1
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Roumeliotis A, Siasos G, Dangas G, Power D, Sartori S, Vavouranakis M, Tsioufis K, Leone PP, Vogel B, Cao D, Oliva A, Oikonomou E, Smith KF, Sweeny J, Krishnan P, Kini A, Sharma S, Mehran R. Significance of diabetes mellitus status in patients undergoing percutaneous left main coronary artery intervention. Catheter Cardiovasc Interv 2024. [PMID: 39152795 DOI: 10.1002/ccd.31179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) is a modifiable risk factor for patients with coronary artery disease (CAD). Treatment with insulin correlates with advanced disease and has been associated with excess cardiovascular risk, but evidence on outcomes of patients with insulin-treated DM (ITDM) undergoing left main percutaneous coronary intervention (LMPCI) remains scarce. AIMS The aim of the presented study is to evluate the risk attributable to DM and ITDM in patients undergoing LMPCI. METHODS We included 869 patients undergoing PCI for unprotected LMCAD. The cohort was divided into three subgroups based on diabetic status: No DM, ITDM, and Non-ITDM. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, spontaneous myocardial infarction (MI), or stroke at 1 year. Results were adjusted for clinically relevant baseline characteristics. RESULTS Amongst participants, 58.7% had no DM, 25.9% non-ITDM, and 15.4% ITDM. Diabetics were younger and more likely to be female. They also exhibited higher body mass index as well as prevalence of comorbidities, including hypertension, anemia, and chronic kidney disease. The number of bifurcation lesions and stents used was similar between groups. At 1 year, when compared to no DM, ITDM (25.4% vs. 10.0%, p < 0.01) but not non-ITDM (10.8% vs. 10.0%, p = 0.94) demonstrated higher MACCE. This finding was driven by increased risk of MI. Mortality was 8.4%, 7.8%, and 17.2% for no DM, Non-ITDM, and ITDM, respectively. Results remained unchanged after adjustment. CONCLUSIONS In a rather contemporary patient population undergoing PCI for LMCAD, ITDM but not non-ITDM was associated with higher risk of 1-year MACCE, primarily driven by MI.
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Affiliation(s)
- Anastasios Roumeliotis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Medical School, National Kapodistrian University of Athens, Athens, Greece
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Gerasimos Siasos
- Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - George Dangas
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Pier Pasquale Leone
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angelo Oliva
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Metropolitan City of Milan, Italy
| | | | - Kenneth F Smith
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sweeny
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prakash Krishnan
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Hamed M, Morcos R, Elbadawi A, Osman A, Jneid H, Khalife W, Maini B, Khalili H. Percutaneous Left Atrial Appendage Closure Among Patients With Diabetes (Insights from a National Database). Am J Cardiol 2023; 202:144-150. [PMID: 37437355 DOI: 10.1016/j.amjcard.2023.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/17/2023] [Accepted: 06/11/2023] [Indexed: 07/14/2023]
Abstract
Atrial fibrillation is a major risk factor for stroke. Left atrial appendage closure (LAAC) has emerged as an alternative to anticoagulation for patients with high risk of bleeding. Diabetes mellitus (DM) is associated with adverse events after cardiac procedures. We sought to compare procedural and hospital outcomes in patients who underwent LAAC with and without DM. The Nationwide Inpatient Database was queried for patients with atrial fibrillation who underwent LAAC between January 1, 2016, and December 31, 2019. The primary outcome was all adverse events that included in-hospital death, acute myocardial infarction, cardiac arrest, stroke, pericardial effusion, pericardial tamponade, pericardiocentesis, pericardial window, and postprocedural hemorrhage requiring blood transfusion. Analysis included 62,220 patients who underwent LAAC from 2016 to 2019; 34.9% of patients had DM. There was a slight increase in the percentage of patients who underwent LAAC who had DM during the study period, from 29.92% to 34.93%. In unadjusted and adjusted analysis, there was no significant difference in all adverse events between patients with and without DM who underwent LAAC (9.18% vs 8.77%, respectively, adjusted p = 0.63), and no difference in length of stay. Patients with DM have higher risk of acute kidney injury (3.75 vs 1.96%, p <0.001). This nationwide retrospective study demonstrates that DM is not associated with an increase in adverse event rates in patients who underwent LAAC.
