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Suryawan IGR, Saputra PBT, Rurus MESE, Saputra ME, Widiarti W, Multazam CECZ, Alkaff FF. Comparison between provisional and dual systematic stenting approach for left main bifurcation disease: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102633. [PMID: 38744356 DOI: 10.1016/j.cpcardiol.2024.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Despite recent advancements, challenges persist in determining the optimal stenting strategy for LM bifurcation disease. Hence, this systematic review aims to compare single provisional and systematic dual stenting for managing LM bifurcation disease. A systematic search was performed until January 14, 2024. For the effect measure, risk ratios (RRs) was calculated. This study included 22 studies with 10776 participants. The all-cause mortality and cardiovascular mortality revealed comparable outcomes between provisional and dual-systematic stenting (RR 1.13, CI95 %: 0.87-1.47, p 0.36, I2 59 %; RR 1.16, CI95 %: 0.73-1.84, p 0.63, I2 80 %). In addition, MACE, MI, TLR, TVR, and in stent thrombosis also showed similar findings. Subgroup analysis revealed that cohort studies was the source of heterogeneity in all-cause mortality, stent thrombosis, and TLR. This meta-analysis suggests comparable outcomes between provisional and dual-systematic stenting in managing LM bifurcation disease. Further study is needed to validate the outcomes of novel techniques.
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Affiliation(s)
- I Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Made Edgard Surya Erlangga Rurus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Mahendra Eko Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Wynne Widiarti
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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2
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Hamed M, Mohamed S, Mahmoud M, Kahan J, Mohsen A, Rahman F, Kayani W, Alfonso F, Brilakis ES, Elgendy IY, Mamas MA, Elbadawi A. Intravascular Imaging-Guided Versus Coronary Angiography-Guided Complex PCI: A Meta-analysis of Randomized Controlled Trials. Cardiol Ther 2024; 13:379-399. [PMID: 38630393 PMCID: PMC11093926 DOI: 10.1007/s40119-024-00364-7] [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: 11/07/2023] [Accepted: 03/04/2024] [Indexed: 05/15/2024] Open
Abstract
INTRODUCTION Trials evaluating the role of intravascular imaging in percutaneous coronary intervention (PCI) for complex coronary artery disease have yielded mixed results. This study aimed to compare the outcomes of intravascular imaging specifically intravascular ultrasound (IVUS) with those from conventional coronary angiography in complex PCI. METHODS Comprehensive electronic search of MEDLINE, EMBASE, and Cochrane databases was performed until March 2023 for randomized clinical trials (RCTs) comparing intravascular imaging with coronary angiography in patients undergoing complex PCI. Complex PCI was defined per each study, and included PCI for American College of Cardiology/American Heart Association (ACC/AHA) type B2/C lesions, unprotected left main coronary artery disease, or multivessel stenting. The primary study outcome was major adverse clinical events (MACE). RESULTS The meta-analysis included 10 RCTs with a total of 6615 patients (3576 in the intravascular imaging group and 3039 in the coronary angiography group). The weighted mean-follow up was 28.9 months. Compared with coronary angiography, intravascular imaging reduced MACE (8% vs. 13.3%; relative risk [RR] 0.63; 95% confidence interval [CI] 0.54-0.73), cardiac death (RR 0.47; 95% CI 0.31-0.73), definite/probable stent thrombosis (RR 0.48; 95% CI 0.24-0.97), target vessel revascularization (RR 0.62; 95% CI 0.46-0.83), and target lesion revascularization (RR 0.61; 95% CI 0.47-0.79). There was no difference between both groups in all-cause death (RR 0.79; 95% CI 0.53-1.18) and myocardial infarction (RR 0.80; 95% CI 0.61-1.04). CONCLUSION In patients undergoing complex PCI, intravascular imaging-specifically IVUS-reduced MACE by decreasing the incidence of cardiac death, stent thrombosis, and target vessel and target lesion revascularization.
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Affiliation(s)
- Mohamed Hamed
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheref Mohamed
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Mohamed Mahmoud
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan Kahan
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University, Loma Linda, CA, USA
| | - Faisal Rahman
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Waleed Kayani
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | | | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Ayman Elbadawi
- Division of Cardiology, Christus Good Shepherd Medical Center, Longview, TX, USA.
- Texas A&M School of Medicine, Bryan, TX, USA.
