1
|
Song L, Li Y, Nie S, Feng Z, Liu Y, Ding F, Gong L, Liu L, Yang G. Using machine learning to predict adverse events in acute coronary syndrome: A retrospective study. Clin Cardiol 2023; 46:1594-1602. [PMID: 37654030 PMCID: PMC10716319 DOI: 10.1002/clc.24127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Up to 30% of patients with acute coronary syndrome (ACS) die from adverse events, mainly renal failure and myocardial infarction (MI). Accurate prediction of adverse events is therefore essential to improve patient prognosis. HYPOTHESIS Machine learning (ML) methods can accurately identify risk factors and predict adverse events. METHODS A total of 5240 patients diagnosed with ACS who underwent PCI were enrolled and followed for 1 year. Support vector machine, extreme gradient boosting, adaptive boosting, K-nearest neighbors, random forest, decision tree, categorical boosting, and linear discriminant analysis (LDA) were developed with 10-fold cross-validation to predict acute kidney injury (AKI), MI during hospitalization, and all-cause mortality within 1 year. Features with mean Shapley Additive exPlanations score >0.1 were screened by XGBoost method as input for model construction. Accuracy, F1 score, area under curve (AUC), and precision/recall curve were used to evaluate the performance of the models. RESULTS Overall, 2.6% of patients died within 1 year, 4.2% had AKI, and 4.7% had MI during hospitalization. The LDA model was superior to the other seven ML models, with an AUC of 0.83, F1 score of 0.90, accuracy of 0.85, recall of 0.85, specificity of 0.68, and precision of 0.99 in predicting all-cause mortality. For AKI and MI, the LDA model also showed good discriminating capacity with an AUC of 0.74. CONCLUSION The LDA model, using easily accessible variables from in-hospital patients, showed the potential to effectively predict the risk of adverse events and mortality within 1 year in ACS patients after PCI.
Collapse
Affiliation(s)
- Long Song
- Department of Cardiovascular SurgeryThe Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Yuan Li
- Xiangya School of Pharmaceutical SciencesCentral South UniversityChangshaHunanChina
| | - Shanshan Nie
- Center of Clinical Pharmacology, The Third Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Zeying Feng
- Xiangya School of Pharmaceutical SciencesCentral South UniversityChangshaHunanChina
| | - Yaxin Liu
- Xiangya School of Pharmaceutical SciencesCentral South UniversityChangshaHunanChina
| | - Fangfang Ding
- Center of Clinical Pharmacology, The Third Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Liying Gong
- Department of Intensive Care UnitThe Third Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Liming Liu
- Department of Cardiovascular SurgeryThe Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Guoping Yang
- Xiangya School of Pharmaceutical SciencesCentral South UniversityChangshaHunanChina
- Center of Clinical Pharmacology, The Third Xiangya HospitalCentral South UniversityChangshaHunanChina
| |
Collapse
|
2
|
Zhao YJ, Sun Y, Wang F, Cai YY, Alolga RN, Qi LW, Xiao P. Comprehensive evaluation of time-varied outcomes for invasive and conservative strategies in patients with NSTE-ACS: a meta-analysis of randomized controlled trials. Front Cardiovasc Med 2023; 10:1197451. [PMID: 37745128 PMCID: PMC10516546 DOI: 10.3389/fcvm.2023.1197451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Background Results from randomized controlled trials (RCTs) and meta-analyses comparing invasive and conservative strategies in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are highly debatable. We systematically evaluate the efficacy of invasive and conservative strategies in NSTE-ACS based on time-varied outcomes. Methods The RCTs for the invasive versus conservative strategies were identified by searching PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov. Trial data for studies with a minimum follow-up time of 30 days were included. We categorized the follow-up time into six varied periods, namely, ≤6 months, 1 year, 2 years, 3 years, 5 years, and ≥10 years. The time-varied outcomes were major adverse cardiovascular event (MACE), death, myocardial infarction (MI), rehospitalization, cardiovascular death, bleeding, in-hospital death, and in-hospital bleeding. Risk ratios (RRs) and 95% confidence intervals (Cis) were calculated. The random effects model was used. Results This meta-analysis included 30 articles of 17 RCTs involving 12,331 participants. We found that the invasive strategy did not provide appreciable benefits for NSTE-ACS in terms of MACE, death, and cardiovascular death at all time points compared with the conservative strategy. Although the risk of MI was reduced within 6 months (RR 0.80, 95% CI 0.68-0.94) for the invasive strategy, no significant differences were observed in other periods. The invasive strategy reduced the rehospitalization rate within 6 months (RR 0.69, 95% CI 0.52-0.90), 1 year (RR 0.73, 95% CI 0.63-0.86), and 2 years (RR 0.77, 95% CI 0.60-1.00). Of note, an increased risk of bleeding (RR 1.80, 95% CI 1.28-2.54) and in-hospital bleeding (RR 2.17, 95% CI 1.52-3.10) was observed for the invasive strategy within 6 months. In subgroups stratified by high-risk features, the invasive strategy decreased MACE for patients aged ≥65 years within 6 months (RR 0.68, 95% CI 0.58-0.78) and 1 year (RR 0.75, 95% CI 0.62-0.91) and showed benefits for men within 6 months (RR 0.71, 95% CI 0.55-0.92). In other subgroups stratified according to diabetes, ST-segment deviation, and troponin levels, no significant differences were observed between the two strategies. Conclusions An invasive strategy is superior to a conservative strategy in reducing early events for MI and rehospitalizations, but the invasive strategy did not improve the prognosis in long-term outcomes for patients with NSTE-ACS. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289579, identifier PROSPERO 2021 CRD42021289579.
Collapse
Affiliation(s)
- Yi-Jing Zhao
- State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
- The Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
| | - Yangyang Sun
- Department of Pharmacy, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fan Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yuan-Yuan Cai
- The Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
| | - Raphael N. Alolga
- State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
- The Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
| | - Lian-Wen Qi
- The Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- College of Traditional Chinese Medicine and Food Engineering, Shanxi University of Chinese Medicine, Taiyuan, China
| | - Pingxi Xiao
- Department of Cardiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Liu N, Lyu J, Wang H, Sun Y, Zhang S, Lin H, Wang Y, Yang X, Ma S, Han N, Mi Y, Zheng D, Yang Z, Zhang H, Jiang Y, Ji Y, Ma L. Weekly Weight Gain in Women with Gestational Diabetes Mellitus and Neonatal Birth Weight - China, 2011-2021. China CDC Wkly 2023; 5:703-709. [PMID: 37614909 PMCID: PMC10442697 DOI: 10.46234/ccdcw2023.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023] Open
Abstract
What is already known about this topic? Elevated gestational weight gain (GWG) during pregnancy among women diagnosed with gestational diabetes mellitus (GDM) is correlated with an increased instance of large for gestational age (LGA) and macrosomia. However, it remains uncertain whether managing weekly GWG following a GDM diagnosis positively impacts fetal birth weight. What is added by this report? Our study found that GWG following GDM diagnosis correlates positively with the risk of LGA and macrosomia among all body mass index (BMI) subgroups, especially for overweight and obese women. What are the implications for public health practice? The results of this research highlight the importance of enforcing a more stringent regulation on GWG on a weekly basis for overweight and obese women diagnosed with GDM, particularly when considering neonatal growth.