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Affiliation(s)
- Mohamed Hamed
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Ramez Morcos
- Division of Cardiology, Florida Atlantic University, Boca Raton, Florida
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ahmed Osman
- Division of Cardiology, Broward Health, Fort Lauderdale, Florida
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Brijeshwar Maini
- Division of Cardiology, Florida Atlantic University, Boca Raton, Florida
| | - Houman Khalili
- Division of Cardiology, Florida Atlantic University, Boca Raton, Florida; Department of Cardiac Services, Memorial Healthcare System, Hollywood, Florida.
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3
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Patti G, Ghiglieno C. Why can primary angioplastics be ineffective despite the precocity of the intervention? Eur Heart J Suppl 2022; 24:I114-I118. [DOI: 10.1093/eurheartjsupp/suac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Early coronary revascularization is a first choice therapeutic strategy in the case of acute myocardial infarction (MI). Despite an early coronary angioplasty, however, in some cases, there is a lower efficacy of revascularization, with less favourable clinical outcome in the short and long terms. Various elements participate in the distant prognosis after primary coronary angioplasty (PCI). Among the clinical risk factors that predispose to a recurrence of ischaemic cardiovascular events are advanced age, diabetes mellitus, chronic renal failure, peripheral vascular disease, atrial fibrillation and the multiplicity of cardiovascular risk factors, which identify a higher baseline risk profile. The risk factors associated with the percutaneous interventional procedure include the presence of diffuse or complex coronary lesions, the use of small diameter stents or a suboptimal post procedural thrombolysis in MI flow. The occurrence of procedural complications, such as no-reflow, is in fact associated with an increase in the infarct area and a worse prognosis, as it favours negative ventricular remodelling. The presence of concomitant right ventricular dysfunction, the high ventricular arrhythmic burden in the acute phase, the presence of risk factors for thrombosis or intra-stent restenosis also affect the outcome after primary PCI.
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Affiliation(s)
- Giuseppe Patti
- University of Eastern Piedmont Amedeo Avogadro
- Maggiore della Carità Hospital , Novara
| | - Chiara Ghiglieno
- University of Eastern Piedmont Amedeo Avogadro
- Maggiore della Carità Hospital , Novara
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Kang J, Park KW, Lee HS, Zheng C, Rhee TM, Ki YJ, Chang M, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Relative Impact of Clinical Risk Versus Procedural Risk on Clinical Outcomes After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2021; 14:e009642. [PMID: 33541106 DOI: 10.1161/circinterventions.120.009642] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The clinical outcome after percutaneous coronary intervention (PCI) is affected by various clinical and procedural risk factors. We investigated the relative impact of clinical and procedural risks on clinical outcomes after PCI. METHODS A total of 13 172 patients were enrolled from the Grand-DES registry. The population was grouped into tertiles (high-, intermediate-, low-risk) according to the number of prespecified clinical and procedural risk factors, respectively. The primary end point was major adverse cardiac and cerebrovascular events (MACCE) at 3 years post-PCI. RESULTS MACCE occurred in 1109 (8.4%) patients during the follow-up period (median duration: 1126 days). Compared with procedural risk, clinical risk showed superior predictive power (area under the curve: 0.678 versus 0.570, P<0.001, for clinical and procedural risks, respectively) and greater magnitude of effect in the multivariate analysis for MACCE (Clinical risk: hazard ratio, 1.953 [95% CI, 1.809-2.109], P<0.001; procedural risk: hazard ratio, 1.240 [95% CI, 1.154-1.331], P<0.001). In subgroup analyses within each clinical risk tertile, procedural risk had no significant impact on MACCE in the lowest clinical risk tertile. An annual landmark analysis revealed that clinical and procedural risks were both significant predictors of MACCE, which occurred within the first and second year post-PCI. However, for MACCE occurring in the third year post-PCI, only clinical risk but not procedural risk was a significant predictor of events. CONCLUSIONS Clinical and procedural risks were both significant predictors for ischemic clinical events in patients undergoing PCI. However, clinical risk had a greater and more prolonged effect on outcomes than procedural risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03507205.