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Bianchini F, Burzotta F, Romagnoli E. Is one better than two? The impact of a four-handed approach in left main percutaneous coronary intervention. Minerva Cardiol Angiol 2024; 72:76-78. [PMID: 37987682 DOI: 10.23736/s2724-5683.23.06459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
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Kim TO, Kang DY, Ahn JM, Kim MJ, Lee PH, Kim H, Choi Y, Lee J, Lee JM, Jo HH, Park YS, Lim SM, Park SJ, Park DW. Impact of Target Lesion Revascularization on Long-Term Mortality After Percutaneous Coronary Intervention for Left Main Disease. JACC Cardiovasc Interv 2024; 17:32-42. [PMID: 38199751 DOI: 10.1016/j.jcin.2023.10.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Although target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease is not rare, its timing of occurrence and prognostic impact on long-term mortality is uncertain. OBJECTIVES This study sought to investigate TLR incidence over time and its impact on mortality after PCI with drug-eluting stents (DES) for LMCA disease. METHODS Using a pooled data from 4 multicenter observational registries (IRIS-DES [Interventional Cardiology Research Incorporation Society-Drug-Eluting Stents], IRIS-MAIN [Interventional Cardiology Research Incorporation Society-Left MAIN Revascularization], MAIN-COMPARE [Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization], and PRECOMBAT [PREmier of Randomized COMparison of Bypass Surgery versus AngioplasTy Using Drug-Eluting Stent in Patients with Left Main Coronary Artery Disease]), we evaluated 1,397 patients with LMCA disease treated with DES and available long-term mortality data. The association between TLR and the 10-year risk of mortality was examined by multivariable Cox proportional hazards regression, with TLR as a time-varying covariate. RESULTS During maximum follow-up of 10 years (median 6.8 years), TLR occurred in 118 patients and its 10-year cumulative incidence was 10.8%. TLR mostly occurred within 2 years after initial PCI and decreased over time: early-stage TLR (within 2 years) in 73 (61.9%) patients and late-stage TLR (beyond 2 years) in 45 (38.1%) patients. Among all TLR patients, 23 patients underwent coronary artery bypass grafting and 95 underwent repeat PCI. In the time-varying multivariable Cox model, the presence of TLR was not significantly associated with an increased risk of mortality (adjusted HR: 0.90; 95% CI: 0.50-1.63; P = 0.73). CONCLUSIONS Although the incidence of ischemia-driven TLR was mostly common within 2 years after left main PCI, TLR occurred steadily during the 10-year follow-up period. However, given that such patients were optimally revascularized, the prognostic impact of TLR on mortality was not substantial. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133; Observational Study for Left Main Disease Treatment [IRIS-MAIN]; NCT01341327; Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease [MAIN COMPARE]; NCT02791412; Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968).
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Affiliation(s)
- Tae Oh Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Joo Kim
- Division of Biostatics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joong Min Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ha Hye Jo
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Sun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So-Min Lim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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5
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Kandzari DE, Kunkel KJ. Left Main Target Lesion Revascularization: Why Does it Happen and What Does it Mean? JACC Cardiovasc Interv 2024; 17:43-45. [PMID: 38199752 DOI: 10.1016/j.jcin.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024]
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Braghieri L, Badwan OZ, Reed G, Menon V, Ziada K, Kapadia SR. Dual Antiplatelet Therapy Duration After Percutaneous Coronary Interventions of Left Main Coronary Artery Disease: A Meta-Analysis. Am J Cardiol 2023; 205:422-424. [PMID: 37660668 DOI: 10.1016/j.amjcard.2023.08.052] [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: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Khaled Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Watanabe Y, Mitomo S, Naganuma T, Nakajima A, Matsuoka S, Tahara S, Okutsu M, Nakamura S, Nakamura S. Impact of Stent Expansion Index on Stent Failure After Left Main Stenting. Am J Cardiol 2023; 205:164-172. [PMID: 37598602 DOI: 10.1016/j.amjcard.2023.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
Impact of the stent expansion index (EXPI) in percutaneous coronary intervention (PCI) for unprotected left main distal bifurcation lesions (ULMD) has been not completely understood especially in current-generation drug-eluting stent (cDES) era. We evaluated the impact of EXPI on clinical outcomes after PCI with cDES for ULMD. We identified 342 patients treated with cDES for ULMD and postintervention intravascular ultrasound between January 2010 and December 2019. In this study, the ratio of minimum stent area (MSA) to reference vessel area at the MSA site was adopted to assess the stent expansion. We defined the patients with the first and second tertile as low-intermediate EXPI group and those with the third tertile as high EXPI group and compared the clinical outcomes between both groups. The primary end point was target lesion failure (TLF). TLF was defined as a composite of cardiac death, target lesion revascularization (TLR) ,and myocardial infarction. The MSA was located in the ostium of left anterior descending coronary artery in most cases (318 of 342 patients; 93.0%). There were no significant differences between both groups in the baseline clinical, lesion, and procedural characteristics. The high EXPI group had lower TLF rate than the low-intermediate EXPI group (10.2% vs 19.9%, log-rank p = 0.033). In conclusion, this is the first report that the higher ratio of MSA to reference vessel area at the MSA site, which was defined as stent EXPI, was associated with more favorable clinical outcomes after PCI for ULMD.
