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Xu P, Cao Y, Ren R, Zhang S, Zhang C, Hao P, Zhang M. Usefulness of the Systemic Inflammation Response Index and the Systemic Immune Inflammation Index in Predicting Restenosis After Stent Implantation. J Inflamm Res 2024; 17:4941-4955. [PMID: 39051057 PMCID: PMC11268991 DOI: 10.2147/jir.s461277] [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: 01/24/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The systemic inflammation response index (SIRI) and the systemic immune inflammation index (SII) are indicators that reflect the body's overall systemic inflammatory response. Inflammation plays an important role in the pathogenesis of in-stent restenosis (ISR). The aim of this study was to investigate the predictive value of preoperative SIRI and SII for the occurrence of ISR in patients undergoing coronary stent implantation. Materials and Methods We retrospectively analyzed the clinical, hematological, and angiographic data of 387 patients who underwent coronary angiography for recurrent angina after coronary stent implantation at Qilu Hospital of Shandong University. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal cutoff values for SIRI and SII to predict ISR. Based on the optimal cutoff values for SIRI and SII, patients were categorized into high-SIRI, low-SIRI, high-SII, and low-SII groups. Multivariate logistic regression models were constructed to assess the predictive value of SIRI and SII for ISR >50% and ISR >70%. Results This study included a total of 387 patients who underwent coronary angiography and follow-up at Qilu Hospital of Shandong University. Patients in the high-SIRI group had a higher incidence of ISR than those in the low-SIRI group (ISR >50%: 44.8% vs 30.7%, p = 0.018; ISR >70%: 41.5% vs 4.5%, p < 0.001). In addition, ISR occurred more frequently in patients with a higher SII than in patients with a lower SII (ISR >50%: 52.6% vs 35.7%, p = 0.001; ISR >70%: 51.9% vs 23%, p < 0.001). In multivariate logistic regression analysis, SIRI and SII were found to be independent predictive factors for ISR, both as continuous and categorical variables. In the ROC analysis, the optimal cutoff value for SIRI was set at 0.54 (sensitivity: 84.5%, specificity: 27%), and the optimal cutoff value for SII was set at 545.29 (sensitivity: 44.1%, specificity: 71.7%). Conclusion Elevated preoperative SIRI and SII values help predict ISR and may serve as a useful screening tool to perform interventional procedures based on the patient's risk of ISR after stent implantation.
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Affiliation(s)
- Panpan Xu
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Yu Cao
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Ruiqing Ren
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Shuai Zhang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Cheng Zhang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Panpan Hao
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Meng Zhang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
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Kapnisis K, Stylianou A, Kokkinidou D, Martin A, Wang D, Anderson PG, Prokopi M, Papastefanou C, Brott BC, Lemons JE, Anayiotos A. Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue. ACS Biomater Sci Eng 2023; 9:4747-4760. [PMID: 37480152 PMCID: PMC10428095 DOI: 10.1021/acsbiomaterials.3c00540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
A recent U.S. Food and Drug Administration report presented the currently available scientific information related to biological response to metal implants. In this work, a multilevel approach was employed to assess the implant-induced and biocorrosion-related inflammation in the adjacent vascular tissue using a mouse stent implantation model. The implications of biocorrosion on peri-implant tissue were assessed at the macroscopic level via in vivo imaging and histomorphology. Elevated matrix metalloproteinase activity, colocalized with the site of implantation, and histological staining indicated that stent surface condition and implantation time affect the inflammatory response and subsequent formation and extent of neointima. Hematological measurements also demonstrated that accumulated metal particle contamination in blood samples from corroded-stetted mice causes a stronger immune response. At the cellular level, the stent-induced alterations in the nanostructure, cytoskeleton, and mechanical properties of circulating lymphocytes were investigated. It was found that cells from corroded-stented samples exhibited higher stiffness, in terms of Young's modulus values, compared to noncorroded and sham-stented samples. Nanomechanical modifications were also accompanied by cellular remodeling, through alterations in cell morphology and stress (F-actin) fiber characteristics. Our analysis indicates that surface wear and elevated metal particle contamination, prompted by corroded stents, may contribute to the inflammatory response and the multifactorial process of in-stent restenosis. The results also suggest that circulating lymphocytes could be a novel nanomechanical biomarker for peri-implant tissue inflammation and possibly the early stage of in-stent restenosis. Large-scale studies are warranted to further investigate these findings.
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Affiliation(s)
- Konstantinos Kapnisis
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | - Andreas Stylianou
- School
of Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Department
of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia 1678, Cyprus
| | - Despoina Kokkinidou
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | - Adam Martin
- Department
of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Dezhi Wang
- Department
of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Peter G. Anderson
- Department
of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Marianna Prokopi
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | | | - Brigitta C. Brott
- Department
of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Jack E. Lemons
- Department
of Biomedical Engineering, University of
Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Andreas Anayiotos
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
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Zhao J, Hou L, Zhu N, Huang R, Su K, Lei Y, Li Y. The Predictive Value of the CHA2DS2-VASc Score for In-Stent Restenosis Among Patients with Drug-Eluting Stents Implantation. Int J Gen Med 2023; 16:69-76. [PMID: 36636712 PMCID: PMC9830419 DOI: 10.2147/ijgm.s391312] [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: 10/03/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Objective The CHA2DS2-VASc score, a system which has been initially recommended for the assessment of thromboembolic risk in patients with atrial fibrillation (AF), arouses attention in the field of adverse coronary events. The purpose of this study was to explore the predictive value of preprocedural CHA2DS2-VASc score on ISR in patients after drug-eluting stent (DES) implantation. Methods To further investigate the relationship between CHA2DS2-VASc scores and ISR after DES, a retrospective study of DES was carried on. Additionally, the preoperative variables for the ISR and control groups were contrasted. Predictive factors were chosen using the optimal subset regression. We validate the model using internal validation. The prediction model was evaluated using the receiver operator characteristic (ROC) analysis. Results We used a 3:7 ratio to create an experimental group and a validation group, and then ran a stepwise regression with the data from each of the two groups. The results showed that CHA2DS2-VASc score was an independent risk factor for ISR in both the experimental (p = 0.0139) and validation groups (p = 0.0014), and both had significant predictive value for ISR. The area of the ROC curve was greater than 0.5 in both groups (AUC = 0.78, 0.719, respectively) indicating that the model fit was good in both groups. Conclusion The CHA2DS2-VASc score is a reliable predictor of in-stent restenosis (ISR) after DES implantation.