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Affiliation(s)
- Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Hak Seung Lee
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Chengbin Zheng
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - You-Jeong Ki
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Mineok Chang
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Korea
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5
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Ashley KE, Hillegass WB. Insulin-treated diabetes mellitus: An actionable risk factor and marker after percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 96:309-310. [PMID: 32797736 DOI: 10.1002/ccd.29170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kellan E Ashley
- Interventional Cardiovascular Section, University of Mississippi Medical Center, Jackson, Mississippi.,Departments of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - William B Hillegass
- Departments of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.,Data Science, University of Mississippi Medical Center, Jackson, Mississippi
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6
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Bawamia BR, Egred M, Jackson M, Purcell I, Austin D, Zaman AG. Percutaneous coronary intervention for left main stem disease: Impact of diabetes mellitus on mortality. Catheter Cardiovasc Interv 2020; 96:E416-E422. [PMID: 32134178 PMCID: PMC7687181 DOI: 10.1002/ccd.28818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/01/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We assessed the impact of diabetes mellitus (DM) on mortality after percutaneous coronary intervention (PCI) for left main stem (LMS) disease. Second, we compared mortality outcomes between non-insulin treated (NITDM) and insulin treated diabetes (ITDM) in different clinical settings. BACKGROUND There is a paucity of "real world" outcomes data in diabetic patients undergoing LMS PCI. METHODS We undertook a retrospective analysis of consecutive patients undergoing unprotected LMS PCI at 2 high volume tertiary centers. Diabetic status and clinical setting for PCI were recorded. The primary outcome measure was all-cause 30-day and long-term mortality (up to 36 months) post index PCI. RESULTS Between 2003 and 2017, 2,675 patients undergoing index LMS PCI were analyzed. Of those, 77.1% were non-DM, 15.8% NITDM, and 7.1% ITDM. Overall, DM status was not associated with higher 30-day mortality (OR 1.39, 95% CI 0.89-2.16, p = .15). During a median follow-up of 36 months, there was a borderline statistical association of DM with long-term mortality in all PCI settings (HR 1.31, 95% CI 1.00-1.71, p = .05). Compared to non-DM, ITDM but not NITDM was associated with short- and long-term mortality in all clinical presentations. CONCLUSIONS Overall, DM did not impact on 30-day mortality and had only a borderline statistical association with long-term mortality. It did not have an influence on mortality in non-emergency LMS PCI. The impact of DM on mortality outcomes following LMS PCI was only significant in the insulin treated patients.
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Affiliation(s)
- Bilal R. Bawamia
- Cardiology DepartmentJames Cook University HospitalMiddlesbroughUK
| | - Mohaned Egred
- Cardiology DepartmentFreeman HospitalNewcastle upon TyneUK
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - Matthew Jackson
- Cardiology DepartmentJames Cook University HospitalMiddlesbroughUK
| | - Ian Purcell
- Cardiology DepartmentFreeman HospitalNewcastle upon TyneUK
| | - David Austin
- Cardiology DepartmentJames Cook University HospitalMiddlesbroughUK
| | - Azfar G. Zaman
- Cardiology DepartmentFreeman HospitalNewcastle upon TyneUK
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
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7
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Razeghian-Jahromi I, Natale A, Nikoo MH. Coronary sinus diverticulum: Importance, function, and treatment. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1582-1587. [PMID: 32815147 DOI: 10.1111/pace.14026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023]
Abstract
The importance of venous structure in the heart is usually overshadowed by that of the arterial system. Coronary sinus (CS) is a part of cardiac venous apparatus and connects left atria to the right atria. Other than having role in physiological contractions of both atria, it contributes substantially to cardiac electrical conduction system. Due to unique placement and connections of the CS, it has become growing interest in clinical cardiology. It is used in cardiac resynchronization therapy with biventricular pacing, left-sided catheter ablation of arrhythmias, and administration of retrograde cardioplegia in cardiac surgery. In some individuals, CS is presented with anatomical variants. CS diverticulum is a congenital outpouching that provides muscular connection between atria and ventricle. This connection provides a suitable substrate for occurrence of arrhythmias, which even results in life-threatening events such as sudden cardiac death. Early diagnosis leads to treatment with ablation techniques, which ultimately eliminates origins of arrhythmias.
