1
|
Guan J, Li X, Gong S, Li L. Impact of diabetes mellitus on all and successful percutaneous coronary intervention outcomes for chronic total occlusions: A systematic review and meta-analysis. Heart Lung 2022; 55:108-116. [PMID: 35533491 DOI: 10.1016/j.hrtlng.2022.04.010] [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: 10/24/2021] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a leading cause of morbidity and mortality globally and can affect numerous vital organs, including the kidney, liver, heart, nervous system, and vascular system. OBJECTIVE To assess the impact of type 2 diabetes mellitus (DM) on outcome in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHODS Academic databases were screened for eligible studies published prior to January 2021. Study quality was assessed using Cochrane's risk of bias tool and the Newcastle Ottawa scale. RESULTS Pooling studies that met inclusion criteria, we carried out a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% confidence intervals (CIs). A total of ten studies featuring 8,276 participants met eligibility criteria. Type 2 DM patients had significantly higher odds of mortality (pooled OR: 1.62; 95% CI: 1.10 to 2.37), revascularization (pooled OR: 1.41; 95% CI: 1.14 to 1.74) and major adverse cardiac events (MACE) (pooled OR: 1.39; 95% CI: 1.18 to 1.63) relative to non-DM patients following PCI for CTO (regardless of PCI success or failure). Similarly, even when only looking at patients who underwent successful PCI, type 2 DM patients had significantly higher odds of revascularization (pooled OR: 1.54; 95% CI: 1.20 to 1.97) and MACE (pooled OR: 1.35; 95% CI: 1.13 to 1.63). CONCLUSION Type 2 DM significantly impacts the risk for adverse clinical outcomes even after successful PCI for CTO. As such, clinicians need to develop a comprehensive intervention package for DM patients with cardiovascular disease.
Collapse
Affiliation(s)
- Jinling Guan
- Cardiovascular department, Qingdao Fifth People's Hospital
| | - Xiaohua Li
- Cardiovascular department, Qingdao Fifth People's Hospital
| | - Suna Gong
- Cardiovascular department, Qingdao Fifth People's Hospital
| | - Lingmei Li
- Department of Endocrinology, Jingyuan people's Hospital, Gansu Province, Post code: 730600, P.R. China.
| |
Collapse
|
2
|
Ellis AG, Trikalinos TA, Wessler BS, Wong JB, Dahabreh IJ. Propensity Score-Based Methods in Comparative Effectiveness Research on Coronary Artery Disease. Am J Epidemiol 2018; 187:1064-1078. [PMID: 28992207 DOI: 10.1093/aje/kwx214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022] Open
Abstract
This review examines the conduct and reporting of observational studies using propensity score-based methods to compare coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy for patients with coronary artery disease. A systematic selection process identified 48 studies: 20 addressing CABG versus PCI; 21 addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG versus medical therapy; 1 addressing PCI versus medical therapy; and 1 addressing drug-eluting stents versus balloon angioplasty. Of 32 studies reporting information on variable selection, 7 relied exclusively on statistical criteria for the association of covariates with treatment, and 5 used such criteria to determine whether product or nonlinear terms should be included in the propensity score model. Twenty-five (52%) studies reported assessing covariate balance using the estimated propensity score, but only 1 described modifications to the propensity score model based on this assessment. The over 400 variables used in the 48 propensity score models were classified into 12 categories and 60 subcategories; only 17 subcategories were represented in at least half of the propensity score models. Overall, reporting of propensity score-based methods in observational studies comparing CABG, PCI, and medical therapy was incomplete; when adequately described, the methods used were often inconsistent with current methodological standards.
Collapse
Affiliation(s)
- Alexandra G Ellis
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, Massachusetts
- Department of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Issa J Dahabreh
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| |
Collapse
|
3
|
Kranjec I, Zavrl Džananovič D, Mrak M, Bunc M. Robustness of Percutaneously Completed Coronary Revascularization in Stable Coronary Artery Disease: Obstructive Versus Occlusive Lesions. Angiology 2018; 70:78-86. [PMID: 29631418 DOI: 10.1177/0003319718767737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study sought to assess long-term outcomes of percutaneously completed coronary revascularization (CCR) in patients with obstructive coronary artery disease (CAD) comprising chronic total occlusions (CTOs). Between 2010 and 2014, percutaneous coronary interventions (PCIs) of the CTOs were attempted in 213 patients: the CCR was achieved in 125 patients (group 1), while the PCI failed in 88 patients (group 2). They were matched against 252 patients (group 3) with the CCR obtained by the non-CTO PCIs. In the 5-year follow-up, more adverse cardiovascular (CV) events occurred in group 2 (29.5% vs 4.8% in group 1 vs 3.5% in group 3, P = .0001), mainly due to recurrent severe symptoms and additional revascularization of the CTOs; CV mortality did not seem to be significantly affected. Survival curves for the successful CTO and non-CTO PCIs appeared indistinguishable. Stent thromboses were infrequent in the CCR groups. In conclusion, long-term outcomes of the patients with the obstructive CAD containing the CTOs showed a favorable outcome if the CCR had been achieved percutaneously.