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Affiliation(s)
- Jinbo Zhao
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Ling Hou
- Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China
| | - Ni Zhu
- Department of Pathology, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Rui Huang
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Ke Su
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Yuhua Lei
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Yuanhong Li
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China,Correspondence: Yuanhong Li, Email
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Fu Y, Yang Y, Fang C, Liu X, Dong Y, Xu L, Chen M, Zuo K, Wang L. Prognostic value of plasma phenylalanine and gut microbiota-derived metabolite phenylacetylglutamine in coronary in-stent restenosis. Front Cardiovasc Med 2022; 9:944155. [PMID: 36110409 PMCID: PMC9468445 DOI: 10.3389/fcvm.2022.944155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study was designed to explore the predictive value of plasma phenylalanine (Phe) and gut microbiota-derived metabolite phenylacetylglutamine (PAGln) in coronary in-stent restenosis (ISR). Methods Patients with coronary ISR, in-stent hyperplasia (ISH), and in-stent patency (ISP) were retrospectively enrolled in this study. Multivariable logistic regression analyses were used to identify independent risk factors of ISR. The predictive value of plasma Phe and PAGln levels was evaluated by receiver operating characteristic (ROC) curve analysis. The areas under the ROC curve (AUCs) were compared using the Z-test. The correlation between PAGln and clinical characteristics were examined using Spearman's correlation analysis. Results Seventy-two patients (mean age, 64.74 ± 9.47 years) were divided into three groups according to coronary stent patency: ISR (n = 28), ISH (n = 11), and ISP (n = 33) groups. The plasma levels of Phe and PAGln were significantly higher in the ISR group than in the ISP group. PAGln was positively associated with the erythrocyte sedimentation rate, homocysteine, SYNTAX score, triglyceride to high-density lipoprotein ratio, Phe, and microbiota-related intermediate metabolite phenylacetic acid (PA). In the ISR group, with the aggravation of restenosis, PAGln levels were also elevated. In multivariate regression analyses, Phe, PAGln and SYNTAX score were independent predictors of coronary ISR (all P < 0.05). In the ROC curve analyses, both Phe [AUC = 0.732; 95% confidence interval (CI), 0.606–0.858; P = 0.002] and PAGln (AUC = 0.861; 95% CI, 0.766–0.957; P < 0.001) had good discrimination performance in predicting coronary ISR, and the predictive power of PAGln was significantly better (P = 0.031). Conclusion Plasma Phe and PAGln are valuable indices for predicting coronary ISR, and gut microbes may be a promising intervention target to prevent ISR progression.
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Csató G, Erdei N, Ványai B, Balla T, Czuriga D, Csanádi Z, Koszegi Z, Édes I, Szabó GT. Predictors of restenosis following percutaneous coronary stent implantation: The role of trimetazidine therapy. Front Cardiovasc Med 2022; 9:873899. [PMID: 35935652 PMCID: PMC9353214 DOI: 10.3389/fcvm.2022.873899] [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] [Received: 02/14/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Aims In-stent restenosis (ISR) is an unresolved problem following percutaneous coronary intervention (PCI), having a negative impact on clinical outcome. The main goal of this study was to find new independent predictors that may influence the development of ISR. Methods and results In this retrospective analysis, 653 PCI patients were involved. All patients had coronary stent implantation and a follow-up coronary angiography. Based on the presence of ISR at follow-up, patients were divided into two groups: 221 in the ISR and 432 in the control group. When evaluating the medical therapy of patients, significantly more patients were on trimetazidine (TMZ) in the control compared to the ISR group (p = 0.039). TMZ was found to be an independent predictor of a lower degree of ISR development (p = 0.007). TMZ treatment was especially effective in bare metal stent (BMS)-implanted chronic coronary syndrome (CCS) patients with narrow coronary arteries. The inflammation marker neutrophil to lymphocyte ratio (NLR) was significantly elevated at baseline in the ISR group compared to controls. The reduction of post-PCI NLR was associated with improved efficacy of TMZ to prevent ISR development. Drug eluting stent implantation (p < 0.001) and increased stent diameter (p < 0.001) were the most important independent predictors of a lower degree of ISR development, while the use of longer stents (p = 0.005) was a major independent predictor of an increased ISR risk. Conclusion TMZ reduces the occurrence of ISR following PCI, with special effectiveness in BMS-implanted patients having CCS and narrow coronary arteries. TMZ treatment may help to lower ISR formation in countries with high BMS utilization rates.