Collapse
Affiliation(s)
- Nana Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jinlang Lyu
- Peking University School of Public Health, Beijing, China
| | - Haijun Wang
- Peking University School of Public Health, Beijing, China
| | - Yin Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Suhan Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Hang Lin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yaxin Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xuanjin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Shuai Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Na Han
- Beijing Tongzhou Maternal and Child Health Hospital, Beijing, China
| | - Yang Mi
- Northwest Women’s and Children Hospital, Xi’an City, Shaanxi Province, China
| | - Dan Zheng
- Guiyang Maternal and Child Health Hospital, Guiyang City, Guizhou , China
| | - Zhifen Yang
- The Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Hongping Zhang
- Wenzhou People’s Hospital, Wenzhou City, Zhejiang Province, China
| | - Yan Jiang
- Dong E County People’s Hospital, Liaocheng City, Shandong Province, China
| | - Yuelong Ji
- Peking University School of Public Health, Beijing, China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| |
Collapse
|
4
|
Hwang SY, Kim SH, Uhm IA, Shin JH, Lim YH. Prognostic implications for patients after myocardial infarction: an integrative literature review and in-depth interviews with patients and experts. BMC Cardiovasc Disord 2022; 22:348. [PMID: 35918641 PMCID: PMC9344648 DOI: 10.1186/s12872-022-02753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background As patients with myocardial infarction (MI) survive for a long time after acute treatment, it is necessary to pay attention to the prevention of poor prognosis such as heart failure (HF). To identify the influencing factors of adverse clinical outcomes through a review of prospective cohort studies of post-MI patients, and to draw prognostic implications through in-depth interviews with post-MI patients who progressed to HF and clinical experts. Methods A mixed-method design was used that combined a scoping review of 21 prospective cohort studies, in-depth interviews with Korean post-MI patients with HF, and focus group interviews with cardiologists and nurses. Results A literature review showed that old age, diabetes, high Killip class, low left ventricular ejection fraction, recurrent MI, comorbidity of chronic disease and current smoking, and low socioeconomic status were identified as influencing factors of poor prognosis. Through interviews with post-MI patients, these influencing factors identified in the literature as well as a lack of disease awareness and lack of self-care were confirmed. Experts emphasized the importance of maintaining a healthy lifestyle after acute treatment with the recognition that it is a chronic disease that must go together for a lifetime. Conclusion This study confirmed the factors influencing poor prognosis after MI and the educational needs of post-MI patients with transition to HF. Healthcare providers should continue to monitor the risk group, which is expected to have a poor prognosis, along with education emphasizing the importance of self-care such as medication and lifestyle modification.
Collapse
Affiliation(s)
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, 222-1 Wangsimniro, Seondong-gu, Seoul, 04763, South Korea.
| | - In Ae Uhm
- School of Nursing, Hanyang University, Seoul, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Gyeonggi-do, South Korea
| | - Young-Hyo Lim
- Division of Cardiology Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea.
| |
Collapse
|
5
|
Jomaa W, Benabdeljelil O, Chamtouri I, Abdallah W, Ben Hamda K, Maatouk F. Long-term predictors of death among Tunisian patients presenting for non ST-elevation acute coronary syndrome. LA TUNISIE MEDICALE 2022; 99:744-750. [PMID: 35261006 PMCID: PMC8796684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in emerging countries. Contemporary data about clinical profile and prognosis in Tunisian patients presenting for non ST-elevation acute coronary syndrome (NSTE-ACS) are lacking. AIM We sought to study the risk profile and 3-year mortality predictors in Tunisian patients presenting for NSTE-ACS in the contemporary setting. METHODS In this single center study, data about all consecutive patients presenting to our center for NSTE-ACS from April 2014 to July 2016 were extracted and outcomes exhaustively updated. 3-year mortality predictors were determined by multivariable survival analysis. RESULTS A total of 340 patients were included, of which 204 (61.8%) were male. Mean age was 63.6 ± 10.3 years. Prevalence of diabetes mellitus, hypertension and smoking was 57.3%, 62.4%, and 45.3%, respectively. In-hospital, 6, 12 and 36-month mortality rate was 2.3%, 3.2%, 7.1% and 15.2%, respectively. In multivariable survival analysis, independent predictors of death were age >75 (HR=5.45, 95% CI: 2.9-10.03, p<0.001), ST-segment deviation (HR=1.86, 95% CI: 1.04-3.33, p=0.036), anemia (HR=2.56, 95% CI: 1.41-4.67, p=0.002), left ventricular ejection fraction (LVEF) <40% (HR=3.5, 95% CI: 1.84-6.67, p<0.001) and a Global Registry of Acute Coronary Events (GRACE) score ≥140 (HR=2.38, 95% CI: 1.02-5.57, p=0.044). CONCLUSION In Tunisian patients presenting for NSTE-ACS, long-term mortality was high. Advanced age, ST-segment deviation, anemia, LVEF <40% and a GRACE score ≥140 were independent long-term predictors of death.
Collapse
|
6
|
Tang Y, Bai Y, Chen Y, Sun X, Shi Y, He T, Jiang M, Wang Y, Wu M, Peng Z, Liu S, Jiang W, Lu Y, Yuan H, Cai J. Development and validation of a novel risk score to predict 5-year mortality in patients with acute myocardial infarction in China: a retrospective study. PeerJ 2022; 9:e12652. [PMID: 35036143 PMCID: PMC8740514 DOI: 10.7717/peerj.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The disease burden from ischaemic heart disease remains heavy in the Chinese population. Traditional risk scores for estimating long-term mortality in patients with acute myocardial infarction (AMI) have been developed without sufficiently considering advances in interventional procedures and medication. The goal of this study was to develop a risk score comprising clinical parameters and intervention advances at hospital admission to assess 5-year mortality in AMI patients in a Chinese population. METHODS We performed a retrospective observational study on 2,722 AMI patients between January 2013 and December 2017. Of these patients, 1,471 patients from Changsha city, Hunan Province, China were assigned to the development cohort, and 1,251 patients from Xiangtan city, Hunan Province, China, were assigned to the validation cohort. Forty-five candidate variables assessed at admission were screened using least absolute shrinkage and selection operator, stepwise backward regression, and Cox regression methods to construct the C2ABS2-GLPK score, which was graded and stratified using a nomogram and X-tile. The score was internally and externally validated. The C-statistic and Hosmer-Lemeshow test were used to assess discrimination and calibration, respectively. RESULTS From the 45 candidate variables obtained at admission, 10 potential predictors, namely, including Creatinine, experience of Cardiac arrest, Age, N-terminal Pro-Brain Natriuretic Peptide, a history of Stroke, Statins therapy, fasting blood Glucose, Left ventricular end-diastolic diameter, Percutaneous coronary intervention and Killip classification were identified as having a close association with 5-year mortality in patients with AMI and collectively termed the C2ABS2-GLPK score. The score had good discrimination (C-statistic = 0.811, 95% confidence intervals (CI) [0.786-0.836]) and calibration (calibration slope = 0.988) in the development cohort. In the external validation cohort, the score performed well in both discrimination (C-statistic = 0.787, 95% CI [0.756-0.818]) and calibration (calibration slope = 0.976). The patients were stratified into low- (≤148), medium- (149 to 218) and high-risk (≥219) categories according to the C2ABS2-GLPK score. The predictive performance of the score was also validated in all subpopulations of both cohorts. CONCLUSION The C2ABS2-GLPK score is a Chinese population-based risk assessment tool to predict 5-year mortality in AMI patients based on 10 variables that are routinely assessed at admission. This score can assist physicians in stratifying high-risk patients and optimizing emergency medical interventions to improve long-term survival in patients with AMI.