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Affiliation(s)
- Yusuke Watanabe
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
| | - Satoru Mitomo
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Akihiro Nakajima
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Satoshi Matsuoka
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Satoko Tahara
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Masaaki Okutsu
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Shotaro Nakamura
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Department of interventional cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
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8
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Wool TH, Ashley SC, Gupta VA. Determination of Left Main Coronary Artery Stenosis Through Noninvasive Testing to Guide Revascularization in Ischemic Heart Disease. Am J Cardiol 2023; 204:345-351. [PMID: 37573613 DOI: 10.1016/j.amjcard.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
Anatomically severe left main coronary artery (LMCA) stenosis (>50%) remains one of the few groups to benefit from early revascularization in stable ischemic heart disease (SIHD). Identification of these patients through widely available noninvasive testing would decrease the need for additional upfront anatomic testing, lowering the overall cost of healthcare. Patients with SIHD who underwent either percutaneous or surgical revascularization over a 7-year period at our institution were retrospectively analyzed and categorized as having LMCA stenosis versus non-LM stenosis. All preceding noninvasive testing, including resting electrocardiogram, echocardiogram, and functional testing was evaluated and compared between groups using chi-square and t test. In total, 806 patients were evaluated. Of those, 121 were identified as having significant LMCA stenosis with 685 patients in the non-LM cohort. Between LMCA versus non-LM cohorts, there were similar rates of electrocardiogram abnormalities (68.9% vs 70.8%, p >0.05), abnormal echocardiograms (72.7% vs 69.7%, p >0.05), abnormal functional testing (83.3% vs 77.4%, p >0.05), and high-risk imaging findings (5.6% vs 4.8%, p >0.05). More importantly, of those with a complete workup, there were similar rates of normal results between the LMCA (3 of 18, 16.7%) and non-LM stenosis (9 of 189, 4.8%) groups. A comprehensive noninvasive profile of patients with IHD failed to identify or exclude patients with anatomically severe LMCA stenosis, necessitating anatomic assessment.
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Affiliation(s)
- Thomas H Wool
- Department of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington, Kentucky.
| | - Sarah C Ashley
- University of Kentucky College of Medicine, University of Kentucky Medical Center, Lexington, Kentucky
| | - Vedant A Gupta
- Department of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington, Kentucky
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9
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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11
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Vadalà G, Alaimo C, Buccheri G, Di Fazio L, Di Caccamo L, Sucato V, Cipriani M, Galassi AR. Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates. Diagnostics (Basel) 2023; 13:2709. [PMID: 37627968 PMCID: PMC10453389 DOI: 10.3390/diagnostics13162709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients and during the first year after transplantation. For these reasons, and due to the shortage of organs available for transplant, it is of utmost importance to identify patients with a good life expectancy after transplant and minimize the transplant peri-operative risk. Various conditions, such as severe pulmonary diseases, recent myocardial infarction or stroke, and severe aorto-iliac atherosclerosis, need to be ruled out before adding a patient to the transplant waiting list. The effectiveness of systematic coronary artery disease (CAD) treatment before kidney transplant is still debated, and there is no universal screening protocol, not to mention that a nontailored screening could lead to unnecessary invasive procedures and delay or exclude some patients from transplantation. Despite the different clinical guidelines on CAD screening in kidney transplant candidates that exist, up to today, there is no worldwide universal protocol. This review summarizes the key points of cardiovascular risk assessment in renal transplant candidates and faces the role of noninvasive cardiovascular imaging tools and the impact of coronary revascularization versus best medical therapy before kidney transplant on a patient's cardiovascular outcome.
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Affiliation(s)
- Giuseppe Vadalà
- Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Chiara Alaimo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Giancarlo Buccheri
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Luca Di Fazio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Leandro Di Caccamo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Vincenzo Sucato
- Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Manlio Cipriani
- Institute of Transplant and Highly Specialized Therapies (ISMETT) of Palermo, 90100 Palermo, Italy;
| | - Alfredo Ruggero Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
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12
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Pellegrini D, Ielasi A, Tespili M, Guagliumi G, De Luca G. Percutaneous Treatment of Left Main Disease: A Review of Current Status. J Clin Med 2023; 12:4972. [PMID: 37568374 PMCID: PMC10419939 DOI: 10.3390/jcm12154972] [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: 05/28/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Percutaneous treatment of the left main coronary artery is one of the most challenging scenarios in interventional cardiology, due to the large portion of myocardium at risk the technical complexity of treating a complex bifurcation with large branches. Our aim is to provide un updated overview of the current indications for percutaneous treatment of the left main, the different techniques and the rationale underlying the choice for provisional versus upfront two-stent strategies, intravascular imaging and physiology guidance in the management of left main disease, and the role of mechanical support devices in complex high-risk PCI.