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Affiliation(s)
- Gábor Csató
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Erdei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Beatrix Ványai
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tímea Balla
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dániel Czuriga
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Koszegi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Tamás Szabó
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- *Correspondence: Gábor Tamás Szabó
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Yi M, Tang WH, Xu S, Ke X, Liu Q. Investigation Into the Risk Factors Related to In-stent Restenosis in Elderly Patients With Coronary Heart Disease and Type 2 Diabetes Within 2 Years After the First Drug-Eluting Stent Implantation. Front Cardiovasc Med 2022; 9:837330. [PMID: 35669469 PMCID: PMC9163371 DOI: 10.3389/fcvm.2022.837330] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe present study aims to explore risk factors related to in-stent restenosis (ISR) in elderly patients with coronary heart disease and type 2 diabetes within 2 years after the first drug-eluting stent (DES) implantation.MethodsThis case-control study retrospectively analyzed the clinical data of patients with coronary heart disease and diabetes undergoing percutaneous coronary intervention (PCI) in Shenzhen Sun Yat-sen Cardiovascular Hospital between January 2010 and March 2020. Univariate and multivariate models were used to assess independent factors for DES-ISR. Categorical principal component analysis of clinical variables was performed to determine important components for DES-ISR. Nomogram was constructed to quantitatively predict the probability of DES-ISR development. The diagnostic potential of clinical variables was determined by receiver operating characteristic curve.ResultsIn the derivation cohort, 1,741 cases were included in this study, and a total of 227 pairs of cases and controls were generated by propensity score matching. In the validation cohort, 102 cases were included with 19 cases (18.6%) with DES-ISR. Glomerular filtration rate <60 ml/min/1.73 m2, fasting blood glucose ≥6.5 mmol/L, multivessel coronary artery disease, coronary artery diffuse disease, PCI operation time (≥60 min), emergency PCI were associated with ISR. High Nomogram score was associated with the increased risk of ISR. Further analysis of the validation cohort showed that higher levels of HbA1c-coefficient of variation (CV) were significantly associated with the increased risk of ISR. HbA1c-CV exhibited good predictive ability for ISR in the validation cohort.ConclusionsIn conclusion, the fasting blood glucose level during the perioperative period of emergency PCI and the long-term variation of HbA1c during the follow-up period are related to the incidence of DES-ISR and the degree of stenosis. Reducing blood glucose fluctuations may decrease the risk of DES-ISR.
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Affiliation(s)
- Ming Yi
- Department of Clinical Medicine, University of South China, Hengyang, China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
- Department of Cardiology, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Wen-hui Tang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
| | - Shuai Xu
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
| | - Xiao Ke
- Department of Clinical Medicine, University of South China, Hengyang, China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
- *Correspondence: Xiao Ke
| | - Qiang Liu
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
- Department of Cardiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Qiang Liu
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ZHANG J, MA Y, WANG Z, LI Y, WANG H, WANG Q. Association between Green Tea Consumption and In-Stent Restenosis in a Chinese Population after Percutaneous Coronary Intervention. J Nutr Sci Vitaminol (Tokyo) 2022; 68:120-126. [DOI: 10.3177/jnsv.68.120] [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]
Affiliation(s)
- Jing ZHANG
- Department of Ultrasound, Zhongda Hospital, Southeast University
| | - Yao MA
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
| | - Zemu WANG
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
| | - Yafei LI
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
| | - Hao WANG
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
| | - Qiming WANG
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
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Safety and Efficacy of Modern Stents in Patients with Metabolic Syndrome. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The impact of metabolic syndrome (MS) on stent performance and outcomes of patients underwent percutaneous coronary intervention (PCI), including stent implantation, had not yet been fully established. The aim of the present study was to investigate long-term safety and efficacy of 2nd generation DES vs. other stent types in MS patients underwent successful PCI for an acute coronary event. Descriptive epidemiology, angiographic characteristics and one-year clinical outcomes, including major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) procedures were evaluated according to the stent type inserted for 204 patients. The occurrence of TLR (6.62% vs. 9.43%, p = 0.50) and the composite outcomes (20.52% vs. 24.52%, p = 0.54) did not differ significantly between patients having 2nd generation drug eluting stents (DES) or other stent types implanted at the index procedure. It seems that the PCI in acute coronary syndrome (ACS) is similarly efficient regardless of the stent type, suggesting that for the treatment of ACS in MS patients, all stent types show similar results, in terms of TLR or MACE.
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Luo Y, Tan N, Zhao J, Li Y. A Nomogram for Predicting In-Stent Restenosis Risk in Patients Undergoing Percutaneous Coronary Intervention: A Population-Based Analysis. Int J Gen Med 2022; 15:2451-2461. [PMID: 35264881 PMCID: PMC8901259 DOI: 10.2147/ijgm.s357250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
Objective In-stent restenosis (ISR) is a fatal complication of percutaneous coronary intervention (PCI). An early predictive model with the medical history of patients, angiographic characteristics, inflammatory indicators and blood biochemical index is urgently needed to predict ISR events. We aim to establish a risk prediction model for ISR in CAD patients undergoing PCI. Methods A total of 477 CAD patients who underwent PCI with DES (drug-eluting stents) between January 2017 and December 2020 were retrospectively enrolled. And the preoperative factors were compared between the non-ISR and ISR groups. The least absolute shrinkage and selection operator (LASSO) and multi-factor logistic regression were used for statistical analysis. The prediction model was evaluated using receiver operator characteristic (ROC) analysis, the Hosmer–Lemeshow 2 statistic, and the calibration curve. Results In this study, 94 patients developed ISR after PCI. Univariate analysis showed that post-PCI ISR was associated with the underlying disease (COPD), higher Gensini score (GS score), higher LDL-C, higher neutrophil/lymphocyte ratio, and higher remnant cholesterol (RC). The multi-factor logistic regression analysis suggested that remnant cholesterol (odds ratio [OR] = 2.09, 95% confidence interval [CI] [1.40–3.11], P < 0.001), GS score (OR = 1.01, 95% CI [1.00, 1.02], P = 0.002), medical history of COPD (OR = 4.56, 95% CI [1.98, 10.40], P < 0.001), and monocyte (OR = 1.30, 95% CI [1.04, 1.70], P < 0.001) were independent risk factors for ISR. A nomogram was generated and displayed favorable fitting (Hosmer-Lemeshow test P = 0.609), discrimination (area under ROC curve was 0.847), and clinical usefulness by decision curve analysis. Conclusion Patients with certain preoperative characteristics, such as a history of COPD, higher GS scores, higher levels of RC, and monocytes, who undergo PCI may have a higher risk of developing ISR. The predictive nomogram, based on the above predictors, can be used to help identify patients who are at a higher risk of ISR early on, with a view to provide post-PCI health management for patients.