Collapse
Affiliation(s)
- Yan Tang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Bai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Chen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuejing Sun
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunmin Shi
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tian He
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengqing Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yujie Wang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Zhiliu Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Suzhen Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Lu
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hong Yuan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| |
Collapse
|
7
|
Watanabe N, Takagi K, Tanaka A, Yoshioka N, Morita Y, Yoshida R, Kanzaki Y, Nagai H, Yamauchi R, Komeyama S, Sugiyama H, Shimojo K, Imaoka T, Sakamoto G, Ohi T, Goto H, Okumura T, Ishii H, Morishima I, Murohara T. Ten-Year Mortality in Patients With ST-Elevation Myocardial Infarction. Am J Cardiol 2021; 149:9-15. [PMID: 33753036 DOI: 10.1016/j.amjcard.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 12/22/2022]
Abstract
Knowledge of the long-term prognosis (>10 years) and mortality predictors of ST-elevation myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (p-PCI) is scarce. Therefore, this study evaluated the long-term prognosis and determined the predictors of long-term outcomes for STEMI patients after p-PCI. Between January, 2006 and December, 2010, we collected data and analyzed 459 consecutive patients with acute STEMI who underwent p-PCI and were discharged from the hospital (mean age, 66.8 years; male, 75.2%; peak creatine phosphokinase level, 2,292.5 IU/L). The primary endpoint was 10-year all-cause mortality. The cumulative 10-year incidence of all-cause death was 23.8%. The Cox multivariate regression analysis identified age ≥ 65 years (adjusted hazard ratio [aHR], p <0.001), body mass index (aHR, 0.93, p = 0.033), presence of atrial fibrillation (aHR, 1.69, p = 0.038), mineralocorticoid receptor antagonist use (aHR, 1.95, p = 0.008), ejection fraction <40% (aHR, 2.14, p = 0.005), and albumin <3.5 g/dL (aHR, 2.01, p = 0.005) as independent predictors of all-cause mortality. In conclusion, a post-discharge 10-year survival rate of 76.2% was identified for STEMI patients who underwent p-PCI.
Collapse
|
8
|
Kim SH, Behnes M, Mashayekhi K, Bufe A, Meyer-Gessner M, El-Battrawy I, Akin I. Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction. J Clin Med 2021; 10:E258. [PMID: 33445664 PMCID: PMC7828144 DOI: 10.3390/jcm10020258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
Coronary chronic total occlusion (CTO) has gained increasing clinical attention as the most advanced form of coronary artery disease. Prior studies already indicated a clear association of CTO with adverse clinical outcomes, especially in patients with acute myocardial infarction (AMI) and concomitant CTO of the non-infarct-related coronary artery (non-IRA). Nevertheless, the prognostic impact of percutaneous coronary intervention (PCI) of CTO in the acute setting during AMI is still controversial. Due to the complexity of the CTO lesion, CTO-PCI leads to an increased risk of complications compared to non-occlusive coronary lesions. Therefore, this review outlines the prognostic impact of CTO-PCI in patients with AMI. In addition, the prognostic impact of periprocedural myocardial infarction caused by CTO-PCI will be discussed.
Collapse
Affiliation(s)
- Seung-Hyun Kim
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany;
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, 47805 Krefeld, Germany;
- University Witten/Herdecke, 58455 Witten, Germany
| | - Markus Meyer-Gessner
- Department of Cardiology and Intensive Care, Augusta Hospital, 40472 Düsseldorf, Germany;
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| |
Collapse
|
9
|
Li YM, Li ZL, Chen F, Liu Q, Peng Y, Chen M. A LASSO-derived risk model for long-term mortality in Chinese patients with acute coronary syndrome. J Transl Med 2020; 18:157. [PMID: 32252780 PMCID: PMC7137217 DOI: 10.1186/s12967-020-02319-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background The formal risk assessment is essential in the management of acute coronary syndrome (ACS). In this study, we develop a risk model for the prediction of 3-year mortality for Chinese ACS patients with machine learning algorithms. Methods A total of 2174 consecutive patients who underwent angiography with ACS were enrolled. The missing data among baseline characteristics were imputed using the MissForest algorithm based on random forest method. In model development, a least absolute shrinkage and selection operator (LASSO) derived Cox regression with internal tenfold cross-validation was used to identify the predictors for 3-year mortality. The clinical performance was assessed with decision curve analysis. Results The average follow-up period was 27.82 ± 13.73 months; during the 3 years of follow up, 193 patients died (mortality rate 8.88%). The Kaplan–Meier estimate of 3-year mortality was 0.91 (95% confidence interval (CI): 0.890.92). After feature selection, 6 predictors were identified: Age,” “Creatinine,” “Hemoglobin,” “Platelets,” “aspartate transaminase (AST)” and “left ventricular ejection fraction (LVEF)”. At tenfold internal validation, our risk model performed well in both discrimination (area under curve (AUC) of receiver operating characteristic (ROC) analysis was 0.768) and calibration (calibration slope was approximately 0.711). As a comparison, the AUC and calibration slope were 0.701 and 0.203 in Global Registry of Acute Coronary Events (GRACE) risk score, respectively. Additionally, the highest net benefit of our model within the entire range of threshold probability for clinical intervention by decision curve analysis demonstrated the superiority of it in daily practice. Conclusion Our study developed a prediction model for 3-year morality in Chinese ACS patients. The methods of missing data imputation and model derivation base on machine learning algorithms improved the ability of prediction. . Trial registration ChiCTR, ChiCTR-OOC-17010433. Registered 17 February 2017–Retrospectively registered
Collapse
Affiliation(s)
- Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Zhuo-Lun Li
- Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, USA
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Qi Liu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
| |
Collapse
|
10
|
Peteiro J, Bouzas-Mosquera A. Is there a role for ischemia detection after an acute myocardial infarction? World J Cardiol 2020; 12:1-6. [PMID: 31984123 PMCID: PMC6952723 DOI: 10.4330/wjc.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/27/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023] Open
Abstract
Coronary angiography and eventual revascularization have become the most common approaches for patients with acute coronary syndromes. Ischemia detection in this scenario is usually regarded as unnecessary for most of the patients. In fact, current guidelines recommend complete revascularization for patients with multivessel disease in the context of ST-elevation myocardial infarction, although it is in contrast with previous recommendations. However, some recent data suggested that ischemia could have a role for the decision of revascularization in these patients. The CROSS-AMI study randomized patients with ST-elevation myocardial infarction treated with primary angioplasty and who also had multivessel disease to a complete anatomic revascularization of the non-infarct related artery lesions vs subsequent revascularization of the non-infarct related artery lesions only if ischemia was demonstrated by stress echocardiography. The main findings were that only 30% of the patients in the ischemia arm needed a second revascularization and that the outcome was similar in both arms. Regarding non-ST-elevation acute coronary syndrome, coronary angiography is in general warranted for most of the patients. However, recent long-term published studies on patients randomized to an invasive or less aggressive approach based on ischemia detection have found no differences in outcome. The ultimate study in non-ST-elevation acute coronary syndrome comparing ischemia detection with an invasive approach is pending. Therefore, ischemia detection might have a role for stratifying these subjects. This is particularly true in the current era of imaging of high quality and sensitivity, last generation stents, radial access and modern antithrombotic therapy.