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Affiliation(s)
- Dario Pellegrini
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Alfonso Ielasi
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Maurizio Tespili
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Giulio Guagliumi
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Giuseppe De Luca
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
- Division of Cardiology, AOU “Policlinico G. Martino”, Via Consolare Valeria, 1, 98124 Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy
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13
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Popova NV, Popov VA, Revishvili AS. [Myocardial revascularization in chronic coronary artery disease. State of art]. KARDIOLOGIIA 2023; 63:3-13. [PMID: 37470728 DOI: 10.18087/cardio.2023.6.n2263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/31/2022] [Indexed: 07/21/2023]
Abstract
The review addresses debatable issues of myocardial revascularization in chronic forms of ischemic heart disease, shows major differences between percutaneous coronary intervention and coronary artery bypass grafting in terms of long-term prognosis, and the dependence of the results on the clinical profile of the disease. The review of current publications demonstrates advantages of open surgery in long-term survival and prevention of adverse outcomes in target groups of patients.
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Affiliation(s)
- N V Popova
- Vishnevsky National Medical Research Center of Surgery, Moscow
| | - V A Popov
- Vishnevsky National Medical Research Center of Surgery, Moscow; Russian Medical Academy of Postgraduate Education, Moscow
| | - A S Revishvili
- Vishnevsky National Medical Research Center of Surgery, Moscow; Russian Medical Academy of Postgraduate Education, Moscow
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14
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Warisawa T, Cook CM, Ahmad Y, Howard JP, Seligman H, Rajkumar C, Toya T, Doi S, Nakajima A, Nakayama M, Vera-Urquiza R, Yuasa S, Sato T, Kikuta Y, Kawase Y, Nishina H, Al-Lamee R, Sen S, Lerman A, Matsuo H, Akashi YJ, Escaned J, Davies JE. Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance. Circ Cardiovasc Interv 2023; 16:e012700. [PMID: 37339234 DOI: 10.1161/circinterventions.122.012700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The majority of randomized controlled trials of revascularization decision-making excludes left main coronary artery disease (LMD). Therefore, contemporary clinical outcomes of patients with stable coronary artery disease and LMD with proven ischemia remain poorly understood. The aim of this study was to assess the long-term clinical outcomes of physiologically significant LMD according to the treatment strategies of revascularization versus revascularization deferral. METHODS In this international multicenter registry of stable LMD interrogated with the instantaneous wave-free ratio, patients with physiologically significant ischemia (instantaneous wave-free ratio ≤0.89) were analyzed according to the coronary revascularization (n=151) versus revascularization deferral (n=74). Propensity score matching was performed to adjust for baseline clinical characteristics. The primary end point was a composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization of left main stem. The secondary end points were as follows: cardiac death or spontaneous LMD-related myocardial infarction; and ischemia-driven target lesion revascularization of left main stem. RESULTS At a median follow-up period of 2.8 years, the primary end point occurred in 11 patients (14.9%) in the revascularized group and 21 patients (28.4%) in the deferred group (hazard ratio, 0.42 [95% CI, 0.20-0.89]; P=0.023). For the secondary end points, cardiac death or LMD-related myocardial infarction occurred significantly less frequently in the revascularized group (0.0% versus 8.1%; P=0.004). The rate of ischemia-driven target lesion revascularization of left main stem was also significantly lower in the revascularized group (5.4% versus 17.6%; hazard ratio, 0.20 [95% CI, 0.056-0.70]; P=0.012). CONCLUSIONS In patients who underwent revascularization for stable coronary artery disease and physiologically significant LMD determined by instantaneous wave-free ratio, the long-term clinical outcomes were significantly improved as compared with those in whom revascularization was deferred.
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Affiliation(s)
- Takayuki Warisawa
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.W., S.D., Y.J.A.)
- Department of Cardiology, NTT Medical Center Tokyo, Japan (T.W.)
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
| | - Christopher M Cook
- The Essex Cardiothroacic Centre, UK (C.M.K.)
- Anglia Ruskin University, Essex, UK (C.M.K.)
| | - Yousif Ahmad
- Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (Y.A.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
- Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
- Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
- Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan (T.T.)