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Affiliation(s)
- Yinhua Luo
- Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China
| | - Ni Tan
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Jingbo Zhao
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Yuanhong Li
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
- Correspondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, People’s Republic of China, Email
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Zhang R, Tao Z, Gong J, Ji Z, Yang M, Ma G, Li Y. Albumin to Globulin Ratio was associated with in-stent restenosis and revascularization events after percutaneous coronary intervention. Clin Transl Sci 2022; 15:1187-1195. [PMID: 35195938 PMCID: PMC9099125 DOI: 10.1111/cts.13236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 01/09/2023] Open
Abstract
In-stent restenosis is a common complication after percutaneous coronary intervention (PCI) for coronary heart disease requiring revascularization. We performed a retrospective analysis to assess the value of inflammatory biomarker Albumin to Globulin Ratio (AGR) in clinical prognosis of percutaneous coronary intervention (PCI). In total, 992 coronary heart disease (CHD) patients who underwent the first drug-eluting stent implantation and reexamination angiography in our hospital were enrolled in this study. Albumin to Globulin Ratio was measured. At mean follow-up of 11.2 ± 4 months, the in-stent restenosis (ISR) and revascularization events (including target lesion revascularization, target vessel revascularization, and revascularization of de novo lesions) occurred in 127 and 284 patients respectively. Compared with the non-ISR or non-event group, AGR was significantly lower in the ISR group and events group. Beyond that, albumin was significantly lower, while urea nitrogen, glucose and gensini score, as well as the proportions of a history of diabetes and peripheral vascular diseases, were significantly higher in the ISR group and events group. Age, heart rate, white blood cell, neutrophils, lymphocyte, monocyte and incidence of ischemic stroke were significantly higher in the events group. Multivariate cox regression analysis showed that AGR was independently associated with ISR (P = 0.032) and events (P = 0.024). Besides, Kaplan-Meier analysis indicated that the higher quartile of AGR had a lower rate of ISR (P = 0.038) and events (p ≤ 0.001). Finally, the receiver operating characteristic (ROC) curve for AGR in diagnosing ISR and events indicated that the area under the curve (AUC) were 0.56 and 0.57 respectively. Therefore, AGR is one of the most important factors that independently associate with the ISR and revascularization events after PCI.
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Affiliation(s)
- Rui Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zaixiao Tao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jing Gong
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenjun Ji
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Mingming Yang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yongjun Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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11
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Jin Z, Shen H, Cha W, Xia H, Liu L. Predictive value of using plasma long non-coding RNAs ANRIL and HOXA11-AS for in-stent restenosis. Exp Ther Med 2022; 23:115. [PMID: 34970338 PMCID: PMC8713178 DOI: 10.3892/etm.2021.11038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
In-stent restenosis (ISR) can pose serious challenges for cardiologists following coronary stent implantation. Early identification of patients at high risk of ISR is considered to be effective for its prevention. However, factors that can reliably predict the risk of ISR remain elusive at present. The present study aimed to investigate the possible association between plasma long non-coding RNA (lncRNA) levels and ISR. A total of 410 patients with single-vessel lesion who received drug-eluting stents (DES) were included in the present study. After 12-36 months of follow-up, coronary angiography was performed and ISR was defined as >50% diameter stenosis at follow-up. RT-qPCR was used to measure lncRNA expression. Expression of the lncRNA RNA antisense non-coding RNA at the INK4 locus (ANRIL) was found to be upregulated whereas the lncRNA homeobox A11 antisense (HOXA11-AS) was downregulated in the plasma of patients with ISR compared with that from patients without ISR (P<0.001). Logistic regression analysis revealed that ANRIL [odds ratio (OR)=2.95; 95% confidence interval (CI)=1.68-8.08] was an independent risk factor for ISR, whilst HOXA11-AS (OR=0.58; 95% CI=0.48-0.71) was found to be an independent protective factor for ISR. Receiver operating characteristic (ROC) analysis demonstrated that high ANRIL expression [area under the ROC (auROC)=0.755; 95% CI=0.702-0.803] and low HOXA11-AS levels (auROC=0.712; 95% CI=0.657-0.763) predicted a high risk for ISR, and the combined score of ANRIL and HOXA11-AS (auROC=0.844; 95% CI=0.798-0.884) was more efficient at predicting ISR than either ANRIL or HOXA11-AS alone (P<0.001). In conclusion, increased ANRIL and decreased HOXA11-AS expressions were associated with ISR. However, combined ANRIL and HOXA11-AS plasma levels proved to be more effective at predicting ISR compared with either ANRIL or HOXA11-AS alone, suggesting that the multiplex detection of lncRNAs could be used to predict ISR in the future.