Collapse
Affiliation(s)
- Jesus Peteiro
- Unit of Echocardiography and Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), CIVER-CV, University of A Coruña, A Coruña 15004, Spain
| | - Alberto Bouzas-Mosquera
- Unit of Echocardiography and Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), CIVER-CV, University of A Coruña, A Coruña 15004, Spain
| |
Collapse
|
11
|
Hall M, Bebb OJ, Dondo TB, Yan AT, Goodman SG, Bueno H, Chew DP, Brieger D, Batin PD, Farkouh ME, Hemingway H, Timmis A, Fox KAA, Gale CP. Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction. Eur Heart J 2019; 39:3798-3806. [PMID: 30202849 PMCID: PMC6220125 DOI: 10.1093/eurheartj/ehy517] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/13/2018] [Indexed: 01/06/2023] Open
Abstract
Aims To investigate whether improved survival from non-ST-elevation myocardial infarction (NSTEMI), according to GRACE risk score, was associated with guideline-indicated treatments and diagnostics, and persisted after hospital discharge. Methods and results National cohort study (n = 389 507 patients, n = 232 hospitals, MINAP registry), 2003–2013. The primary outcome was adjusted all-cause survival estimated using flexible parametric survival modelling with time-varying covariates. Optimal care was defined as the receipt of all eligible treatments and was inversely related to risk status (defined by the GRACE risk score): 25.6% in low, 18.6% in intermediate, and 11.5% in high-risk NSTEMI. At 30 days, the use of optimal care was associated with improved survival among high [adjusted hazard ratio (aHR) −0.66 95% confidence interval (CI) 0.53–0.86, difference in absolute mortality rate (AMR) per 100 patients (AMR/100–0.19 95% CI −0.29 to −0.08)], and intermediate (aHR = 0.74, 95% CI 0.62–0.92; AMR/100 = −0.15, 95% CI −0.23 to −0.08) risk NSTEMI. At the end of follow-up (8.4 years, median 2.3 years), the significant association between the use of all eligible guideline-indicated treatments and improved survival remained only for high-risk NSTEMI (aHR = 0.66, 95% CI 0.50–0.96; AMR/100 = −0.03, 95% CI −0.06 to −0.01). For low-risk NSTEMI, there was no association between the use of optimal care and improved survival at 30 days (aHR = 0.92, 95% CI 0.69–1.38) and at 8.4 years (aHR = 0.71, 95% CI 0.39–3.74). Conclusion Optimal use of guideline-indicated care for NSTEMI was associated with greater survival gains with increasing GRACE risk, but its use decreased with increasing GRACE risk.
Collapse
Affiliation(s)
- Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK
| | - Owen J Bebb
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK.,Cardiology Department, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, UK
| | - Tatandashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK
| | - Andrew T Yan
- Department of Medicine, Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada
| | - Shaun G Goodman
- Department of Medicine, Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle de Melchor Fernandez Almagro, 3, s/n, Madrid, Spain.,Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, s/n, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramon y Cajal, s/n, Madrid, Spain
| | - Derek P Chew
- Cardiology Department, Flinders Medical Centre and Flinders University, Flinders Drive, Bedford Park, Adelaide, SA, Australia
| | - David Brieger
- Cardiology Department, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW, Australia
| | - Philip D Batin
- Cardiology Department, The Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, UK
| | - Michel E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, David Naylor Building, 6 Queen's Park Cres W, Toronto, Ontario, Canada
| | - Harry Hemingway
- Research Department of Clinical Epidemiology, The Farr Institute of Health Informatics Research, University College London, 222 Euston Road, Kings Cross, London, UK.,The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, 170 Tottenham Court Road, London, UK
| | - Adam Timmis
- Cardiology Department, Barts Health Centre, Queen Mary University, W Smithfield, London, UK
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Old College South Bridge, Edinburgh, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK.,Cardiology Department, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, UK
| |
Collapse
|
12
|
Nakachi T, Fukui K, Kato S, Kamimura D, Kosuge M, Kimura K, Tamura K. Impact of the Temporal Distribution of Coronary Artery Disease Progression on Subsequent Consequences in Patients with Acute Coronary Syndrome. Int Heart J 2019; 60:287-295. [PMID: 30745543 DOI: 10.1536/ihj.18-394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The late consequences of acute coronary syndrome (ACS) have been underestimated. We hypothesized that the temporal distribution of the clinically silent coronary artery disease progression (CP) is associated with the subsequent consequences of ACS.We studied 243 patients (202 men, 64 ± 10 years) with ACS undergoing percutaneous coronary intervention (PCI) during initial hospitalization. All patients underwent serial coronary angiograms (CAGs) immediately before PCI and at 7 ± 3 and 60 ± 10 months after presentation. CP was defined as an increase ≥ 15% in stenosis severity of the lesion between 2 serial CAGs. The impact of CP between each 2 serial CAGs on subsequent major adverse cardiovascular and cerebrovascular events (MACCEs) after the final CAG was examined using multivariate Cox and propensity-matched analyses.During the median follow-up duration after the final CAG of 67 months, 76 MACCEs (31.3%) were observed. Multivariate Cox proportional hazards analysis revealed that CP between the first and second CAGs (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.32-3.94; P = 0.003) and CP between the second and final CAGs (HR, 1.96; 95% CI, 1.20-3.21; P = 0.008) were independently associated with a higher rate of MACCEs beyond the final CAG. Consistent results were obtained in the propensity score-matched analyses.CP in both the early (0-7 months) and late phases (7-60 months) were independently associated with subsequent clinical events. This may indicate the prognostic significance of persistent widespread coronary disease activity following presentation in patients with ACS undergoing PCI.
Collapse
Affiliation(s)
- Tatsuya Nakachi
- Department of Cardiology, Kanagawa Prefectural Ashigarakami Hospital.,Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Daisuke Kamimura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| |
Collapse
|
13
|
De Palo M, Quagliara T, Dachille A, Carrozzo A, Giardinelli F, Mureddu S, Mastro F, Rotunno C, Paparella D. Trials Comparing Percutaneous And Surgical Myocardial Revascularization: A Review. Rev Recent Clin Trials 2019; 14:95-105. [PMID: 30706789 DOI: 10.2174/1574887114666190201102353] [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: 05/04/2017] [Revised: 06/10/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Ischemic heart diseases are the major leading cause of death worldwide. Revascularization procedures dramatically reduced the overall risk for death related to acute coronary syndromes. Two kinds of myocardial revascularization can grossly be outlined: percutaneous coronary intervention (PCI) and surgical coronary artery bypass graft intervention (CABG). The net clinical benefit coming from these two kinds of procedures is still under debate. METHODS We have traced the state-of-the-art background about myocardial revascularization procedures by comparing the most important trials dealing with the evaluation of percutaneous interventions versus a surgical approach to coronary artery diseases. RESULTS Both PCI and CABG have become effective treatments for revascularization of patients suffering from advanced CAD. The advance in technology and procedural techniques made PCI an attractive and, to some extent, more reliable procedure in the context of CAD. However, there are still patients that cannot undergo PCI and have to be rather directed towards CABG. CONCLUSION CABG still remains the best strategy for the treatment of multiple vessel CAD due to improved results in term of survival and freedom from reintervention. Anyway, a systematic, multidisciplinary approach to revascularization is the fundamental behaviour to be chased in order to effectively help the patients in overcoming its diseases. The creation of the "heart team" seems to be a good option for the correct treatment of patients suffering from stable and unstable CAD.
Collapse
Affiliation(s)
- Micaela De Palo
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.,Department of Cardiovascular Diseases, Mater Dei Hospital, Bari, Italy
| | - Teresa Quagliara
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Annamaria Dachille
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Carrozzo
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giardinelli
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Simone Mureddu
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | - Florinda Mastro
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
| | | | - Domenico Paparella
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.,Department of Cardiovascular Surgery, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| |
Collapse
|
14
|
Hinkel R, Klett K, Bähr A, Kupatt C. Thymosin β4-mediated protective effects in the heart. Expert Opin Biol Ther 2019; 18:121-129. [PMID: 30063857 DOI: 10.1080/14712598.2018.1490409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Despite recent advances in the treatment of coronary heart disease, a significant number of patients progressively develop heart failure. Reduction of infarct size after acute myocardial infarction and normalization of microvasculature in chronic myocardial ischemia could enhance cardiac survival. AREAS COVERED Induction of neovascularization using vascular growth factors has emerged as a promising novel approach for cardiac regeneration. Thymosin β4 (Tβ4) might be a promising candidate for the treatment of ischemic heart disease. It has been characterized as a major G-actin-sequestering factor regulating cell motility, migration, and differentiation. During cardiac development, Thymosin β4 seems essential for vascularization of the myocardium. In the adult organism, Thymosin β4 has anti-inflammatory properties, increases myocyte and endothelial cell survival accompanied by differentiation of epicardial progenitor cells. In chronic myocardial ischemia, Tβ4 overexpression enhances micro- and macrovasculature in the ischemic area and thereby improves myocardial function. A comparable effect is seen in diabetic and dyslipidemic pig ischemic hearts, suggesting an attractive therapeutic potential of adeno-associated virus encoding for Tβ4 for patients with ischemic heart disease. EXPERT OPINION Induction of mature micro-vessels is a prerequisite for chronic myocardial ischemia and might be achieved via a long-term overexpression of Thymosin β4.