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Affiliation(s)
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,MetroHealth Medical Center, CaseWestern Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California.,Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California
| | - Mohammad Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Nous FMA, Coenen A, Boersma E, Kim YH, Kruk MBP, Tesche C, de Geer J, Yang DH, Kepka C, Schoepf UJ, Persson A, Kurata A, Budde RPJ, Nieman K. Comparison of the Diagnostic Performance of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve in Patients With Versus Without Diabetes Mellitus (from the MACHINE Consortium). Am J Cardiol 2019; 123:537-543. [PMID: 30553510 DOI: 10.1016/j.amjcard.2018.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 02/05/2023]
Abstract
Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) is a noninvasive application to evaluate the hemodynamic impact of coronary artery disease by simulating invasively measured FFR based on CT data. CT-FFR is based on the assumption of a normal coronary microvascular response. We assessed the diagnostic performance of a machine-learning based application for on-site computation of CT-FFR in patients with and without diabetes mellitus with suspected coronary artery disease. The study population included 75 diabetic and 276 nondiabetic patients who were enrolled in the MACHINE consortium. The overall diagnostic performance of coronary CT angiography alone and in combination with CT-FFR were analyzed with direct invasive FFR comparison in 110 coronary vessels of the diabetic group and in 415 coronary vessels of the nondiabetic group. Per-vessel discrimination of lesion-specific ischemia by CT-FFR was assessed by the area under the receiver operating characteristic curves. The overall diagnostic accuracy of CT-FFR in diabetic patients was 83% and in nondiabetic patients 75% (p = 0.088), showing improvement over the diagnostic accuracy of coronary CT angiography, which was 58% and 65% (p = 0.223), respectively. In addition, the diagnostic accuracy of CT-FFR was similar between diabetic and nondiabetic patients per stratified CT-FFR group (CT-FFR < 0.6, 0.6 to 0.69, 0.7 to 0.79, 0.8 to 0.89, ≥0.9). The area under the curves for diabetic and nondiabetic patients were also comparable, 0.88 and 0.82 (p = 0.113), respectively. In conclusion, on-site machine-learning CT-FFR analysis improved the diagnostic performance of coronary CT angiography and accurately discriminated lesion-specific ischemia in both diabetic and nondiabetic patients suspected of coronary artery disease.
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Affiliation(s)
- Fay M A Nous
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Adriaan Coenen
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mariusz B P Kruk
- Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland
| | - Christian Tesche
- Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jakob de Geer
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina
| | - Anders Persson
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Akira Kurata
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Koen Nieman
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Stanford University School of Medicine, Cardiovascular Institute, Stanford, California
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9
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Outcomes in Patients with Diabetes Mellitus According to Insulin Treatment After Percutaneous Coronary Intervention in the Second-Generation Drug-Eluting Stent Era. Am J Cardiol 2018; 121:1505-1511. [PMID: 29751955 DOI: 10.1016/j.amjcard.2018.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022]
Abstract
Limited data exist regarding the clinical outcomes of patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES), especially according to DM treatment. The purpose of this study was to compare clinical outcomes among patients without DM, with non-insulin-treated DM (non-ITDM), and with ITDM after PCI using second-generation DES. We analyzed 4,812 consecutive patients who underwent PCI using second-generation DES. Primary outcomes were patient-oriented composite outcome (a composite of all-cause mortality, any myocardial infarction, and any revascularization) at 3 years. Among the total population, 3,026 patients have no DM, 1,169 have non-ITDM, and 617 have ITDM. Patients with DM, regardless of non-ITDM and ITDM, showed significantly higher risk of patient-oriented composite outcome (21.0% vs 14.5%; adjusted hazard ratio [HRadj]1.41, 95% confidence interval [CI] 1.19 to 1.66, p <0.001), mainly driven by significantly higher risk of cardiac death and any revascularization compared with non-DM. Among DM population, ITDM showed significantly higher risk of cardiac death (7.7% vs 3.7%; HRadj 1.97, 95% CI 1.19 to 3.27, p = 0.009), any revascularization (17.0% vs 11.4%; HRadj 1.40, 95% CI 1.01 to 1.93, p = 0.041), and definite/probable stent thrombosis (1.7% vs 0.7%; HRadj 2.80, 95% CI 1.04 to 7.56, p = 0.042) compared with non-ITDM. In conclusion, even in the era of second-generation DES, patients with DM are at significantly higher risk of patient-oriented adverse events. Among these, patients with ITDM showed the highest risk of adverse events, mainly driven by higher risk of mortality, any revascularization, and definite/probable stent thrombosis.
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10
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Azizy O, Rammos C, Lehmann N, Rassaf T, Kälsch H. Percutaneous closure of the left atrial appendage in patients with diabetes mellitus. Diab Vasc Dis Res 2017; 14:407-414. [PMID: 28595459 DOI: 10.1177/1479164117712176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus. METHODS We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study. RESULTS Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHA2DS2-VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHA2DS2-VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p < 0.001 for both). Pre- and periprocedural risk was elevated in patients with diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p < 0.01; Society of Thoracic Surgeons (STS)-Score: 4.0 ± 2.5 vs 2.6 ± 1.2, p < 0.01). Procedural success was similar. Periprocedural major adverse cardiac and cerebrovascular events occurred in one patient from the control group (2.1%), whereas patients with diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672). CONCLUSION Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.