Collapse
Affiliation(s)
- Igor Kranjec
- 1 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | | | - Miha Mrak
- 1 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Matjaz Bunc
- 1 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| |
Collapse
|
4
|
Giza DE, Boccalandro F, Lopez-Mattei J, Iliescu G, Karimzad K, Kim P, Iliescu C. Ischemic Heart Disease: Special Considerations in Cardio-Oncology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:37. [PMID: 28425056 DOI: 10.1007/s11936-017-0535-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OPINION STATEMENT The interplay and balance between the competing morbidity and mortality of cardiovascular diseases and cancer have a significant impact on both short- and long-term health outcomes of patients who survived cancer or are being treated for cancer. Ischemic heart disease in patients with cancer or caused by cancer therapy is a clinical problem of emerging importance. Prompt recognition and optimum management of ischemic heart disease mean that patients with cancer can successfully receive therapies to treat their malignancy and reduce morbidity and mortality due to cardiovascular disease. In this sense, the presence of cancer and cancer-related comorbidities (e.g., thrombocytopenia, propensity to bleed, thrombotic status) substantially complicates the management of cardiovascular diseases in cancer patients. In this review, we will summarize the current state of knowledge on the management strategies for ischemic disease in patients with cancer, focusing on the challenges encountered when addressing these complexities.
Collapse
Affiliation(s)
- Dana Elena Giza
- The Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Fernando Boccalandro
- Odessa Heart Institute,Department of Internal Medicine, Permian Research Foundation, Texas-Tech University, Odessa, TX, 79761, USA
| | - Juan Lopez-Mattei
- The Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Gloria Iliescu
- The Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Kaveh Karimzad
- The Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Peter Kim
- The Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Cezar Iliescu
- The Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
| |
Collapse
|
5
|
Shuvy M, Guo H, Wijeysundera HC, Feindel CM, Cohen EA, Austin PC, Kingsbury K, Natarajan MK, Tu JV, Ko DT. Medical Therapy and Coronary Revascularization for Patients With Stable Coronary Artery Disease and Unclassified Appropriateness Score. Am J Cardiol 2015; 116:1815-21. [PMID: 26611121 DOI: 10.1016/j.amjcard.2015.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
Abstract
Although the appropriate use criteria incorporate common clinical scenarios for coronary revascularization, a significant proportion of patients with stable coronary artery disease (CAD) cannot be assigned an appropriateness score. Our objective was to characterize these patients and to evaluate whether coronary revascularization is associated with improved outcomes. A population-based cohort of patients aged ≥66 years, who underwent cardiac catheterization in Ontario, Canada, were included. Clinical characteristics were compared between patients with and without an appropriateness score. Clinical outcomes between coronary revascularization and medical therapy in patients with unclassified appropriateness score were compared using the inverse probability of treatment-weighted propensity method for confounder adjustment. Of the 19,228 patients with stable CAD, 11.2% (2,153 patients) were not assigned to an appropriateness score, mostly (92.9%) because of a lack of ischemic evaluation or a noninterpretable test. These patients were older, had higher rate of severe angina, and had more medical co-morbidities compared to patients with an appropriateness score. The 2-year rate of death or myocardial infarction in patients with unclassified appropriateness score was 15.3% in the revascularization group versus 20.7% in the medical therapy group. After propensity weighting, revascularization was associated with significantly lower hazard ratio (0.70; 95% confidence interval 0.61 to 0.79) for death or myocardial infarction compared with medical therapy. In conclusion, in patients aged ≥66 years with stable CAD and unclassified appropriateness score, revascularization is associated with improved outcomes.
Collapse
|
6
|
Chinese Herbal Medicines Might Improve the Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: Results of a Decision-Analytic Markov Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:639267. [PMID: 26495019 PMCID: PMC4606398 DOI: 10.1155/2015/639267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
Abstract
Aims. The priority of Chinese herbal medicines (CHMs) plus conventional treatment over conventional treatment alone for acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) was documented in the 5C trial (chictr.org number: ChiCTR-TRC-07000021). The study was designed to evaluate the 10-year effectiveness of CHMs plus conventional treatment versus conventional treatment alone with decision-analytic model for ACS after PCI. Methods and Results. We constructed a decision-analytic Markov model to compare additional CHMs for 6 months plus conventional treatment versus conventional treatment alone for ACS patients after PCI. Sources of data came from 5C trial and published reports. Outcomes were expressed in terms of quality-adjusted life years (QALYs). Sensitivity analyses were performed to test the robustness of the model. The model predicted that over the 10-year horizon the survival probability was 77.49% in patients with CHMs plus conventional treatment versus 77.29% in patients with conventional treatment alone. In combination with conventional treatment, 6-month CHMs might be associated with a gained 0.20% survival probability and 0.111 accumulated QALYs, respectively. Conclusions. The model suggested that treatment with CHMs, as an adjunctive therapy, in combination with conventional treatment for 6 months might improve the long-term clinical outcome in ACS patients after PCI.
