 95% CI 1.27-3.46; p<0.01) were independent predictors of a MACCE. CONCLUSIONS Older patients presenting with NSTEACS who have left ventricular systolic dysfunction or renal impairment are at increased risk of MACCE post PCI. Randomised studies are required to determine if invasive management remains beneficial for these patents compared with medical therapy.
Collapse
Affiliation(s)
- Michael Lim
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Christopher Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia.
| |
Collapse
|
9
|
Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease. J Interv Cardiol 2020; 2020:6736704. [PMID: 32372888 PMCID: PMC7191400 DOI: 10.1155/2020/6736704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background Many studies have compared the outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (<45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a second-generation drug-eluting stent (DES) and CABG in young patients with LM or three-vessel disease. Methods In young patients with complex CAD who underwent PCI or CABG, a Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stroke, death, and repeat revascularization. Results During follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% of patients in the CABG group (hazard ratio (HR): 3.263, 95% confidence interval (CI): 1.379 to 7.722, p=0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7%, respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p=0.002). There were no significant differences in the other endpoints. After propensity score matching, no conclusions were modified. Conclusions In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However, this did not translate into hard endpoint differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.
Collapse
|
10
|
Ma X, Dong R, Chen P, Zhao Y, Zeng C, Xin M, Ye Q, Wang J. Percutaneous coronary intervention in diabetic versus non-diabetic patients with prior coronary artery bypass grafting: a propensity score matching study. BMC Cardiovasc Disord 2020; 20:159. [PMID: 32252636 PMCID: PMC7137249 DOI: 10.1186/s12872-020-01447-8] [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: 08/22/2019] [Accepted: 03/25/2020] [Indexed: 11/15/2022] Open
Abstract
Background The target of this study was to explore the outcomes of percutaneous coronary intervention (PCI) in diabetic versus non-diabetic patients with prior coronary artery bypass grafting (CABG) surgery. Methods Seven hundred and twenty four patients who had previously received CABG and had been treated using PCI combined with drug-eluting stents (DES) between 2009 and 2017 were selected for a retrospective study and allocated into either a diabetes mellitus (DM) or non-diabetes mellitus (No DM) group. A 1:1 propensity score-matched evaluation was conducted and risk adjusted for analysis. The primary outcomes were cardiac death, myocardial infarction, heart failure and revascularization, with a median follow-up duration of 5.13 years. Results After matching, two-, 5- and 8-year event rate of overall major adverse cardiac events (MACEs) were found to be higher in the DM group (No DM vs DM:15.3, 30.9, 38.5% vs 19.8, 37.8, 52.2%, respectively), although no significant difference was found in the event rate of overall MACEs (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.00 to 1.83 for DM vs No DM; P = 0.052), cardiac death (HR: 0.94; 95% CI: 0.45 to 1.95; P = 0.871), MI (HR: 1.49; 95% CI: 0.95 to 2.32; P = 0.080), HF (HR: 1.54; 95% CI: 0.90 to 2.63 for; P = 0.120) or revascularization (HR: 1.07; 95% CI: 0.72 to 1.59; P = 0.747). Subgroup analysis of PCI in only the NCA showed MACEs (adjusted HR: 1.13; 95% CI: 0.85 to 1.49 for DM vs No DM; P = 0.325), cardiac death (adjusted HR: 0.85; 95% CI: 0.41 to 1.78 for DM vs No DM; P = 0.781), MI (adjusted HR: 1.32; 95% CI: 0.84 to 2.01 for DM vs No DM; P = 0.069), HF (adjusted HR: 1.41; 95% CI: 0.87 to 2.27 for DM vs No DM; P = 0.211) or repeated revascularization (adjusted HR: 0.93; 95% CI: 0.64 to 1.37 for DM vs No DM; P = 0.836). Conclusions Compared with non-diabetic patients with prior CABG, subsequent implantation of DES in the native coronary artery of diabetic patients resulted in apparently similar outcomes. Trial registration This study was not registered in an open access database.
Collapse
Affiliation(s)
- Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Pengfei Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yichen Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Caiwu Zeng
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Meng Xin
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing Ye
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
11
|
Coronary Angiography Characteristics of Symptomatic Patients with Prior Coronary Artery Bypass Graft: A Descriptive Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1832128. [PMID: 31815124 PMCID: PMC6877980 DOI: 10.1155/2019/1832128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
Objectives The target of this study was to explore the coronary angiography characteristics for symptomatic patients with prior coronary artery bypass graft (CABG). Methods Between 2009 and 2017, 993 patients who had undergone CABG but subsequently suffered recurrent symptoms in Beijing Anzhen Hospital were selected for this study and divided into either medical therapy (MT) group (n = 351) or percutaneous coronary intervention (PCI) group (n = 642) based on the treatment. Clinical data were analyzed between two groups. Results Patients in the MT group were older and more likely to have chronic lung disease (6.6% vs 3.4%, P=0.026) while patients in the PCI group were more likely to have prior MI (8.8% vs 17.0%, P < 0.001). In the MT group, 54.4% of patients had newly developed lesions both in the graft and native coronary artery while 58.1% in the PCI group (P=0.003), and in the MT group, 80.6% had type C coronary artery disease while 60.1% in the PCI group (P < 0.001). Patients in the MT group presented higher proportion of diffuse lesions (49.3% vs 15.0%, P < 0.001) in native coronary arteries. Conclusion Patients receiving MT (35.3%) likely had occluded grafts and type C coronary artery disease featuring as diffuse lesions.