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Affiliation(s)
- Obayda Azizy
- 1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany
| | - Christos Rammos
- 1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- 2 Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- 1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany
| | - Hagen Kälsch
- 3 Department of Cardiology, Alfried Krupp Krankenhaus, Essen, Germany
- 4 Witten/Herdecke University, Witten, Germany
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11
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Badour SA, Dimitrova KR, Kanei Y, Tranbaugh RF, Hajjar MM, Kabour A, Schwann TA, Alam S, Badr K, Habib RH. First and second generation DESs reduce diabetes adverse effect on mortality and re-intervention in multivessel coronary disease: 9-Year analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:265-273. [PMID: 28314676 DOI: 10.1016/j.carrev.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Diabetes portends an increased risk of adverse early and late outcomes in patients undergoing PCI. In this study, we aimed to investigate if the adverse effect of diabetes mellitus (DM) on early and late PCI outcomes is reduced with drug-eluting (DES) compared to bare-metal (BMS) stents. METHODS/MATERIALS We reviewed the Mount Sinai Beth Israel Hospital first PCI experience for multivessel coronary artery disease (CAD, 1998-2009). Patients were excluded if they had single-vessel CAD, emergency, no stent, prior bypass graft or myocardial infarction <24h. Diabetes-effect was derived from 9-year all-cause mortality and re-intervention risk-adjusted hazard ratios [AHR (95% confidence intervals)] for DES (N=2679; 48% three-vessel; 39% DM) and BMS (N=2651; 40% three-vessel; 33% DM) and then stratified based on stent (DES/BMS) and vessel disease (two/three). RESULTS Diabetes-effect on mortality was lower for DES (AHRDM/NoDM=1.41 [1.14-1.74]) versus BMS (AHRDM/NoDM=1.71 [1.50-2.01]), but this was predominantly driven by two-vessel patients. This diabetes effect was similar for first (DES1: AHRDM/NoDM=1.43 [1.14-1.79]) and second (DES2: AHRDM/NoDM=1.53 [0.77-3.07]) generation DES. Re-intervention comparisons were similarly increased by diabetes in all sub-cohorts. CONCLUSIONS Our analysis of a large real-world PCI series indicates that diabetes is associated with worse 9-year mortality irrespective of stent type, albeit this is mitigated to varying degrees with DES, particularly in DES2 and in case of 2-vessel disease. A complementary stent-effect analysis confirmed DES-to-BMS and DES2-to-DES1 superiority in both diabetics and non-diabetics.
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Affiliation(s)
- Sanaa A Badour
- Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon
| | - Kamellia R Dimitrova
- Divisions of Cardiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Yumiko Kanei
- Cardiothoracic Surgery, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Robert F Tranbaugh
- Divisions of Cardiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Mark M Hajjar
- Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon
| | - Ameer Kabour
- Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine, Toledo, OH, USA
| | - Samir Alam
- Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon
| | - Kamal Badr
- Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon
| | - Robert H Habib
- Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon.
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Second-generation versus first-generation drug-eluting stents in patients with and without diabetes mellitus: pooled analysis from the RESET and NEXT trials. Cardiovasc Interv Ther 2017; 33:125-134. [PMID: 28150119 DOI: 10.1007/s12928-017-0458-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
The impact of second-generation drug-eluting stent (G2-DES) implantations compared with first-generation drug-eluting stents (G1-DES) implantations on long-term clinical outcomes after percutaneous coronary intervention in patients with and without diabetes mellitus (DM) has not yet been adequately assessed. This pooled analysis compared 3-year clinical outcomes between G1- and G2-DES according to the presence or absence of DM, using individual patient-level data from the RESET and NEXT trials. Among 6431 patients, G1-DES and G2-DES were used in 713 and 2211 patients, respectively, in the DM stratum, and 887 and 2620 patients, respectively, in the non-DM stratum. Cumulative incidence of and adjusted hazard ratio (HR) for target-lesion revascularization (TLR) were not significantly different between G2- and G1-DES in both strata [DM, 8.7 versus 10.1%, adjusted HR: 0.80, 95% confidence interval (CI) 0.59-1.10, P = 0.17; non-DM, 5.7 versus 6.2%, adjusted HR: 0.86, 95% CI 0.62-1.22, P = 0.38]. In the insulin-treated DM (ITDM), G2-DES had a significantly lower adjusted HR for TLR compared with G1-DES, although there was no significant difference in the non-ITDM (ITDM, adjusted HR: 0.54, 95% CI 0.32-0.96, P = 0.04; non-ITDM, adjusted HR: 0.95, 95% CI 0.66-1.42, P = 0.81). G2-DES provided similar risk for TLR in non-ITDM and non-DM patients compared with G1-DES. However, G2-DES compared with G1-DES had a lower risk for TLR among ITDM patients.