Collapse
|
7
|
Bagnall A, Spyridopoulos I. The evidence base for revascularisation of chronic total occlusions. Curr Cardiol Rev 2015; 10:88-98. [PMID: 24694105 PMCID: PMC4021288 DOI: 10.2174/1573403x10666140331125659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 01/20/2014] [Indexed: 01/22/2023] Open
Abstract
When patients with ischaemic heart disease are considered for revascularisation the Heart Team's aim is to choose a therapy that will provide complete relief of angina for an acceptable procedural risk. Complete functional revascularisation of ischaemic myocardium is thus the goal and for this reason the presence of a chronic total occlusion (CTO) - which remain the most technically challenging lesions to revascularise percutaneously - is the most common reason for selecting coronary artery bypass surgery. From the behaviour of Heart Teams it is clear that physicians believe that CTOs are important. Yet when faced with patients with CTOs for whom surgery appears excessive (e.g. nonproximal LAD) or too high risk, there remains a reluctance to undertake CTO PCI, despite significant recent advances in procedural success and safety and a considerable body of evidence supporting a survival benefit following successful CTO PCI. This article reviews the relationship between CTOs, symptoms of angina, ischaemia and left ventricular dysfunction and further explores the evidence relating their treatment to improved quality of life and prognosis in patients with these features.
Collapse
Affiliation(s)
| | - Ioakim Spyridopoulos
- Department of Cardiology, The Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN. UK.
| |
Collapse
|
8
|
Pellegrini DO, Gomes VO, Lasevitch R, Smidt L, Azeredo MA, Ledur P, Bodanese R, Sinnott L, Moriguchi E, Caramori P. Efficacy and safety of drug-eluting stents in the real world: 8-year follow-up. Arq Bras Cardiol 2014; 103:174-82. [PMID: 25098375 PMCID: PMC4193064 DOI: 10.5935/abc.20140110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/14/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Drug-eluting stents have been used in daily practice since 2002, with the clear
advantages of reducing the risk of target vessel revascularization and an
impressive reduction in restenosis rate by 50%-70%. However, the occurrence of a
late thrombosis can compromise long-term results, particularly if the risks of
this event were sustained. In this context, a registry of clinical cases gains
special value. Objective: To evaluate the efficacy and safety of drug-eluting stents in the real world. Methods: We report on the clinical findings and 8-year follow-up parameters of all patients
that underwent percutaneous coronary intervention with a drug-eluting stent from
January 2002 to April 2007. Drug-eluting stents were used in accordance with the
clinical and interventional cardiologist decision and availability of the
stent. Results: A total of 611 patients were included, and clinical follow-up of up to 8 years was
obtained for 96.2% of the patients. Total mortality was 8.7% and nonfatal
infarctions occurred in 4.3% of the cases. Target vessel revascularization
occurred in 12.4% of the cases, and target lesion revascularization occurred in 8%
of the cases. The rate of stent thrombosis was 2.1%. There were no new episodes of
stent thrombosis after the fifth year of follow-up. Comparative subanalysis showed
no outcome differences between the different types of stents used, including
Cypher®, Taxus®, and Endeavor®. Conclusion: These findings indicate that drug-eluting stents remain safe and effective at very
long-term follow-up. Patients in the "real world" may benefit from drug-eluting
stenting with excellent, long-term results.
Collapse
Affiliation(s)
- Denise Oliveira Pellegrini
- Mailing Address: Denise Machado de Oliveira Pellegrini, Avenida Alegrete
423/1601, Petrópolis. Postal Code 90460-100, Porto Alegre, RS, Brazil.
;
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Garg S, Serruys P. Benefits of and safety concerns associated with drug-eluting coronary stents. Expert Rev Cardiovasc Ther 2014; 8:449-70. [DOI: 10.1586/erc.09.138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Loh JP, Pendyala LK, Kitabata H, Badr S, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. A propensity score matched analysis to determine if second-generation drug-eluting stents outperform first-generation drug-eluting stents in a complex patient population. Int J Cardiol 2013; 170:43-8. [PMID: 24169532 DOI: 10.1016/j.ijcard.2013.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/15/2013] [Accepted: 10/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) are routinely used in complex patients, but the impact of 1st- versus 2nd-generation DES on clinical outcomes has not been well described. This study aimed to assess the efficacy and safety of 2nd-generation (everolimus-eluting) DES compared to 1st-generation (sirolimus- and paclitaxel-eluting) DES in a selected, higher-risk population with complex clinical and angiographic features. METHODS The study included 5693 consecutive patients with the presence of ≥ 1 predefined complex clinical and angiographic characteristic treated with either generation DES. Using propensity score matching, the clinical outcomes of 1076 patients treated with 2nd-generation DES were compared with the outcomes of a matched population treated with 1st-generation DES over 1-year follow-up. RESULTS After matching, baseline clinical and angiographic characteristics were similar between groups. At 1-year follow-up, the rate of major adverse cardiac events was 9.4% with 2nd-generation DES and 11.3% with 1st-generation DES (p=0.16). There were no significant differences in the rates of death (3.2 vs. 4.0%, p=0.30), myocardial infarction (1.6 vs. 1.3%, p=0.57), target vessel revascularization (5.9 vs. 7.3%, p=0.17) or target lesion revascularization (4.4 vs. 5.0%, p=0.50). Definite stent thrombosis was less frequent with 2nd-generation DES (0.1 vs. 0.8%, p=0.011), as was definite or probable stent thrombosis (0.7 vs. 1.6%, p=0.040). CONCLUSION In this propensity score matched patient population with complex features undergoing percutaneous coronary intervention, the use of 2nd-generation DES was associated with lower rates of stent thrombosis, and similar 1-year major adverse cardiac events compared to 1st-generation DES.