Collapse
Affiliation(s)
- Rabea Hinkel
- a Internal Medicine I , Klinikum rechts der Isar der TU München , Munich , Germany.,b Institut for Cardiovascular Prevention , LMU Munich , Munich , Germany.,c DZHK (German Center for Cardiovascular Research) , partner site Munich Heart Alliance , Munich , Germany
| | - Katharina Klett
- b Institut for Cardiovascular Prevention , LMU Munich , Munich , Germany.,c DZHK (German Center for Cardiovascular Research) , partner site Munich Heart Alliance , Munich , Germany
| | - Andrea Bähr
- a Internal Medicine I , Klinikum rechts der Isar der TU München , Munich , Germany.,c DZHK (German Center for Cardiovascular Research) , partner site Munich Heart Alliance , Munich , Germany
| | - Christian Kupatt
- a Internal Medicine I , Klinikum rechts der Isar der TU München , Munich , Germany.,c DZHK (German Center for Cardiovascular Research) , partner site Munich Heart Alliance , Munich , Germany
| |
Collapse
|
15
|
Fitzpatrick T, Perrier L, Shakik S, Cairncross Z, Tricco AC, Lix L, Zwarenstein M, Rosella L, Henry D. Assessment of Long-term Follow-up of Randomized Trial Participants by Linkage to Routinely Collected Data: A Scoping Review and Analysis. JAMA Netw Open 2018; 1:e186019. [PMID: 30646311 PMCID: PMC6324362 DOI: 10.1001/jamanetworkopen.2018.6019] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/26/2018] [Indexed: 12/21/2022] Open
Abstract
Importance Follow-up of participants in randomized trials may be limited by logistic and financial factors. Some important randomized trials have been extended well beyond their original follow-up period by linkage of individual participant information to routinely collected data held in administrative records and registries. Objective To perform a scoping review of randomized clinical trials extended by record linkage to characterize this literature and explore any additional insights into treatment effectiveness provided by long-term follow-up using record linkage. Data Sources A literature search in Embase, CINAHL, MEDLINE, and the Cochrane Register of Controlled Trials was performed for the period January 1, 1945, through November 25, 2016. Study Selection Various combinations of search terms were used, as there is no accepted terminology. Determination of study eligibility and extraction of information about trial characteristics and outcomes, for both original and extended trial reports, were performed in duplicate. Data Extraction and Synthesis Assessment of study eligibility and data extraction were performed independently by 2 reviewers. All analyses were descriptive. Main Outcomes and Measures Outcomes in the pairs of original and extended trials were categorized according to whether any benefits or harms from interventions were sustained, were lost, or emerged during long-term follow-up. Results A total of 113 extended trials were included in the study. Linkage to administrative and registry data extended follow-up by between 1 and 55 years. The most common interventions were pharmaceuticals (47 [41.6%]), surgery (19 [16.8%]), and disease screening (19 [16.8%]). End points most frequently studied through record linkage included mortality (88 [77.9%]), cancer (41 [36.3%]), and cardiovascular events (37 [32.7%]). One hundred four trial extensions (92.0%) were analyzed according to the original trial randomization. The reports provided details of 155 analyses of study outcomes. Seventy-four analyses (47.7%) identified statistically significant benefits in the trial extension phase. In 21 of these (28.4%), benefits were significant only in this period. Null results in both the original and extended trials were seen in 34 of the analyses (21.9%). Loss of significant benefits of an intervention were seen in 12 analyses (7.7%). Statistically significant harms were seen in 16 trial extension analyses (10.3%), and in 14 of these (87.5%), the harms were significant only in the trial extension phase. Conclusions and Relevance Trial extension by linkage to routinely collected data is a versatile underused approach that may add critical insights beyond those of the original trial. Some beneficial and harmful outcomes of interventions are captured only in the extension phase of randomized trials.
Collapse
Affiliation(s)
- Tiffany Fitzpatrick
- Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laure Perrier
- University of Toronto Libraries, Toronto, Ontario, Canada
| | - Sharara Shakik
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Cairncross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C. Tricco
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - David Henry
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| |
Collapse
|
16
|
Issa M, Alqahtani F, Ziada KM, Stanazai Q, Aljohani S, Berzingi C, Giordano J, Alkhouli M. Incidence and Outcomes of Non-ST Elevation Myocardial Infarction in Patients Hospitalized with Decompensated Diabetes. Am J Cardiol 2018; 122:1297-1302. [PMID: 30131108 DOI: 10.1016/j.amjcard.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
Single center studies suggested that non-ST elevation myocardial infarction (NSTEMI) in patients admitted with acute decompensated diabetes is associated with poor long-term prognosis. We hypothesize that acute decompensated diabetes is also associated with worse early morbidity and mortality in patients admitted with NSTEMI. Adult patients with a primary discharge diagnosis of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) were identified in the national inpatient sample. We then assessed contemporary trends in the incidence and management patents of NSTEMI in patients admitted with DKA/HHS and compared in-hospital morbidity and mortality, resource utilization, and cost between DKA/HHS patients with and without NSTEMI. In 431,037 patients admitted with decompensated diabetes from 2003 to 2014, 13,069 (3.03%) suffered a NSTEMI during their hospitalization. Patients with NSTEMI were older and had higher prevalence of atherosclerotic and nonatherosclerotic comorbidities. After propensity score matching, NSTEMI was associated with a 60% increase in in-hospitalmortality (9.1% vs 5.5%; p < 0.001), higher incidences of stroke, acute kidney injury, blood transfusion, longer hospitalizations, and higher costs. A minority (35%) ofNSTEMI patients underwent invasive coronary assessment, and those had lower in-hospitalmortality compared with NSTEMI patients who did not undergo invasive assessment(3.3% vs 12.2%, adjusted OR 0.30, 95%CI 0.24 to 0.36, p < 0.001). About 3% of patients admitted with decompensated diabetes suffer a NSTEMI and those experience higher in-hospital morbidity and mortality, longer hospitalization, and higher cost.
Collapse
|
17
|
Chuang AMY, Hancock DG, Halabi A, Horsfall M, Vaile J, De Pasquale C, Sinhal A, Jones D, Brogan R, Chew DP. Invasive management of acute coronary syndrome: Interaction with competing risks. Int J Cardiol 2018; 269:13-18. [PMID: 30037631 DOI: 10.1016/j.ijcard.2018.07.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/24/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to characterise the interaction between ACS- and non-ACS-risk on the benefits of invasive management in patients presenting with acute coronary syndrome (ACS). METHODS Consecutive patients admitted to a tertiary hospital's Cardiac Care Unit in the months of July-December, 2003-2011 with troponin elevation (>30 ng/L) were included. "ACS-specific-risk" was estimated using the GRACE score and "non-ACS-risk" was estimated using the Charlson-Comorbidity-Index (CCI). Inverse-probability-of-treatment weighting was used to adjust for baseline differences between patients who did or did not receive invasive management. A multivariable flexible parametric model was used to characterise the time-varying hazard. RESULTS In total, 3057 patients were included with a median follow-up of 9.0 years. Based on CCI, 1783 patients were classified as 'low-non-ACS risk' (CCI ≤ 1; invasive management 81%; 12-month mortality 5%), 820 as 'medium-non-ACS risk' (CCI 2-3; invasive management 68%; 12-month mortality 13%), and 468 as 'high-non-ACS risk' (CCI ≥ 4; invasive management 47%; 12-month mortality 29%). After adjustment, invasive management was associated with a significant reduction in one-year overall-mortality in the 'low-risk' and 'medium-risk' groups (HR = 0.38, 95%CI:0.26-0.56; HR = 0.46, 95%CI:0.32-0.67); but not in the 'high-risk' group (HR = 1.02, 95%CI:0.67-1.56). The absolute benefit of invasive management was greatest with higher baseline ACS-risk, with a non-linear interaction between ACS- and non-ACS-risk. CONCLUSIONS There is a complex interaction between ACS- and non-ACS-risk on the benefit of invasive management. These results highlight the need to develop robust methods to objectively quantify risk attributable to non-ACS comorbidities in order to make informed decisions regarding the use of invasive management in individuals with numerous comorbidities.