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13
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Noman A, Balasubramaniam K, Alhous MHA, Lee K, Jesudason P, Rashid M, Mamas MA, Zaman AG. Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus. Catheter Cardiovasc Interv 2016; 89:1195-1204. [PMID: 28029209 PMCID: PMC5484298 DOI: 10.1002/ccd.26882] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 10/13/2016] [Accepted: 11/13/2016] [Indexed: 12/13/2022]
Abstract
Objectives To assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency). Background DM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI. Methods Retrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011. Results About 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings. Conclusion In the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Awsan Noman
- Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | | | - M Hafez A Alhous
- Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Kelvin Lee
- Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Peter Jesudason
- Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, United Kingdom
| | - Mamas A Mamas
- Cardiovascular Institute, Manchester University, Manchester, United Kingdom.,Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, United Kingdom
| | - Azfar G Zaman
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.,Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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Kereiakes DJ, Ellis SG, Kimura T, Abizaid A, Zhao W, Veldhof S, Vu MT, Zhang Z, Onuma Y, Chevalier B, Serruys PW, Stone GW. Efficacy and Safety of the Absorb Everolimus-Eluting Bioresorbable Scaffold for Treatment of Patients With Diabetes Mellitus: Results of the Absorb Diabetic Substudy. JACC Cardiovasc Interv 2016; 10:42-49. [PMID: 28017311 DOI: 10.1016/j.jcin.2016.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study sought to evaluate the efficacy and safety of the Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) (Abbott Vascular, Abbott Park, Illinois) in patients with diabetes mellitus. BACKGROUND Randomized, controlled trials have demonstrated comparable clinical outcomes following percutaneous coronary intervention with either Absorb BVS or metallic Xience everolimus-eluting stent. However, these trials lack power required to provide reliable treatment effect estimates in this high-risk population. METHODS In a pre-specified, powered analysis, patients with diabetes who received ≥1 Absorb were pooled from the ABSORB II, III, and JAPAN randomized trials and from the single arm ABSORB EXTEND registry. The study composite primary endpoint was target lesion failure (TLF) at 1 year following Absorb BVS compared with a performance goal of 12.7%. RESULTS Among 754 diabetic patients included in analysis (27.3% insulin treated), the 1-year TLF rate was 8.3% (upper 1-sided 95% confidence limit: 10.1%; p = 0.0001 vs. performance goal). Scaffold thrombosis (definite or probable) was observed in 2.3% of patients. Multivariable regression identified older age, insulin treatment, and smaller pre-procedure reference vessel diameter as significant independent predictors of 1-year TLF. CONCLUSIONS The Absorb diabetic substudy suggests efficacy and safety of the Absorb BVS for treatment of patients with diabetes mellitus.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, The Lindner Research Center, Cincinnati, Ohio.
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | - Zhen Zhang
- Abbott Vascular, Santa Clara, California
| | | | | | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, United Kingdom
| | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
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15
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Hillegass WB. Insulin-treated diabetes mellitus: An important, actionable risk marker after coronary stenting. Catheter Cardiovasc Interv 2016; 87:63-4. [PMID: 27410954 DOI: 10.1002/ccd.26385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/05/2015] [Indexed: 11/11/2022]
Abstract
Insulin treatment for diabetes is a simple but important risk marker for doubled adjusted death and myocardial infarction rates and tripled stent thrombosis risk after coronary stenting. Insulin treatment does not predict meaningfully increased major bleeding or additional revascularization procedures after drug eluting coronary stent implantation. Third generation P2 Y12 receptor antagonists substantially lower risk of events in diabetics after stenting with insulin treated diabetics having twice the magnitude of benefit of diabetics not needing insulin.
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Affiliation(s)
- William B Hillegass
- Heart South Cardiovascular Group, Department of Biostatistics, University of Alabama at Birmingham, Alabaster and Birmingham, Alabama
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16
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Hillegass WB. Diabetes is not sufficient justification for IIb/IIIa use in percutaneous coronary intervention. Catheter Cardiovasc Interv 2015; 86:376-7. [PMID: 26276231 DOI: 10.1002/ccd.26130] [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: 07/09/2015] [Accepted: 07/11/2015] [Indexed: 11/05/2022]
Abstract
Diabetics, particularly insulin treated, have increased risk of ischemic events and bleeding with percutaneous coronary intervention (PCI). The relative risk of atherothrombotic versus bleeding events is higher in diabetics than non-diabetics. Bivalirudin with provisional IIb/IIIa therapy has less bleeding and lower one-year mortality than routine IIb/IIIa therapy in diabetics undergoing PCI. IIb/IIIa agents should be reserved for provisional and niche applications during PCI.