Collapse
Affiliation(s)
- Joshua P Loh
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, United States
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Douglas H, Johnston NG, Bagnall AJ, Walsh SJ. Current evidence base for chronic total occlusion revascularization. Interv Cardiol 2013. [DOI: 10.2217/ica.13.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
12
|
Bagnall AJ, Paranamana R. Research Highlights: Highlights from the latest articles in chronic total occlusion percutaneous coronary intervention. Interv Cardiol 2013. [DOI: 10.2217/ica.13.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
13
|
Wessely R, Marzocchi A, Schwacke H, Bertel O, Laanmets P, Perisic Z, Toelg R, Jagic N, Elsässer A, Danzi GB. Long-term follow-up of coronary venous bypass graft lesions treated with a new generation drug-eluting stent with bioabsorbable polymer. J Interv Cardiol 2013; 26:425-33. [PMID: 23962106 DOI: 10.1111/joic.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To date, no published data are available regarding long-term follow-up of new generation DES implanted in coronary artery bypass graft (CABG) lesions. OBJECTIVES To assess the long-term clinical outcome of patients receiving the new generation Biolimus A9-coated drug-eluting stent (DES) with biodegradable polymer in saphenous vein grafts (SVG). METHODS Three thousand sixty-seven patients were included in the NOBORI 2 registry: 71 patients with a total of 117 lesions received at least 1 biolimus A9 DES in SVG lesions and 2,959 patients received percutaneous coronary intervention in other lesions. Clinical follow-up was performed at 1, 6, and 12 months, and annually up to 3 years. RESULTS Compared to the non-CABG group, patients with CABG lesions were older (P < 0.001), had a higher Charlson Comorbidity Index (P = 0.004), and presented more often with acute coronary syndrome (P = 0.02). At 3-year follow-up, cardiac death occurred in 9.7% versus 2.1% (P < 0.001), myocardial infarction (MI) in 8.3% versus 3.0% (P = 0.02), target lesion failure in 13.9% versus 6.4% (P = 0.03), and major adverse cardiac event in 18.1% versus 8.6% (P = 0.01). No differences were observed in TV-MI and TLR, nor stent thrombosis (ST) which was generally low in both groups (1.4% vs 0.8%, P = NS). CONCLUSION Albeit 3-year outcomes were less favorable in the CABG group, the higher cardiac mortality was apparently not driven by ST, target vessel MI, or TLR, but is likely due to advanced disease and age as well as comorbidity. The low TLR rate as well as the absence of late and very late ST suggest that BES are safe and effective for the treatment of CABG lesions.
Collapse
Affiliation(s)
- Rainer Wessely
- Zentrum für Herz-Gefaess- und Lungenmedizin Mediapark, Cologne, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Drug-eluting stents in multivessel coronary artery disease: cost effectiveness and clinical outcomes. Adv Pharmacol Sci 2013; 2012:679013. [PMID: 23346105 PMCID: PMC3533590 DOI: 10.1155/2012/679013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/07/2012] [Accepted: 11/25/2012] [Indexed: 11/29/2022] Open
Abstract
Multivessel coronary artery disease is more often treated either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) with stenting. The advent of drug-eluting stent (DES) has changed the revascularization strategy, and caused an increase in the use of DES in multivessel disease (MVD), with reduced rate of repeat revascularization compared to conventional bare metal stent. The comparative studies of DES-PCI over CABG have shown comparable safety; however, the rate of major adverse cerebrovascular and cardiac events and repeat revascularization was significantly higher with DES-PCI at long term. In diabetic patients with MVD, concern of repeat revascularization with DES-PCI is persistent. More recent, one-year economic outcomes have reported that the CABG is favored among patients with high angiographic complexity. The higher rate of repeat revascularization with DES-PCI in MVD would lead to increased economic burden on patient at long term besides bearing high cost of DES. In diabetic MVD patients, CABG is associated with having better clinical outcomes and being more cost-effective approach when compared to DES-PCI at long term.