Collapse
Affiliation(s)
- Anthony Ming-Yu Chuang
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - David G Hancock
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Amera Halabi
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Matthew Horsfall
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Julian Vaile
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Carmine De Pasquale
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Ajay Sinhal
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Dylan Jones
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Richard Brogan
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Derek P Chew
- School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| |
Collapse
|
18
|
Abstract
Acute coronary syndrome (ACS) represents an umbrella of ischemic myocardial disease and diagnoses encompassing unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). UA and NSTEMI for all intents and purposes, share similar pathophysiology, but at increasing severity. This article focuses on the diagnosis, risk stratification, management, and strategies that impact outcomes in NSTEMI.
Collapse
Affiliation(s)
- Tarlan Hedayati
- Department of Emergency Medicine, John Stroger Hospital of Cook County, 1900 West Polk Street, Room 1047, Chicago, IL 60612, USA.
| | - Neha Yadav
- Cardiac Catheterization Laboratory, Division of Cardiology, John Stroger Hospital of Cook County, 1900 West Polk Street, Chicago, IL 60612, USA
| | - Jagadish Khanagavi
- Interventional Cardiology, Rush University Medical Center, 1164 West Madison Street, Apartment 718, Chicago, IL 60607, USA
| |
Collapse
|
19
|
Three-Year Impact of Immediate Invasive Strategy in Patients With Non-ST-Segment Elevation Myocardial Infarction (from the RIDDLE-NSTEMI Study). Am J Cardiol 2018; 122:54-60. [PMID: 29705375 DOI: 10.1016/j.amjcard.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/10/2018] [Accepted: 03/16/2018] [Indexed: 01/09/2023]
Abstract
Previous studies compared clinical outcomes of early versus delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome up to 1-year follow-up, but long-term data remain scarce. Our aim was to evaluate the long-term effects of immediate invasive intervention in patients with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). The Randomized Study of Immediate Versus Delayed Invasive Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction (RIDDLE-NSTEMI) was a randomized, investigator-initiated, parallel-group trial that assigned 323 patients with NSTEMI (1:1) to either immediate (median time to intervention 1.4 hours) or delayed invasive strategy (61.0 hours). The primary end point was the composite of death or new myocardial infarction (MI). At 3 years, immediate invasive intervention was associated with a lower rate of death or new MI, compared with a delayed invasive strategy (12.3% vs 22.5%, hazard ratio 0.50, 95% confidence interval 0.29 to 0.87, p = 0.014). The observed benefit of immediate intervention was mainly driven by an increased early reinfarction risk in delayed strategy, with similar new MI rates beyond 30 days (4.4% in the immediate and 5.6% in the delayed group, p = 0.61). Three-year mortality was 9.3% in the immediate invasive strategy, and 10.0% in the delayed strategy (p = 0.83). High baseline Global Registry of Acute Coronary Events score (>140) was associated with a significant increase in long-term mortality, regardless of the timing of invasive intervention. In conclusion, whereas immediate invasive intervention significantly reduced the early risk of new MI, the timing of invasive intervention appears to have no significant impact on clinical outcomes beyond 30 days, which seem to mostly be related to the baseline clinical risk profile.
Collapse
|
20
|
Impact of marital status on outcomes following ST-segment elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:237-240. [DOI: 10.1016/j.carrev.2017.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/13/2017] [Accepted: 07/20/2017] [Indexed: 11/24/2022]
|
21
|
Teng HI, Sung SH, Huang SS, Pan JP, Lin SJ, Chan WL, Lee WL, Lu TM, Wu CH. The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction. J Interv Cardiol 2018; 31:302-309. [PMID: 29495125 DOI: 10.1111/joic.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. METHODS Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group). RESULTS The 30-day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30-day survivals was performed. After a mean of 2.5-year follow-up, the long-term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long-term cardiac death (HR 0.310, 95% CI, 0.109-0.881, P = 0.028) in all population and in propensity-score matched cohort (P = 0.007). CONCLUSIONS Successful revascularization of CTO was associated with reduced risk of long-term cardiac death in patients with NSTEMI and concomitant CTO.
Collapse
Affiliation(s)
- Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Lieng Lee
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tse-Min Lu
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
22
|
Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem 2017; 52:131-136. [PMID: 29132766 DOI: 10.1016/j.clinbiochem.2017.11.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/25/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Neutrophil to lymphocyte ratio (NLR) might be associated with the mortality or major adverse cardiac events (MACEs) in acute coronary syndrome (ACS) patients. We performed a meta-analysis to evaluate the correlation between NLR and mortality/MACEs in ACS. METHODS We assessed clinical trials through Pubmed, EMBASE, the Cochrane Library and Web of science in investigating the association between NLR and mortality/MACEs in ACS patients up to August 15, 2017. The primary outcome was mortality or recurrent MACEs. RESULTS In total, 8 studies of 9406 patients were included in the systematic and meta-analysis. Our analysis indicated that elevated pretreatment NLR was a poor prognostic marker for patients with recent ACS in predicting medium to long-term mortality/MACEs (OR 1.26, 95%CI 1.13-1.41). And the analysis indicated that higher pretreatment NLR value was associated with higher in-hospital mortality in ACS patients (OR 6.39, 95%CI 1.49-27.38, p<0.001). The NLR value of 5.0 maybe a cut-off value for ACS risk. CONCLUSIONS In patients with a recent ACS, an elevated pretreatment NLR value is effective in predicting the risk of mortality/MACEs.
Collapse
Affiliation(s)
- Chao-Hui Dong
- Department of Cardio-Pulmonary Rehabilitation, The Affiliated Rehabilitation Hospital of Chongqing Medical University, China
| | - Zhang-Min Wang
- Department of Cardio-Pulmonary Rehabilitation, The Affiliated Rehabilitation Hospital of Chongqing Medical University, China
| | - Si-Yu Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
23
|
Schulman-Marcus J, Boden WE. Early Revascularization in NSTE-ACS: Insights From the ICTUS Long-Term Follow-Up. J Am Coll Cardiol 2017; 70:1423-1424. [PMID: 28882243 DOI: 10.1016/j.jacc.2017.05.078] [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: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
|
24
|
Henderson R. Early invasive strategy in patients with non-ST segment elevation acute coronary syndrome delays death or MI by 18 months. EVIDENCE-BASED MEDICINE 2017; 22:97. [PMID: 28356318 DOI: 10.1136/ebmed-2016-110642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Robert Henderson
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| |
Collapse
|
25
|
Hoedemaker NPG, Damman P, Woudstra P, Hirsch A, Windhausen F, Tijssen JGP, de Winter RJ. Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial. J Am Coll Cardiol 2017; 69:1883-1893. [PMID: 28408018 DOI: 10.1016/j.jacc.2017.02.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an early invasive strategy was found at 1 and 5 years. OBJECTIVES The aim of this study was to determine the 10-year clinical outcomes of an early invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and an elevated cardiac troponin T. METHODS The ICTUS trial was a multicenter, randomized controlled clinical trial that included 1,200 patients with NSTE-ACS and an elevated cardiac troponin T. Enrollment was from July 2001 to August 2003. We collected 10-year follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone calls, general practitioners, and hospital records. The primary outcome was the 10-year composite of death or spontaneous MI. Additional outcomes included the composite of death or MI, death, MI (spontaneous and procedure-related), and revascularization. RESULTS Ten-year death or spontaneous MI was not statistically different between the 2 groups (33.8% vs. 29.0%, hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.97 to 1.46; p = 0.11). Revascularization occurred in 82.6% of the early invasive group and 60.5% in the selective invasive group. There were no differences in additional outcomes, except for a higher rate of death or MI in the early invasive group compared with the rates for the selective invasive group (37.6% vs. 30.5%; HR: 1.30; 95% CI: 1.07 to 1.58; p = 0.009), driven by a higher rate of procedure-related MI in the early invasive group (6.5% vs. 2.4%; HR: 2.82; 95% CI: 1.53 to 5.20; p = 0.001). CONCLUSIONS In patients with NSTE-ACS and elevated cardiac troponin T levels, an early invasive strategy has no benefit over a selective invasive strategy in reducing the 10-year composite outcome of death or spontaneous MI, and a selective invasive strategy may be a viable option in selected patients.