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Affiliation(s)
- Zhijiang Jin
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China.,Department of Cardiology, Shaoxing Municipal Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Hongfeng Shen
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China.,Department of Cardiology, Shaoxing Municipal Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Wei Cha
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China.,Department of Cardiology, Shaoxing Municipal Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Haijiang Xia
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China.,Department of Cardiology, Shaoxing Municipal Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Longbin Liu
- Department of Cardiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, P.R. China.,Department of Cardiology, Shaoxing Municipal Hospital, Shaoxing, Zhejiang 312000, P.R. China
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12
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Li J, Guo MT, Yang X, Gao F, Li N, Huang MG. The usefulness of subtraction coronary computed tomography angiography for in-stent restenosis assessment of patients with CoCr stent using 320-row area detector CT. Medicine (Baltimore) 2021; 100:e28345. [PMID: 34941141 PMCID: PMC8701865 DOI: 10.1097/md.0000000000028345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to assess in-stent restenosis (ISR) of coronary artery for patients with CoCr stent using subtraction coronary computed tomography angiography (CCTA) with one-breath-hold scan on 320-row area detector CT, invasive coronary angiography (ICA) as clinical standard.Patients who were referred for CCTA from January 2020 to May 2021 were retrospectively analyzed. Pre-contrast and CCTA was performed with dedicated one-breath-hold subtraction scan protocol and post processing to get subtracted-CCTA image without stent. Subjective image qualities and diagnosable rate were analyzed for CCTA and subtracted-CCTA respectively. The ISR degree of each stent was evaluated both on CCTA and subtracted-CCTA images. The receiver-operating characteristic curve with sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA in the diagnosis of ISR were calculated with ICA as reference.Forty patients with 85 CoCr coronary stents of 3 to 3.5 mm diameter with ICA confirmation within 1 month were finally included. Subtracted-CCTA showed more diagnosable segments of stent (91.76% [78/85]) than those of CCTA (50.59% [43/85]) (P < .001). The subjective image quality score of CCTA was 2.23 ± 1.32 while 3.41 ± 0.90 on subtracted-CCTA (P < .001). Both subtracted-CCTA and CCTA showed high consistency with ICA (Kappa = 0.795 and 0.918 respectively). The area under the curve was 0.607 for CCTA and 0.757 for subtracted-CCTA (P < .001) for stent based diagnose, respectively. The sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA were 90.0%, 97.0%, 95.3%, and 87.5%, 100.0%, 97.43%, respectively.Subtracted-CCTA showed improved diagnose performance for ISR, which potentially reduce further follow-up ICA procedures for patients with CoCr stents.
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Affiliation(s)
- Jian Li
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Man-Tao Guo
- Department of Radiology, Xianyang Hospital of Yan’an University, Xianyang, Shaanxi, China
| | - Xiao Yang
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Fang Gao
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Na Li
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Ming-Gang Huang
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
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13
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Schumacher D, Liehn EA, Nilcham P, Mayan DC, Rattanasopa C, Anand K, Crespo-Avilan GE, Hernandez-Resendiz S, Singaraja RR, Cook SA, Hausenloy DJ. A neutralizing IL-11 antibody reduces vessel hyperplasia in a mouse carotid artery wire injury model. Sci Rep 2021; 11:20674. [PMID: 34667238 PMCID: PMC8526715 DOI: 10.1038/s41598-021-99880-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Vascular restenosis remains a major problem in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Neointimal hyperplasia, defined by post-procedure proliferation and migration of vascular smooth muscle cells (VSMCs) is a key underlying pathology. Here we investigated the role of Interleukin 11 (IL-11) in a mouse model of injury-related plaque development. Apoe-/- mice were fed a hyperlipidaemic diet and subjected to carotid wire injury of the right carotid. Mice were injected with an anti-IL11 antibody (X203), IgG control antibody or buffer. We performed ultrasound analysis to assess vessel wall thickness and blood velocity. Using histology and immunofluorescence approaches, we determined the effects of IL-11 inhibition on VSMC and macrophages phenotypes and fibrosis. Treatment of mice with carotid wire injury using X203 significantly reduced post-endothelial injury vessel wall thickness, and injury-related plaque, when compared to control. Immunofluorescence staining of the injury-related plaque showed that X203 treatment did not reduce macrophage numbers, but reduced the number of VSMCs and lowered matrix metalloproteinase 2 (MMP2) levels and collagen content in comparison to control. X203 treatment was associated with a significant increase in smooth muscle protein 22α (SM22α) positive cells in injury-related plaque compared to control, suggesting preservation of the contractile VSMC phenotype. Interestingly, X203 also reduced the collagen content of uninjured carotid arteries as compared to IgG, showing an additional effect on hyperlipidemia-induced arterial remodeling in the absence of mechanical injury. Therapeutic inhibition of IL-11 reduced vessel wall thickness, attenuated neointimal hyperplasia, and has favorable effects on vascular remodeling following wire-induced endothelial injury. This suggests IL-11 inhibition as a potential novel therapeutic approach to reduce arterial stenosis following revascularization in CAD and PAD patients.