Collapse
|
15
|
Wijeysundera DN, Wijeysundera HC, Yun L, Wąsowicz M, Beattie WS, Velianou JL, Ko DT. Risk of elective major noncardiac surgery after coronary stent insertion: a population-based study. Circulation 2012; 126:1355-62. [PMID: 22893606 DOI: 10.1161/circulationaha.112.102715] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Guidelines recommend that noncardiac surgery be delayed until 30 to 45 days after bare-metal stent implantation and 1 year after drug-eluting stent implantation. METHODS AND RESULTS We used linked registry data and population-based administrative health care databases to conduct a cohort study of 8116 patients (≥40 years of age) who underwent major elective noncardiac surgery in Ontario, Canada between 2003 and 2009, and received coronary stents within 10 years before surgery. Approximately 34% (n=2725) underwent stent insertion within 2 years before surgery, of whom 905 (33%) received drug-eluting stents. For comparison, we assembled a separate cohort of 341 350 surgical patients who had not undergone coronary revascularization. The primary outcome was 30-day major adverse cardiac events (mortality, readmission for acute coronary syndrome, or repeat coronary revascularization). The overall rate of 30-day events in patients with coronary stents was 2.1% (n=170). When the interval between stent insertion and surgery was <45 days, event rates were high for bare-metal (6.7%) and drug-eluting (20.0%) stents. When the interval was 45 to 180 days, the event rate for bare-metal stents was 2.6%, approaching that of intermediate-risk nonrevascularized individuals. Adjusted analyses suggested that event rates were increased if this interval exceeded 180 days. For drug-eluting stents, the event rate was 1.2% once the interval exceeded 180 days, approaching that of intermediate-risk nonrevascularized individuals. CONCLUSIONS The earliest optimal time for elective surgery is 46 to 180 days after bare-metal stent implantation or >180 days after drug-eluting stent implantation.
Collapse
Affiliation(s)
- Duminda N Wijeysundera
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
| | | | | | | | | | | | | |
Collapse
|
16
|
D'Ascenzo F, Cavallero E, Biondi-Zoccai G, Moretti C, Omedè P, Bollati M, Castagno D, Modena MG, Gaita F, Sheiban I. Use and Misuse of Multivariable Approaches in Interventional Cardiology Studies on Drug-Eluting Stents: A Systematic Review. J Interv Cardiol 2012; 25:611-21. [PMID: 22882654 DOI: 10.1111/j.1540-8183.2012.00753.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
17
|
SINGH JAGMEETP, ELLENBOGEN KENNETHA, DESAI NIHARR, MCALISTER FINLAYA. ICDs, Guidelines, and National Registries: Opportunities to Enhance Quality of Patient Care. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:253-8. [DOI: 10.1111/j.1540-8159.2011.03300.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
McAlister FA. The end of the risk-treatment paradox? A rising tide lifts all boats. J Am Coll Cardiol 2011; 58:1766-7. [PMID: 21996388 DOI: 10.1016/j.jacc.2011.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 07/26/2011] [Indexed: 11/15/2022]
|
19
|
Ko DT, Guo H, Wijeysundera HC, Zia MI, Džavík V, Chu MW, Fremes SE, Cohen EA, Tu JV. Long-Term Safety and Effectiveness of Drug-Eluting Stents for the Treatment of Saphenous Vein Grafts Disease. JACC Cardiovasc Interv 2011; 4:965-73. [DOI: 10.1016/j.jcin.2011.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/14/2011] [Indexed: 11/29/2022]
|
20
|
Stefanini GG, Serruys PW, Silber S, Khattab AA, van Geuns RJ, Richardt G, Buszman PE, Kelbæk H, van Boven AJ, Hofma SH, Linke A, Klauss V, Wijns W, Macaya C, Garot P, Di Mario C, Manoharan G, Kornowski R, Ischinger T, Bartorelli AL, Gobbens P, Windecker S. The impact of patient and lesion complexity on clinical and angiographic outcomes after revascularization with zotarolimus- and everolimus-eluting stents: a substudy of the RESOLUTE All Comers Trial (a randomized comparison of a zotarolimus-eluting stent with an everolimus-eluting stent for percutaneous coronary intervention). J Am Coll Cardiol 2011; 57:2221-32. [PMID: 21616282 DOI: 10.1016/j.jacc.2011.01.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/27/2010] [Accepted: 01/26/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of patient and lesion complexity on outcomes with newer-generation zotarolimus-eluting stents (ZES) and everolimus-eluting stents (EES). BACKGROUND Clinical and angiographic outcomes of newer-generation stents have not been described among complex patients. METHODS Patients enrolled in the RESOLUTE All Comers trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention) were stratified into "complex" and "simple." RESULTS Of 2,292 patients, 1,520 (66.3%) were complex and treated with ZES (n = 764) or EES (n = 756). Event rates were higher among complex patients, and results did not differ between ZES and EES, regardless of complexity. At 1 year, target lesion failure was 8.9% in ZES- and 9.7% in EES-treated complex patients (p = 0.66) and 6.8% in ZES- and 5.7% in EES-treated simple patients (p = 0.55). Rates of cardiac death (1.3% vs. 2.2%, p = 0.24), target-vessel myocardial infarction (4.3% vs. 4.4%, p = 0.90), and clinically indicated target lesion revascularization (4.4% vs. 4.0%, p = 0.80) were similar for both stent types among complex patients. Definite or probable stent thrombosis occurred in 20 (1.3%) complex patients with no difference between ZES (1.7%) and EES (0.9%, p = 0.26). Angiographic follow-up showed similar results for ZES and EES in terms of in-stent percentage diameter stenosis (22.2 ± 15.4% vs. 21.4 ± 15.8%, p = 0.67) and in-segment binary restenosis (6.6% vs. 8.0%, p = 0.82) in the complex group. CONCLUSIONS In this all-comers randomized trial, major adverse cardiovascular events were more frequent among complex than simple patients. The newer-generation ZES and EES proved to be safe and effective, regardless of complexity, with similar clinical and angiographic outcomes for both stent types through 1 year. (RESOLUTE-III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention; NCT00617084).