Collapse
Affiliation(s)
- Niels P G Hoedemaker
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter Damman
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pier Woudstra
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Fons Windhausen
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | -
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
26
|
Elgendy IY, Mahmoud AN, Wen X, Bavry AA. Meta-Analysis of Randomized Trials of Long-Term All-Cause Mortality in Patients With Non-ST-Elevation Acute Coronary Syndrome Managed With Routine Invasive Versus Selective Invasive Strategies. Am J Cardiol 2017; 119:560-564. [PMID: 27939385 DOI: 10.1016/j.amjcard.2016.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
Abstract
Randomized trials and meta-analyses demonstrated that a routine invasive strategy improves outcomes in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) compared to a selective invasive strategy. Benefit was driven primarily by a reduction in the risk of myocardial infarction. However, the impact of either strategy on long-term mortality is unknown. Trials that compared a routine invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and reported data on all-cause mortality ≥1 year were included. Summary odds ratios (OR) were constructed using Peto's model for all-cause mortality using the longest available follow-up data. Subgroup analysis was performed for follow-up at 1 to ≤5 years and >5 years. Eight trials with 6,657 patients were available for analysis. At a mean of 10.3 years, the risk of all-cause mortality was similar with both strategies (28.5% vs 28.5%; OR 1.00, 95% confidence interval [CI] 0.90 to 1.12, p = 0.97). This effect was similar on subgroup analysis for follow-up at 1 to ≤5 years (OR 0.89, 95% CI 0.77 to 1.04, p = 0.15) and >5 years (OR 1.02, 95% CI 0.90 to 1.14, p = 0.79). There was no difference in treatment effect across various study-level covariates such as age, gender, diabetes, and positive troponin (all P for interaction >0.05). In conclusion, in patients with NSTE-ACS, both routine invasive and selective invasive strategies have a similar risk of all-cause mortality at ∼10 years. This illustrates there are still opportunities to change the trajectory of mortality events among invasively treated patients with NSTE-ACS.
Collapse
|
27
|
More Time to SORT OUT Clinical Outcomes After First-Generation Drug-Eluting Stents. J Am Coll Cardiol 2017; 69:625-627. [DOI: 10.1016/j.jacc.2016.11.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022]
|
28
|
Management Strategy in Non-Limb-Threatening Acute Ischaemia of Limbs: Should We Rethink? Case Rep Vasc Med 2016; 2016:8146295. [PMID: 27843672 PMCID: PMC5098073 DOI: 10.1155/2016/8146295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022] Open
Abstract
The Society of Vascular Surgery and the International Society of Cardiovascular Surgery identify three types of acute limb ischaemia to inform prognosis and management. Type 1 limb ischaemia is non-limb-threatening and is currently managed conservatively. We describe three cases of Type 1 limb ischaemia with femoropopliteal occlusion that were managed differently. The first case was initially managed conservatively but resulted in an adverse outcome following worsening of ischaemia. Overall, the cases managed with earlier intervention had good outcomes suggesting that conservative management alone may not be sufficient despite resolution of symptoms. The trend in other vessel diseases such as NSTEMI and TIA is towards earlier intervention, for example, PCI and CEA. It is likely that acute limb ischaemia has a similar natural history to these conditions. It is time to consider earlier revascularisation in selected patients with non-limb-threatening ischaemia.
Collapse
|
29
|
Weintraub WS. Invasive management of acute coronary syndromes. Lancet 2016; 388:1856-1857. [PMID: 27585758 PMCID: PMC5621638 DOI: 10.1016/s0140-6736(16)31273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/21/2022]
|
30
|
Wallentin L, Lindhagen L, Ärnström E, Husted S, Janzon M, Johnsen SP, Kontny F, Kempf T, Levin LÅ, Lindahl B, Stridsberg M, Ståhle E, Venge P, Wollert KC, Swahn E, Lagerqvist B. Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study. Lancet 2016; 388:1903-1911. [PMID: 27585757 DOI: 10.1016/s0140-6736(16)31276-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/14/2016] [Accepted: 07/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up. METHODS The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. FINDINGS At a minimum of 15 years' follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p=0·0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; pinteraction=0·0182), patients with elevated troponin T (778 days, 357-1165; pinteraction=0·0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; pinteraction=0·0210). The difference was mainly driven by postponement of new myocardial infarction, whereas the early difference in mortality alone was not sustained over time. The invasive strategy led to a mean of 1128 days (95% CI 830-1366) postponement of death or next readmission to hospital for ischaemic heart disease, which was consistent in all subgroups (p<0·0001). INTERPRETATION During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome. FUNDING Swedish Heart-Lung Foundation, Swedish Foundation for Strategic Research, and Uppsala Clinical Research Center.
Collapse
Affiliation(s)
- Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Elisabet Ärnström
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Steen Husted
- Medical Department, Hospital Unit West, Herning/Holstebro, Denmark
| | - Magnus Janzon
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Division of Health Care Analysis, Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Frederic Kontny
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway; Drammen Heart Center, Drammen, Norway
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars-Åke Levin
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Division of Health Care Analysis, Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Mats Stridsberg
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences, Thoracic Surgery, Uppsala University, Uppsala, Sweden
| | - Per Venge
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Kai C Wollert
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eva Swahn
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| |
Collapse
|
31
|
Magri CJ, Debono R, Calleja N, Galea J, Fava S. Prognostic indicators and generation of novel risk equations for estimation of 10-year and 20-year mortality following acute coronary syndrome. Postgrad Med J 2016; 93:245-249. [PMID: 27543420 DOI: 10.1136/postgradmedj-2016-134129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/29/2016] [Accepted: 08/01/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Although risk assessment is an integral part of management, there are currently no risk calculators of long-term mortality after acute coronary syndrome (ACS). The aim was to provide risk equations for 10-year and 20-year mortality following ACS. METHODS Patients hospitalised with ACS from December 1990 to June 1994 were recruited and followed up through 31 December 2012. RESULTS The study followed 881 patients for 10 years and 712 patients for 20 years. Using Cox regression analysis, 20-year all-cause mortality was associated with myocardial infarction (MI) in the index admission, age and diabetes mellitus (DM). Twenty-year cardiovascular disease (CVD) and cardiac mortality were both associated with MI in the index admission, age, DM and female gender. 10-year all-cause mortality was associated with age and total cholesterol levels; age, DM and total cholesterol levels were found to be independent predictors of 10-year CVD and cardiac mortality. Risk equations were consequently generated for 10-year and 20-year cardiac, cardiovascular and all-cause mortality, with age and DM emerging as the strongest and most consistent predictors of all outcomes studied. CONCLUSIONS Novel risk equations for all-cause, cardiovascular and cardiac mortality at 10 and 20 years were generated using follow-up data in a large patient population.