Collapse
|
12
|
Cormican D, Jayaraman AL, Sheu R, Peterson C, Narasimhan S, Shaefi S, Núñez-Gil IJ, Ramakrishna H. Coronary Artery Bypass Grafting Versus Percutaneous Transcatheter Coronary Interventions: Analysis of Outcomes in Myocardial Revascularization. J Cardiothorac Vasc Anesth 2018; 33:2569-2588. [PMID: 30340948 DOI: 10.1053/j.jvca.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Daniel Cormican
- Division of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | | | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Carly Peterson
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Seshasayee Narasimhan
- Department of Cardiology, Manning Base Hospital, Taree, New South Wales, Australia University of Newcastle, Callaghan, New South Wales, Australia; University of New England, Armidale, New South Wales, Australia
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Iván J Núñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clinico Universitario San Carlos, Madrid, Spain; Cardiovascular Unit, Centro Medico Paris, Pozuelo, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
| |
Collapse
|
13
|
van der Heijden LC, Kok MM, Zocca P, Sen H, Löwik MM, Mariani S, de Man FHAF, Hartmann M, Stoel MG, van Houwelingen KG, Louwerenburg JHW, Linssen GCM, Doggen CJM, Grandjean JG, von Birgelen C. Long-Term Outcome of Consecutive Patients With Previous Coronary Bypass Surgery, Treated With Newer-Generation Drug-Eluting Stents. J Am Heart Assoc 2018; 7:JAHA.117.007212. [PMID: 29382666 PMCID: PMC5850240 DOI: 10.1161/jaha.117.007212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Percutaneous coronary intervention (PCI) in patients with previous coronary artery bypass grafting (CABG) is associated with adverse clinical events. Although newer generation drug‐eluting stents showed favorable short‐term safety profiles, there is a lack of long‐term outcome data. We evaluated the impact of previous CABG on 5‐year clinical outcomes of patients treated with PCI using newer‐generation drug‐eluting stents. Methods and Results In this patient‐level pooled analysis of the prospective TWENTE (The Real‐World Endeavor Resolute versus Xience V Drug‐Eluting Stent Study in Twente) trial and nonenrolled TWENTE registry, we assessed a consecutive series of patients who underwent PCI with newer‐generation drug‐eluting stents for non–ST‐segment–elevation acute coronary syndromes or stable angina. Of all 1709 patients, 202 (11.8%) had a history of CABG. Patients with previous CABG had significantly higher 5‐year rates of cardiac death (10.4% versus 4.3%; P<0.001) and target vessel revascularization (25.0% versus 8.1%; P<0.001). These differences remained statistically significant after adjustment for differences in baseline characteristics. Landmark analysis revealed that from 1‐ to 5‐year follow‐up, the rates of cardiac death (8.1% versus 3.2%; P<0.001) and target vessel revascularization (17.1% versus 5.9%; P<0.001) were significantly higher in patients with previous CABG. Among patients with a history of CABG, PCI of an obstructed vein graft was associated with a higher rate of 5‐year target vessel revascularization (P=0.003). Conclusions At 5‐year follow‐up after PCI with newer‐generation drug‐eluting stents, the risk of cardiac death and target vessel revascularization was significantly higher in patients with previous CABG. The target vessel revascularization rate was highest in patients who underwent PCI of obstructed vein grafts.
Collapse
Affiliation(s)
- Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Hanim Sen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marije M Löwik
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Silvia Mariani
- Department of Cardiothoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Frits H A F de Man
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marc Hartmann
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Martin G Stoel
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J Hans W Louwerenburg
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Jan G Grandjean
- Department of Cardiothoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands .,Department of Health Technology and Services Research, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| |
Collapse
|
14
|
Inhibition of neddylation by MLN4924 improves neointimal hyperplasia and promotes apoptosis of vascular smooth muscle cells through p53 and p62. Cell Death Differ 2017; 25:319-329. [PMID: 29027989 DOI: 10.1038/cdd.2017.160] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023] Open
Abstract
Targeting apoptosis of vascular smooth muscle cells (VSMCs) represents an attractive approach to diminish the occurrence of restenosis. Neddylation is a highly conserved post-translational modification process and inhibition of neddylation has been shown to regulate apoptosis of other cells. However, the impacts of neddylation inhibition on VSMCs and neointimal hyperplasia have not been studied. In our present study, we have shown that MLN4924, a selective inhibitor of NEDD8-activating enzyme (NAE), markedly inhibited neointimal hyperplasia and accumulation of VSMCs, whereas increased apoptosis in the vascular wall. In vitro studies revealed that MLN4924 induced G2/M arrest and apoptosis of human VSMCs. Knockdown of NAE1 had similar effects. MLN4924 upregulated p53 and p62 in human VSMCs. Knockdown of either p53 or p62 mitigated the impacts of MLN4924 on G2/M arrest and apoptosis. Moreover, p53 knockdown abolished MLN4924-induced upregulation of p62. Finally, smooth muscle p53 knockout mice were generated and subjected to femoral artery injury and MLN4924 treatment. Deficiency of p53 in smooth muscle blocked the effects of MLN4924 on neointimal hyperplasia and apoptosis. Together, our results revealed that neddylation inhibition induces apoptosis through p53 and p62 in VSMCs and improves neointimal hyperplasia mainly by promoting apoptosis through smooth muscle p53 in mice. These pre-clinical data provide strong translational implications for targeting restenosis by perturbation of neddylation using MLN4924.
Collapse
|
15
|
Vogiatzi G, Toutouzas K, Synetos A, Latsios G, Tousoulis D. Re-intervention of a fibrotic lesion in a saphenous vein graft: Insights into procedural characteristics using the right transradial approach. Hellenic J Cardiol 2017; 58:297-299. [DOI: 10.1016/j.hjc.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/25/2017] [Indexed: 10/20/2022] Open
|