Collapse
|
21
|
High on Treatment Platelet Reactivity and Stent Thrombosis. Heart Lung Circ 2011; 20:525-31. [DOI: 10.1016/j.hlc.2011.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/18/2011] [Accepted: 04/13/2011] [Indexed: 11/21/2022]
|
22
|
Romagnoli E, Godino C, Ielasi A, Gasparini G, Tzifos V, Sciahbasi A, Lioy E, Presbitero P, Colombo A, Sangiorgi G. Resolute italian study in all comers. Catheter Cardiovasc Interv 2011; 79:567-74. [DOI: 10.1002/ccd.23046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/13/2011] [Indexed: 11/09/2022]
|
23
|
Ko DT, Wijeysundera HC, Yun L, Austin PC, Cantor WJ, Tu JV. Effectiveness of Preprocedural Statin Therapy on Clinical Outcomes for Patients With Stable Coronary Artery Disease After Percutaneous Coronary Interventions. Circ Cardiovasc Qual Outcomes 2011; 4:459-66. [DOI: 10.1161/circoutcomes.111.960740] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Data have shown that preprocedural statin therapy reduces periprocedural myocardial infarction after percutaneous coronary intervention (PCI). However, whether preprocedural statins improve clinical outcomes in patients with stable coronary artery disease (CAD) has not been established. We aimed to evaluate the clinical effectiveness of preprocedural statin therapy in patients with stable CAD undergoing PCI.
Methods and Results—
We conducted an observational study of 12 980 patients, age >65 years with stable CAD, who underwent PCI from December 1, 2003, to March 31, 2008. Using propensity score–matching analysis, 3098 unique matched pairs (6196 patients) who had similar likelihood of receiving preprocedural statins were identified. Additional analyses adjusting for postprocedural statins as a time-varying variable were performed. The main outcome measure was a composite of death or recurrent acute coronary syndrome. In the propensity-matched cohort, at 90 days, the primary outcome of death and acute coronary syndrome occurred in 5.6% in the preprocedural statin group as compared with 7.4% in the no-pretreatment group (
P
=0.005). Improved clinical outcomes associated with preprocedural statins were still observed at 2 years (16.7% versus 19.3%,
P
=0.007). The effectiveness of preprocedural statins was most pronounced at 90 days after PCI (adjusted hazard ratio, 0.80; 95% confidence interval, 0.65 to 0.98) but was no longer significant at 1 year (adjusted hazard ratio, 0.92; 95% confidence interval, 0.79 to 1.07) after accounting for postprocedural statin therapy.
Conclusions—
Preprocedural statin therapy was associated with significant reduction in the risk of death or recurrent acute coronary syndrome in stable CAD patients after PCI. These findings support the routine use of preprocedural statins for suitable candidates.
Collapse
Affiliation(s)
- Dennis T. Ko
- From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., L.Y., P.C.A., J.V.T.); Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., H.C.W., J.V.T.); the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (D.T.K., H.C.W., W.J.C., J.V.T.); and Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.)
| | - Harindra C. Wijeysundera
- From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., L.Y., P.C.A., J.V.T.); Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., H.C.W., J.V.T.); the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (D.T.K., H.C.W., W.J.C., J.V.T.); and Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.)
| | - Lingsong Yun
- From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., L.Y., P.C.A., J.V.T.); Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., H.C.W., J.V.T.); the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (D.T.K., H.C.W., W.J.C., J.V.T.); and Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.)
| | - Peter C. Austin
- From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., L.Y., P.C.A., J.V.T.); Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., H.C.W., J.V.T.); the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (D.T.K., H.C.W., W.J.C., J.V.T.); and Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.)
| | - Warren J. Cantor
- From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., L.Y., P.C.A., J.V.T.); Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., H.C.W., J.V.T.); the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (D.T.K., H.C.W., W.J.C., J.V.T.); and Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.)
| | - Jack V. Tu
- From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., L.Y., P.C.A., J.V.T.); Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., H.C.W., J.V.T.); the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (D.T.K., H.C.W., W.J.C., J.V.T.); and Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.)