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Affiliation(s)
- David Schumacher
- Institute of Experimental Medicine and Systems Biology, University Hospital, RWTH Aachen University, Aachen, Germany.,Department of Anesthesiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Elisa A Liehn
- Department of Cardiology, Angiology and Intensive Medicine, University Hospital Aachen, Aachen, Germany.,Victor Babes National Institute of Pathology, Bucharest, Romania.,Department of Intensive Care and Intermediate Care, University Hospital, RWTH Aachen University, Aachen, Germany.,National Heart Research Institute Singapore, National Heart Centre, Singapore, 169609, Singapore
| | - Pakhwan Nilcham
- Department of Anesthesiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - David Castaño Mayan
- Translational Laboratories in Genetic Medicine, Agency for Science, Research and Technology, Singapore, 138648, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, 169857, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, 119228, Singapore
| | - Chutima Rattanasopa
- Translational Laboratories in Genetic Medicine, Agency for Science, Research and Technology, Singapore, 138648, Singapore
| | - Kaviya Anand
- Translational Laboratories in Genetic Medicine, Agency for Science, Research and Technology, Singapore, 138648, Singapore
| | - Gustavo E Crespo-Avilan
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 169609, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Biochemistry, Medical Faculty, Justus Liebig-University, Giessen, Germany
| | - Sauri Hernandez-Resendiz
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 169609, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Roshni R Singaraja
- Translational Laboratories in Genetic Medicine, Agency for Science, Research and Technology, Singapore, 138648, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, 169857, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, 119228, Singapore
| | - Stuart A Cook
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 169609, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.,MRC LMS, London, W12 0NN, UK
| | - Derek J Hausenloy
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 169609, Singapore. .,Yong Loo Lin School of Medicine, National University Singapore, Singapore, 169857, Singapore. .,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore. .,The Hatter Cardiovascular Institute, University College London, London, WC1E 6BT, UK. .,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
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14
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Ullrich H, Olschewski M, Münzel T, Gori T. Coronary In-Stent Restenosis–Predictors and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:637-644. [PMID: 34379053 DOI: 10.3238/arztebl.m2021.0254] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 02/23/2021] [Accepted: 05/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in certain lesion/patient subsets. ISR causes increased morbidity after stent implantation; acute myocardial infarction is a frequent correlate to a clinical ISR, arising in 5-10% of cases. Compared to de novo stenosis, patients with ISR also present more frequently with symptoms of unstable angina pectoris (45% versus 61%). In this article, we discuss the risk factors for ISR and the corresponding diagnostic measures and effective treatment strategies. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to current international guidelines and specialist society recommendations. RESULTS The type of implanted stent, the presence of diabetes mellitus, previous bypass surgery, and small vessel caliber are predictors for ISR. In their guidelines, the European specialist societies (ESC/EACTS) recommend repeated PCI with DES implantation or drug-coated balloon (DCB) angioplasty as the methods of choice for the treatment of ISR. This approach is supported by evidence from meta-analyses. The RIBS-IV trial showed that revascularization treatment of the target lesion is needed less often after everolimus-eluting stent (EES) implantation than after DCB dilatation (11 [7.1%] versus 24 [15.6%]; p = 0.015; hazard ratio: 0.43; 95% confidence interval: [0.21; 0.87]). CONCLUSION Because the pathogenesis of ISR is multifactorial, differentiated risk stratification is necessary. The identification of patient-, stent-, and lesion-related predictors is particularly important, as the most effective way to combat ISR is to prevent it.
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15
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Ji C, Pan Y, Xu S, Yu C, Ji J, Chen M, Hu F. Propolis ameliorates restenosis in hypercholesterolemia rabbits with carotid balloon injury by inhibiting lipid accumulation, oxidative stress, and TLR4/NF-κB pathway. J Food Biochem 2021; 45:e13577. [PMID: 33729587 DOI: 10.1111/jfbc.13577] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022]
Abstract
Neointima formation and atherosclerosis are the main complications after the endovascular intervention and vascular surgery, and there are no effective drugs. Propolis is a kind of resin substance produced by honeybees and has numerous health-beneficial effects. In this study, we evaluated the effects of propolis (125 and 250 mg·kg-1 ·day-1 , 6 weeks) on carotid restenosis in hypercholesterolemia rabbits. Propolis significantly ameliorated the degree of carotid restenosis, inhibited neointima hyperplasia, reduced serum lipids profile, and enhanced the anti-oxidative activities in hypercholesterolemia rabbits. Furthermore, propolis reduced the plasma levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α (TNF-α), and inhibited the expression of CD68, TLR4, NF-κB p65, MMP-9, and TNF-α in the carotid arteries. The results indicate that propolis has a protective effect on carotid restenosis in rabbits, which is associated with regulating blood lipids, inhibiting oxidative stress and inflammation, and its anti-inflammatory activity may be related to inhibit TLR4-mediated NF-κB signaling pathway. PRACTICAL APPLICATIONS: Restenosis is a primary challenge in angioplasty and atherosclerotic treatment. Hyperlipidemia can induce inflammation and accelerate the formation of restenosis. Recently, natural products have been widely used to prevent intimal hyperplasia of common cardiovascular diseases. Propolis is currently a popular functional food, but the role of propolis on carotid restenosis after angioplasty and its underlying mechanism remains unclear. This study showed that propolis inhibits the effect of carotid restenosis in hypercholesterolemia rabbits. The results of this study may provide a basis for propolis to prevent and treat vascular restenosis.