Collapse
Affiliation(s)
- Caroline J Magri
- Department of Cardiology, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, Mater Dei Hospital, Msida, Malta
| | - Roberto Debono
- Directorate Health Information & Research, Mater Dei Hospital, G'Mangia, Malta
| | - Neville Calleja
- Directorate Health Information & Research, Mater Dei Hospital, G'Mangia, Malta
| | - Joseph Galea
- University of Malta Medical School, Mater Dei Hospital, Msida, Malta.,Department of Cardiac Services, Mater Dei Hospital, Msida, Malta
| | - Stephen Fava
- University of Malta Medical School, Mater Dei Hospital, Msida, Malta.,Department of Medicine, Diabetes & Endocrine Centre, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
32
|
Elgendy IY, Kumbhani DJ, Mahmoud AN, Wen X, Bhatt DL, Bavry AA. Routine invasive versus selective invasive strategies for Non-ST-elevation acute coronary syndromes: An Updated meta-analysis of randomized trials. Catheter Cardiovasc Interv 2016; 88:765-774. [DOI: 10.1002/ccd.26679] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/25/2016] [Accepted: 07/03/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Islam Y. Elgendy
- Department of Medicine; University of Florida; Gainesville Florida
| | - Dharam J. Kumbhani
- Department of Medicine; University of Texas Southwestern Medical Center; Dallas Texas
| | - Ahmed N. Mahmoud
- Department of Medicine; University of Florida; Gainesville Florida
| | - Xuerong Wen
- Department of Medicine; University of Florida; Gainesville Florida
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School; Boston Massachusetts
| | - Anthony A. Bavry
- Department of Medicine; University of Florida; Gainesville Florida
- North Florida/South Georgia Veterans Health System; Gainesville Florida
| |
Collapse
|
33
|
Cambios en el tratamiento y el pronóstico del síndrome coronario agudo con la implantación del código infarto en un hospital con unidad de hemodinámica. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
34
|
Fuster V. Editor-in-Chief's Top Picks From 2015: Part One. J Am Coll Cardiol 2016; 67:687-711. [PMID: 26868695 DOI: 10.1016/j.jacc.2015.12.002] [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] [Indexed: 11/25/2022]
Abstract
Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become very familiar with every paper that we publish. Thus, I have personally selected the papers (both original investigations and review articles) from 13 distinct specialties for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. There are approximately 130 articles selected across this 2-part series, which represent less than 3% of the papers submitted to the Journal in 2015. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts over the course of 2 issues in JACC. Part One includes the sections: Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Cardiac Failure, Cardiomyopathies, Genetics, Omics, & Tissue Regeneration, and Hypertension (1-60). Part Two includes the sections: Imaging, Metabolic Disorders & Lipids, Rhythm Disorders, Statistics, Valvular Heart Disease, and Vascular Medicine.
Collapse
|
35
|
McDaniel M, Wenger N. Do the 10-Year Mortality Outcomes of RITA-3 Inform Contemporary Clinical Practice? J Am Coll Cardiol 2016; 67:1502. [PMID: 27012413 DOI: 10.1016/j.jacc.2015.11.069] [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: 10/20/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
|
36
|
Henderson RA, Jarvis C, Clayton T, Pocock SJ, Fox KAA. Reply: Do the 10-Year Mortality Outcomes of RITA-3 Inform Contemporary Clinical Practice? J Am Coll Cardiol 2016; 67:1502-1503. [PMID: 27012414 DOI: 10.1016/j.jacc.2015.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
|
37
|
Anderson RD. Does RIDDLE-NSTEMI Provide an Answer to the Timing of ACS Therapy? JACC Cardiovasc Interv 2016; 9:550-2. [PMID: 27013154 DOI: 10.1016/j.jcin.2016.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/14/2016] [Indexed: 11/15/2022]
Affiliation(s)
- R David Anderson
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
| |
Collapse
|
38
|
Cordero A, López-Palop R, Carrillo P, Frutos A, Miralles S, Gunturiz C, García-Carrilero M, Bertomeu-Martínez V. Changes in Acute Coronary Syndrome Treatment and Prognosis After Implementation of the Infarction Code in a Hospital With a Cardiac Catheterization Unit. ACTA ACUST UNITED AC 2016; 69:754-9. [PMID: 26979766 DOI: 10.1016/j.rec.2015.12.021] [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: 09/15/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome. METHODS A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol. RESULTS The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications. CONCLUSIONS After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.
Collapse
Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
| | - Ramón López-Palop
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Pilar Carrillo
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Araceli Frutos
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Sandra Miralles
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Clara Gunturiz
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - María García-Carrilero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Vicente Bertomeu-Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| |
Collapse
|
39
|
Ferguson TB, Buch AN. Improving quality and outcomes of coronary artery bypass grafting procedures. Expert Rev Cardiovasc Ther 2016; 14:617-31. [PMID: 26818448 DOI: 10.1586/14779072.2016.1147347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The evolution in the approach, clinical care and outcomes of ischemic heart disease, has been dramatic over the past decade. Optimizing medical therapy initially and throughout the care delivery process has been transformative. The addition of new physiologic data to the traditional anatomic framework for diagnosis and therapy of more extensive stable ischemic heart disease (SIHD) enables quality and outcomes improvements in this patient population overall and in the patient subsets of acute coronary syndrome and SIHD. In patients undergoing coronary artery bypass grafting (CABG), these developments have changed the objective goal of surgical revascularization over this time interval. This review discusses the opportunities for quality and outcomes improvement in CABG, in the context of SIHD overall.
Collapse
Affiliation(s)
- T Bruce Ferguson
- a Department of Cardiovascular Sciences , East Carolina Heart Institute, East Carolina Diabetes and Obesity Institute, The Brody School of Medicine at ECU , Greenville , NC , USA
| | - Ashesh N Buch
- b Department of CV Sciences , East Carolina Heart Institute, The Brody School of Medicine at ECU , Greenville , NC , USA
| |
Collapse
|
40
|
Kostis WJ, Moreyra AE, Cabrera J, Kostis JB. Survival Differences in Clinical Trials With Long-Term Follow-Up. J Am Coll Cardiol 2016; 67:600. [PMID: 26846958 DOI: 10.1016/j.jacc.2015.09.110] [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: 08/17/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
|
41
|
Henderson RA, Jarvis C, Clayton T, Pocock SJ, Fox KAA. Reply: Survival Differences in Clinical Trials With Long-Term Follow-up. J Am Coll Cardiol 2016; 67:601. [PMID: 26846959 DOI: 10.1016/j.jacc.2015.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/20/2015] [Indexed: 11/19/2022]
|
42
|
The Reply. Am J Med 2016; 129:e45. [PMID: 26777619 DOI: 10.1016/j.amjmed.2015.10.005] [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: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 11/23/2022]
|
43
|
Kline KP, Conti CR, Winchester DE. Historical perspective and contemporary management of acute coronary syndromes: from MONA to THROMBINS2. Postgrad Med 2015; 127:855-62. [DOI: 10.1080/00325481.2015.1092374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
44
|
Patel MR, Ohman EM. The Early Invasive Strategy in Acute Coronary Syndromes: Should the Guideline Recommendations Be Revisited? J Am Coll Cardiol 2015; 66:521-3. [PMID: 26227189 DOI: 10.1016/j.jacc.2015.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Manesh R Patel
- Division of Cardiovascular Medicine, Duke Heart Center, Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina.
| | - E Magnus Ohman
- Division of Cardiovascular Medicine, Duke Heart Center, Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina
| |
Collapse
|