| |
Collapse
|
24
|
Yeh RW, Chandra M, McCulloch CE, Go AS. Accounting for the mortality benefit of drug-eluting stents in percutaneous coronary intervention: a comparison of methods in a retrospective cohort study. BMC Med 2011; 9:78. [PMID: 21702899 PMCID: PMC3141543 DOI: 10.1186/1741-7015-9-78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/24/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Drug-eluting stents (DES) reduce rates of restenosis compared with bare metal stents (BMS). A number of observational studies have also found lower rates of mortality and non-fatal myocardial infarction with DES compared with BMS, findings not observed in randomized clinical trials. In order to explore reasons for this discrepancy, we compared outcomes after percutaneous coronary intervention (PCI) with DES or BMS by multiple statistical methods. METHODS We compared short-term rates of all-cause mortality and myocardial infarction for patients undergoing PCI with DES or BMS using propensity-score adjustment, propensity-score matching, and a stent-era comparison in a large, integrated health system between 1998 and 2007. For the propensity-score adjustment and stent era comparisons, we used multivariable logistic regression to assess the association of stent type with outcomes. We used McNemar's Chi-square test to compare outcomes for propensity-score matching. RESULTS Between 1998 and 2007, 35,438 PCIs with stenting were performed among health plan members (53.9% DES and 46.1% BMS). After propensity-score adjustment, DES was associated with significantly lower rates of death at 30 days (OR 0.49, 95% CI 0.39 - 0.63, P < 0.001) and one year (OR 0.58, 95% CI 0.49 - 0.68, P < 0.001), and a lower rate of myocardial infarction at one year (OR 0.72, 95% CI 0.59 - 0.87, P < 0.001). Thirty day and one year mortality were also lower with DES after propensity-score matching. However, a stent era comparison, which eliminates potential confounding by indication, showed no difference in death or myocardial infarction for DES and BMS, similar to results from randomized trials. CONCLUSIONS Although propensity-score methods suggested a mortality benefit with DES, consistent with prior observational studies, a stent era comparison failed to support this conclusion. Unobserved factors influencing stent selection in observational studies likely account for the observed mortality benefit of DES not seen in randomized clinical trials.
Collapse
Affiliation(s)
- Robert W Yeh
- Cardiology Division, GRB800, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
25
|
Bell AD, Roussin A, Cartier R, Chan WS, Douketis JD, Gupta A, Kraw ME, Lindsay TF, Love MP, Pannu N, Rabasa-Lhoret R, Shuaib A, Teal P, Théroux P, Turpie AG, Welsh RC, Tanguay JF. The Use of Antiplatelet Therapy in the Outpatient Setting: Canadian Cardiovascular Society Guidelines. Can J Cardiol 2011; 27 Suppl A:S1-59. [DOI: 10.1016/j.cjca.2010.12.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 12/09/2010] [Accepted: 12/10/2010] [Indexed: 01/17/2023] Open
|
26
|
BRILAKIS EMMANOUILS, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Outcomes after Utilization of the TAXUS Paclitaxel-Eluting Stent in Bifurcations and Multivessel Stenting in the ARRIVE Registries. J Interv Cardiol 2011; 24:342-50. [DOI: 10.1111/j.1540-8183.2011.00646.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
|
27
|
Comparison between on-label versus off-label use of drug-eluting coronary stents in clinical practice: results from the German DES.DE-Registry. Clin Res Cardiol 2011; 100:701-9. [PMID: 21416192 DOI: 10.1007/s00392-011-0301-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 02/23/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Observational studies from the USA have demonstrated that off-label use of drug-eluting stents (DES) is common. Data on off-label use in Western Europe are limited. METHODS We analyzed the data of consecutive patients receiving DES prospectively enrolled in the multicenter German DES.DE registry (Deutsches Drug-Eluting Stent Register) between October 2005 and October 2006. Off-label use was defined in the presence of one of the following criteria: ST-elevation myocardial infarction, in-stent stenosis, chronic total occlusion, lesions in a bypass graft, in bifurcation or left main stem, stent length per lesion ≥32 mm, and vessel diameter <2.5 or >3.5 mm. RESULTS Overall, 4,295 patients were included in this analysis and divided into two groups: 2,366 (55.1%) received DES for off-label and 1,929 (44.9%) for on-label indications. There were substantial differences in the rates of off-label use at the participating hospitals. Patients with off-label DES more often presented with high-risk features such as acute coronary syndrome, cardiogenic shock, congestive heart failure, and more complex coronary anatomy. Among hospital survivors, the incidence of the composite endpoint of death, myocardial infarction and stroke (MACCE) (9.2 vs. 7.4%, p < 0.05), and target vessel revascularization (TVR) (11.3 vs. 9.1%, p < 0.05) was increased in the off-label group at the 1-year follow-up. However, in the multivariate analysis off-label use was not linked with an elevated risk for MACCE (hazard ratio 0.86, 95% confidence interval 0.62-1.18) and TVR (hazard ratio 1.05, 95% confidence interval 0.78-1.42). CONCLUSIONS In clinical practice, DES was very frequently used off-label. After adjustment for confounding variables, off-label use was not associated with an increase of adverse events.
Collapse
|
28
|
Abstract
The cancer patient with coronary disease presents particular challenges that directly impact on the management of coronary disease, both stable and acute. The frequent need for surgery in the cancer patient is an important consideration in avoiding a coronary artery stent or any percutaneous coronary intervention for management of chronic stable angina, which will delay surgery or pose of risk of stent thrombosis during surgery. Cancer surgery is considered low or intermediate cardiac risk so revascularization before surgery is needed only in exceptional circumstances. Medical treatment in most patients or coronary artery bypass graft in high risk situations may be preferable if the cancer is being actively treated. The likelihood of thrombocytopenia, either primary from bone marrow disease, or secondarily during chemotherapy causes concern about the need for continuous use of platelet suppressing agents, aspirin for all patients, or double antiplatelet therapy in all patients after receiving a coronary artery stent. Drug-eluting stents pose special problems and should be avoided. Even bare metal stents may have a higher long-term risk of stent thrombosis in the cancer patient. The increase in propensity for venous clotting, either as a result of the cancer itself, or especially with selected chemotherapeutic agents may be an issue after stenting and certainly early after coronary bypass surgery. Aggressive medical treatment to reduce risk factors, especially with statins is essential to stabilize the underlying coronary disease.