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Affiliation(s)
- William B Hillegass
- Heath South Cardiovascular Group, Alabaster, Alabama.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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17
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Stam-Slob MC, van der Graaf Y, de Borst GJ, Cramer MJ, Kappelle LJ, Westerink J, Visseren FL. Effect of Type 2 Diabetes on Recurrent Major Cardiovascular Events for Patients With Symptomatic Vascular Disease at Different Locations. Diabetes Care 2015; 38:1528-35. [PMID: 26038582 DOI: 10.2337/dc14-2900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/07/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our aim is to compare the effect of type 2 diabetes on recurrent major cardiovascular events (MCVE) for patients with symptomatic vascular disease at different locations. RESEARCH DESIGN AND METHODS A total of 6,841 patients from the single-center, prospective Second Manifestations of ARTerial disease (SMART) cohort study from Utrecht, the Netherlands, with clinically manifest vascular disease with (n = 1,155) and without (n = 5,686) type 2 diabetes were monitored between 1996 and 2013. The effect of type 2 diabetes on recurrent MCVE was analyzed with Cox proportional hazards models, stratified for disease location (cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm, coronary artery disease, or polyvascular disease, defined as ≥2 vascular locations). RESULTS Five-year risks for recurrent MCVE were 9% in cerebrovascular disease, 9% in peripheral artery disease, 20% in those with an abdominal aortic aneurysm, 7% in coronary artery disease, and 21% in polyvascular disease. Type 2 diabetes increased the risk of recurrent MCVE in coronary artery disease (hazard ratio [HR] 1.67; 95% CI 1.25-2.21) and seemed to increase the risk in cerebrovascular disease (HR 1.36; 95% CI 0.90-2.07), while being no risk factor in polyvascular disease (HR 1.12; 95% CI 0.83-1.50). Results for patients with peripheral artery disease (HR 1.42; 95% CI 0.79-2.56) or an abdominal aortic aneurysm (HR 0.93; 95% CI 0.23-3.68) were inconclusive. CONCLUSIONS Type 2 diabetes increased the risk of recurrent MCVE in patients with coronary artery disease, but there is no convincing evidence that it is a major risk factor for subsequent MCVE in all patients with symptomatic vascular disease.
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Affiliation(s)
- Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L J Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Hillegass WB, Brott BC. Percutaneous coronary intervention: ever closer to real world silver bullets!? Catheter Cardiovasc Interv 2015; 85:807-8. [PMID: 25789729 DOI: 10.1002/ccd.25885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 11/10/2022]
Abstract
Bare metal and early drug eluting stents have not meaningfully reduced subsequent rates of death and myocardial infarction compared to balloon angioplasty. Second generation drug eluting stents are associated with meaningful reductions in death and myocardial infarction compared to first generation drug eluting stents.
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Affiliation(s)
- William B Hillegass
- Interventional Cardiovascular Section, Heart South Cardiovascular Group, Alabaster, Alabama; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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Hillegass WB, Brott BC. Optimal DAPT duration: each in their own time. Catheter Cardiovasc Interv 2015; 85:41-2. [PMID: 25521927 DOI: 10.1002/ccd.25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/09/2022]
Affiliation(s)
- William B Hillegass
- Heart South Cardiovascular Group, Alabaster, AL and University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Hellhammer K, Zeus T, Balzer J, van Hall S, Rammos C, Wagstaff R, Kelm M, Rassaf T. Safety and efficacy of percutaneous mitral valve repair using the MitraClip® system in patients with diabetes mellitus. PLoS One 2014; 9:e111178. [PMID: 25375257 PMCID: PMC4222883 DOI: 10.1371/journal.pone.0111178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/22/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with diabetes mellitus show a negative outcome in percutaneous coronary intervention, aortic valve replacement and cardiac surgery. The impact of diabetes on patients undergoing treatment of severe mitral regurgitation (MR) using the MitraClip system is not known. We therefore sought to assess whether percutaneous mitral valve repair with the MitraClip system is safe and effective in patients with diabetes mellitus. METHODS AND RESULTS We included 58 patients with severe and moderate-to-severe MR in an open-label observational single-center study. Ninteen patients were under oral medication or insulin therapy for type II diabetes mellitus. MitraClip devices were successfully implanted in all patients with diabetes and in 97.4% (n = 38) of patients without diabetes (p = 0.672). Periprocedural major cardiac adverse and cerebrovascular events (MACCE) occurred in 5.1% (n = 2) of patients without diabetes whereas patients with diabetes did not show any MACCE (p = 0.448). 30-day mortality was 1.7% (n = 1) with no case of death in the diabetes group. Short-term follow up of three months showed a significant improvement of NYHA class and quality of life evaluated by the Minnesota Living with Heart Failure Questionnaire in both groups, with no changes in the 6-minute walk test. CONCLUSIONS Mitral valve repair with the MitraClip system is safe and effective in patients with type II diabetes mellitus. TRIAL REGISTRATION MitraClip Registry NCT02033811.