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Affiliation(s)
- Chao Ji
- Huai'an Bee Products Engineering Research Center, Huai'an, China
| | - Yongming Pan
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Songtao Xu
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen Yu
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian Ji
- Huai'an Bee Products Engineering Research Center, Huai'an, China
| | - Minli Chen
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fuliang Hu
- College of Animal Sciences, Zhejiang University, Hangzhou, China
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16
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Nan J, Meng S, Hu H, Jia R, Chen C, Peng J, Jin Z. <p>The Predictive Value of Monocyte Count to High-Density Lipoprotein Cholesterol Ratio in Restenosis After Drug-Eluting Stent Implantation</p>. Int J Gen Med 2020; 13:1255-1263. [PMID: 33269001 PMCID: PMC7701365 DOI: 10.2147/ijgm.s275202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/03/2020] [Indexed: 02/03/2023] Open
Abstract
Background The clinical value of monocyte count to high-density lipoprotein cholesterol ratio (MHR) in in-stent restenosis (ISR) of patients who have undergone bare metal stent implantation has been studied. However, the predictive value of MHR in ISR for patients who have undergone drug-eluting stent (DES) implantation has not been explored. Methods Non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients who had undergone DES implantation and coronary angiography follow-up at the Beijing Shijitan Hospital, Capital Medical University, between January 1, 2008, and December 31, 2018, were retrospectively enrolled. Patients were divided into ISR and non-ISR groups depending on the follow-up coronary angiography results. Relative clinical information was recorded and analyzed. The receiver operating characteristic curve analysis was used to determine the optimum cut-off pre-procedural MHR to predict ISR. Results A total of 214 patients were enrolled in our study. The mean period between two coronary angiography procedures was 25.4±9.8 months. Percutaneous coronary intervention due to NSTE myocardial infarction, a bifurcation lesion, increased platelet count, and a high MHR were the independent risk factors in multivariate logistic regression analyses. Conclusion Our results indicated that elevated MHR is an independent and useful predictor of ISR in NSTE-ACS patients who have undergone DES implantation.
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Affiliation(s)
- Jing Nan
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuai Meng
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hongyu Hu
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ruofei Jia
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ce Chen
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jianjun Peng
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Jianjun PengDepartment of Cardiology, Beijing Shijitan Hospital, Capital Medical University, No. 4 Tieyi Road, Haidian Distict, Beijing100038, People’s Republic of ChinaTel +86 18811332608 Email
| | - Zening Jin
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Zening JinDepartment of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing100070, People’s Republic of ChinaTel +86 15652966904 Email
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17
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In-Stent Restenosis and a Drug-Coated Balloon: Insights from a Clinical Therapeutic Strategy on Coronary Artery Diseases. Cardiol Res Pract 2020; 2020:8104939. [PMID: 33163230 PMCID: PMC7605950 DOI: 10.1155/2020/8104939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
Coronary heart disease is a major cause of death and disability in developed countries. Stent implantation has become an efficacious treatment for a culprit lesion vessel of the coronary artery. However, 10%–20% restenosis is still an important complication that restricts the clinical safety and efficacy of drug-eluting stents. In-stent restenosis may lead to the recurrence of major cardiovascular adverse events, including angina pectoris, acute myocardial infarction, and even sudden cardiac death. These events are currently serious problems that occur after coronary stent implantation. Clinical physicians face a difficult choice for in-stent restenosis treatment. Recent studies indicate that a drug-coated balloon has promising clinical efficacy similar to the drug-eluting stents for treating coronary in-stent restenosis. Therefore, in this study, we highlight the progress of coronary intervention and the use of drug-coated balloons in the treatment of in-stent restenosis (ISR).
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18
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Kurihara O, Shinohara H, Kim HO, Russo M, Araki M, Nakajima A, Lee H, Takano M, Mizuno K, Komuro I, Jang I. Comparison of post‐stent optical coherence tomography findings: Layered versus non‐layered culprit lesions. Catheter Cardiovasc Interv 2020; 97:1320-1328. [DOI: 10.1002/ccd.28940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/23/2020] [Accepted: 04/12/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Hiroki Shinohara
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Hyung Oh Kim
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Michele Russo
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Masamichi Takano
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Ik‐Kyung Jang
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
- Division of Cardiology Kyung Hee University Hospital Seoul South Korea
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19
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Guo J, Mao L, Yu X, Song C, Zhao X. Design and Biomechanical Analysis of a Novel Retrievable Peripheral Vascular Stent. J Med Device 2020. [DOI: 10.1115/1.4046796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Structurally retrievable drug-eluting stents may have valuable clinical applications because they do not leave any foreign materials inside the patient's body. This article presents a novel design of retrievable peripheral vascular stent and the results from biomechanical analysis of its performance. Using the finite element analysis method, principal parameters of the stent were studied. Moreover, to ensure the practicability of the retrieval process, simulation, and in vitro experiments were performed. The retrieval force reached the maximum value when the whole retrievable part had been retrieved. Furthermore, the force was gradually increased during the retrieval process and remained constant after the main part had been retrieved. When the stent was being compressed, the maximum strain of the stent occurred at the connection between the stent's retrieval part and the main body part, at a value of 4%. The index of nonuniformity of the stent was too small to be counted both at the end of the compression and self-expansion processes. With the increase of moment, the bending stiffness (EI) of the stent decreased gradually. After bending moment was applied, the large strain region was mainly located in the stent's main body part rather than the retrieval part. The results of preliminary stent retrieval experiments demonstrated that the stent could be retrieved successfully. This novel retrievable stent displays promising biomechanical performance. The preliminary experiments demonstrated that the stent could be retrieved smoothly from the blood vessels.
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Affiliation(s)
- Jingzhen Guo
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Shanghai 200093, China
| | - Lin Mao
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Shanghai 200093, China
| | - Xitong Yu
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Shanghai 200093, China
| | - Chengli Song
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Shanghai 200093, China
| | - Xue Zhao
- Department of Cardiology, Shanghai Eastern Hepatobiliary Surgery Hospital, 225 Changhai Road, Shanghai 200438, China
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20
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The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era. J Interv Cardiol 2019; 2019:3270132. [PMID: 31772522 PMCID: PMC6739790 DOI: 10.1155/2019/3270132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/27/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).