Collapse
Affiliation(s)
- Ronald J Krone
- Department of Medicine, Division of Cardiology, Washington University, School of Medicine, 660 S Euclid, Box 8086, St. Louis, MO 63130, USA.
| |
Collapse
|
29
|
Garg S, Serruys PW. Coronary Stents. J Am Coll Cardiol 2010; 56:S1-42. [PMID: 20797502 DOI: 10.1016/j.jacc.2010.06.007] [Citation(s) in RCA: 307] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 01/07/2023]
|
30
|
Holzhey DM, Luduena MM, Rastan A, Jacobs S, Walther T, Mohr FW, Falk V. Is the SYNTAX Score a Predictor of Long-term Outcome after Coronary Artery Bypass Surgery? Heart Surg Forum 2010; 13:E143-8. [DOI: 10.1532/hsf98.20091157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
31
|
|
32
|
Ko DT, Yun L, Wijeysundera HC, Jackevicius CA, Rao SV, Austin PC, Marquis JF, Tu JV. Incidence, Predictors, and Prognostic Implications of Hospitalization for Late Bleeding After Percutaneous Coronary Intervention for Patients Older Than 65 Years. Circ Cardiovasc Interv 2010; 3:140-7. [DOI: 10.1161/circinterventions.109.928721] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background—
Previous data on bleeding after percutaneous coronary intervention (PCI) have been obtained primarily from randomized trials that focused on in-hospital bleeding. The incidence of late bleeding after PCI, its independent predictors, and its prognostic importance in clinical practice has not been fully addressed.
Methods and Results—
We evaluated 22 798 patients aged >65 years who underwent PCI from December 1, 2003, to March 31, 2007, in Ontario, Canada. Cox proportional hazard models were used to determine factors associated with late bleeding, which was defined as hospitalization for bleeding after discharge from the index PCI, and to estimate risk of death or myocardial infarction associated with late bleeding. We found that 2.5% of patients were hospitalized for bleeding in the year after PCI, with 56% of bleeding episodes due to gastrointestinal bleed. The most significant predictor of late bleeding was warfarin use after PCI (hazard ratio [HR], 3.12). Other significant predictors included age (HR, 1.41 per 10 years), male sex (HR, 1.24), cancer (HR, 1.80), previous bleeding (HR, 2.42), chronic kidney disease (HR, 1.93), and nonsteroidal antiinflammatory drug use (HR, 1.73). After adjusting for baseline covariates, hospitalization for a bleeding episode was associated with a significantly increased 1-year hazard of death or myocardial infarction (HR, 2.39; 95% CI, 1.93 to 2.97) and death (HR, 3.38; 95% CI, 2.60 to 4.40).
Conclusions—
Hospitalization for late bleeding after PCI is associated with substantially increased risk of death and myocardial infarction. The use of triple therapy (ie, aspirin, thienopyridine, and warfarin) is associated with the highest risk of late bleeding.
Collapse
Affiliation(s)
- Dennis T. Ko
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Lingsong Yun
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Harindra C. Wijeysundera
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Cynthia A. Jackevicius
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Sunil V. Rao
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Peter C. Austin
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Jean-François Marquis
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| | - Jack V. Tu
- From the Institute for Clinical Evaluative Sciences (D.T.K., L.Y., C.A.J., P.C.A., J.V.T.); Division of Cardiology (D.T.K., H.C.W., J.V.T.), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Health Policy, Management and Evaluation (D.T.K., C.A.J., P.C.A., J.V.T.), University of Toronto, Toronto, Ontario, Canada; College of Pharmacy (C.A.J.), Western University of Health Sciences, Pomona, Calif; VA Greater Los Angeles Healthcare System (C.A.J.), Los Angeles, Calif; Duke
| |
Collapse
|
33
|
Efficacy and Safety of Drug-Eluting Stents in Chronic Total Coronary Occlusion Recanalization. J Am Coll Cardiol 2010; 55:1854-66. [PMID: 20413038 DOI: 10.1016/j.jacc.2009.12.038] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 11/13/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
|
34
|
Albarrán A, Mauri J, Pinar E, Baz JA. Actualización en cardiología intervencionista. Rev Esp Cardiol 2010; 63 Suppl 1:86-100. [DOI: 10.1016/s0300-8932(10)70143-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
|
36
|
Inoue K. Drug-Eluting Stents Are Not Indicated for Patients With Acute Coronary Syndrome - Should Drug-Eluting Stents Be Indicated for Patients With Acute Coronary Syndrome? (Con) -. Circ J 2010; 74:2232-8. [DOI: 10.1253/circj.cj-10-0722] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Katsumi Inoue
- Department of Laboratory Medicine, Kokura Memorial Hospital
| |
Collapse
|