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Affiliation(s)
- Katharina Hellhammer
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Jan Balzer
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Silke van Hall
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Christos Rammos
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Rabea Wagstaff
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Malte Kelm
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Tienush Rassaf
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
- * E-mail:
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Dangas GD, Farkouh ME, Sleeper LA, Yang M, Schoos MM, Macaya C, Abizaid A, Buller CE, Devlin G, Rodriguez AE, Lansky AJ, Siami FS, Domanski M, Fuster V. Long-Term Outcome of PCI Versus CABG in Insulin and Non–Insulin-Treated Diabetic Patients. J Am Coll Cardiol 2014; 64:1189-97. [DOI: 10.1016/j.jacc.2014.06.1182] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 05/14/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
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Sharma PK, Agarwal S, Ellis SG, Goel SS, Cho L, Tuzcu EM, Lincoff AM, Kapadia SR. Association of Glycemic Control With Mortality in Patients With Diabetes Mellitus Undergoing Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2014; 7:503-9. [DOI: 10.1161/circinterventions.113.001107] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Praneet K. Sharma
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - Shikhar Agarwal
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - Stephen G. Ellis
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - Sachin S. Goel
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - Leslie Cho
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - E. Murat Tuzcu
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - A. Michael Lincoff
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
| | - Samir R. Kapadia
- From the Department of Interventional Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.)
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Ndrepepa G, Schulz S, Neumann FJ, Laugwitz KL, Richardt G, Byrne RA, Pöhler A, Kastrati A, Pache J. Prognostic value of bleeding after percutaneous coronary intervention in patients with diabetes. EUROINTERVENTION 2014; 10:83-9. [DOI: 10.4244/eijv10i1a14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lopez-de-Andres A, Jimenez-García R, Hernandez-Barrera V, Perez-Farinos N, de Miguel-Yanes JM, Mendez-Bailon M, Jimenez-Trujillo I, de Miguel AG, Pino CG, Carrasco-Garrido P. National trends in utilization and outcomes of coronary revascularization procedures among people with and without type 2 diabetes in Spain (2001-2011). Cardiovasc Diabetol 2014; 13:3. [PMID: 24383412 PMCID: PMC3881504 DOI: 10.1186/1475-2840-13-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/18/2013] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Diabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011. METHODS We identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index). RESULTS From 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00).Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes. CONCLUSIONS The annual percent change in PCI procedures increased in diabetic and non-diabetic patients. Higher comorbidity and the female gender are associated with a higher IHM in PCI procedures. In diabetic and non-diabetic patients, we found a decrease in the use of CABG procedures. IHM was higher in patients without diabetes than in those with diabetes.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Rodrigo Jimenez-García
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Napoleon Perez-Farinos
- Agencia Española de Seguridad Alimentaria y Nutrición, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain
| | | | | | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Angel Gil de Miguel
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Carmen Gallardo Pino
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Layland J, Judkins C, Palmer S, Whitbourn R, Wilson-O'Brien A, MacIsaac A, Wilson A. The resting status of the coronary microcirculation is a predictor of microcirculatory function following elective PCI for stable angina. Int J Cardiol 2013; 169:121-5. [DOI: 10.1016/j.ijcard.2013.08.092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/12/2013] [Accepted: 08/29/2013] [Indexed: 11/24/2022]
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Hillegass WB. Stent paleology: diabetic lessons from extinct stents. Catheter Cardiovasc Interv 2013; 81:1125-6. [PMID: 23704065 DOI: 10.1002/ccd.24963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/13/2013] [Indexed: 11/09/2022]
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