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Zhao SG, Xu JJ, Tao ZH, Jin L, Liu Q, Zheng WY, Jiang LQ, Wang NF. CHA 2DS 2-Vasc score and CHA 2DS 2-Vasc-HS score are poor predictors of in-stent restenosis among patients with coronary drug-eluting stents. J Int Med Res 2019; 47:2533-2544. [PMID: 31039653 PMCID: PMC6567721 DOI: 10.1177/0300060519841836] [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] [Indexed: 01/07/2023] Open
Abstract
Objective To evaluate the ability of two scoring systems (CHA2DS2-VASc score and CHA2DS2-VASc+hyperlipidaemia+smoking [CHA2DS2-VASc-HS score]) to predict in-stent restenosis (ISR) among patients undergoing drug-eluting stent (DES) implantation. Methods This retrospective study enrolled patients who underwent coronary angiography to assess coronary artery disease severity secondary to a diagnosis of stable angina or acute coronary syndrome that subsequently underwent DES implantations. Demographic, clinical, angiographic and biochemical parameters were compared between those patients that experienced ISR and those that did not during the study follow-up period. Univariate and multivariate logistic regression analyses were used to evaluate associations between the baseline parameters, the two scoring systems and ISR risk. Results A total of 358 patients (non-ISR group n = 316; ISR group n = 42) participated in the study. Compared with the non-ISR group, more patients in the ISR group had diabetes mellitus and received stents with smaller diameters but longer lengths. There were no significant differences with regard the predictive ability for ISR of either the CHA2DS2-Vasc or the CHA2DS2-Vasc-HS scores. Multivariate logistic regression analyses demonstrated that stent diameter, follow-up duration and glycosylated haemoglobin were independent risk factors for ISR. Conclusions The CHA2DS2-Vasc and CHA2DS2-Vasc-HS scores did not predict ISR in patients after coronary DES placement.
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Affiliation(s)
- Sheng Gang Zhao
- 1 Department of Cardiology, The Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, Zhejiang Province, China.,2 Department of Cardiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Jian Jiang Xu
- 2 Department of Cardiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Zhen Hao Tao
- 3 Graduate College, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Lei Jin
- 4 Medical College, Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Qin Liu
- 3 Graduate College, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Wen Yue Zheng
- 5 Department of Internal Medicine, TongXiang Maternity and Child Health Hospital, Jiaxing, Zhejiang Province, China
| | - Li Qin Jiang
- 2 Department of Cardiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Ning Fu Wang
- 1 Department of Cardiology, The Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, Zhejiang Province, China
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Jubran A, Willemink MJ, Nieman K. Coronary CT in Patients with a History of PCI or CABG: Helpful or Harmful? CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Sato T, Taya Y, Suzuki N, Yuasa S, Kishi S, Koshikawa T, Fuse K, Fujita S, Ikeda Y, Kitazawa H, Takahashi M, Okabe M, Aizawa Y. The comparison of early healing 1-month after PCI among CoCr-everolimus-eluting stent (EES), biodegradable polymer (BP)-EES and BP-sirolimus-eluting stent: Insights from OFDI and coronary angioscopy. IJC HEART & VASCULATURE 2018; 20:40-45. [PMID: 30167453 PMCID: PMC6113672 DOI: 10.1016/j.ijcha.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/29/2018] [Accepted: 08/05/2018] [Indexed: 11/25/2022]
Abstract
Background Third-generation stents with abluminal biodegradable polymer (BP) might facilitate early healing. Therefore, we compared early healing between second-generation and third-generation stents using coronary angioscopy (CAS) and optical frequency domain imaging [OFDI]. Methods We prospectively enrolled 30 consecutive patients with stent implantation for acute coronary syndrome (cobalt‑chromium [CoCr] everolimus-eluting stent [EES] [n = 10], BP-EES [n = 10], and BP-sirolimus eluting stent [SES] [n = 10]). All patients underwent CAS and OFDI 1 month after initial percutaneous coronary intervention. On OFDI, the stent coverage (SC), thrombus, and peri-strut low intensity area (PLIA) were assessed. CAS findings were recorded for the grade of SC, grade of yellow color (YC), and grade of the thrombus (TG). Results On OFDI, the incidences of any thrombus at the 1-month follow-up were 70%, 80%, and 80% in the CoCr-EES, BP-EES, and BP-SES groups, respectively. The percentage of coverage was comparable among the groups (CoCr-EES 79.8 vs. BP-EES 79.9 vs. BP-SES 80.1%, P = 0.96). However, the number of struts with PLIA was numerically higher in the BP-SES group than in the CoCr-EES and BP-EES groups (46.4 ± 25.1 vs. 21.6 ± 13.2 vs. 22.0 ± 7.2%, P = 0.08). In the CoCr-EES, BP-EES, and BP-SES groups, mean grades of SC were 1.25 ± 0.5, 1.25 ± 0.5, and 0.85 ± 0.70 (P = 0.60); mean grades of YC were 0.75 ± 0.5, 0.80 ± 0.45, and 0.88 ± 0.37 (P = 0.65), and mean grades of TG were 1.00 ± 1.00, 1.20 ± 0.83, and 0.88 ± 0.64 (P = 0.75), respectively. Conclusion Third-generation stents are not inferior to second-generation stents regarding stent coverage. However, PLIA on OFDI was often observed with BP-SESs, indicating involvement of the fibrin component.
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Affiliation(s)
- Takao Sato
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Yuji Taya
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | | | - Sho Yuasa
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Shohei Kishi
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | | | - Koichi Fuse
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | | | - Yoshio Ikeda
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | | | | | - Masaaki Okabe
- Cardiology, Tachikawa General Hospital, Nagaoka, Japan
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