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.T., A.L.)
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.W., S.D., Y.J.A.)
| | - Akihiro Nakajima
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (A.N.)
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (M.N., Y.K., H.M.)
- Cardiovascular Center, Toda Central General Hospital, Japan (M.N.)
| | - Rafael Vera-Urquiza
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Spain (R.V.-U., S.Y., J.E.)
| | - Sonoka Yuasa
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Spain (R.V.-U., S.Y., J.E.)
| | - Takao Sato
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan (T.S.)
| | - Yuetsu Kikuta
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (M.N., Y.K., H.M.)
- Division of Cardiology, Fukuyama Cardiovascular Hospital, Japan (Y.K.)
| | | | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Japan (H.N.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
- Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)
- Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.T., A.L.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (M.N., Y.K., H.M.)
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.W., S.D., Y.J.A.)
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Spain (R.V.-U., S.Y., J.E.)
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15
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Dumitrascu S, Bartos D, Ungureanu C. Outcomes after Percutaneous Coronary Intervention in Patients with Extremely Calcified Left Main Lesions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050825. [PMID: 37241057 DOI: 10.3390/medicina59050825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Available data with regard to the outcomes of patients with severely calcified left main (LM) lesions after revascularization by percutaneous coronary intervention (PCI) when compared to non-calcified LM lesions is unclear. Materials and Methods: The present study sought to retrospectively investigate in hospital and 1 year post-intervention outcomes of patients with extremely calcified LM lesions after PCI facilitated by calcium-dedicated devices (CdD). Seventy consecutive patients with LM PCI were included. CdD requirement was based on suboptimal results after balloon angioplasty. Results: Twenty-two patients (31.4%) required at least one CdD, while nine patients (12.8%) required at least two. Intravascular lithotripsy and rotational atherectomy were the predominantly used methods(59.1% and 40.9% respectively, for in-group ratios), while ultra-high pressure and scoring balloons contributed the least to lesion preparation (9%). In 20 patients (28.5%), severe or moderate calcifications were angiographically identified, but non-compliant balloon predilation was adequate and CdD were not necessary. Total procedural time was significantly higher in CdD group (p-value 0.02). Procedural and clinical success were obtained in 100% of cases. There were no major adverse cardiac and cerebrovascular events (MACCE) recorded during hospitalization. MACCE at 1 year post-procedure were recorded in three patients (4.2% overall). All three events were documented in the control group (6.2%), and no events were recorded in CdD group (p-value 0.23). There was one cardiac death at 10 months and two target lesion revascularizations for side-branch restenosis. Conclusions: Patients with extremely calcified LM lesions treated by PCI present a favorable prognosis if angioplasty is facilitated by more aggressive lesion debulking using calcium-dedicated devices.
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Affiliation(s)
- Silviu Dumitrascu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bvd. Eroii Sanitari 8, 050474 Bucharest, Romania
- Cardiovascular Department, Jolimont Hospital, Ferrer St. 159, 7100 La Louviere, Belgium
| | - Daniela Bartos
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bvd. Eroii Sanitari 8, 050474 Bucharest, Romania
| | - Claudiu Ungureanu
- Cardiovascular Department, Jolimont Hospital, Ferrer St. 159, 7100 La Louviere, Belgium
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16
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Funaki K, Adachi T, Kameshima M, Fujiyama H, Iritani N, Tanaka C, Sakui D, Hara Y, Sugiura H, Yamada S. Factors Associated With Changes in Objectively Measured Moderate to Vigorous Physical Activity in Patients After Percutaneous Coronary Intervention: A Prospective Cohort Study. J Phys Act Health 2023; 20:279-291. [PMID: 36812917 DOI: 10.1123/jpah.2022-0396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/03/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aimed to clarify factors affecting changes in moderate to vigorous physical activity (MVPA) in patients 1 to 3 months after undergoing percutaneous coronary intervention (PCI). METHODS In this prospective cohort study, we enrolled patients aged <75 years who underwent PCI. MVPA was objectively measured using an accelerometer at 1 and 3 months after hospital discharge. Factors associated with increased MVPA (≥150 min/wk at 3 mo) were analyzed in participants with MVPA < 150 minutes per week at 1 month. Univariate and multivariate logistic regression analyses were performed to explore variables potentially associated with increasing MVPA, using MVPA ≥ 150 minutes per week at 3 months as the dependent variable. Factors associated with decreased MVPA (<150 min/wk at 3 mo) were also analyzed in participants with MVPA ≥ 150 minutes per week at 1 month. Logistic regression analysis was performed to explore factors of declining MVPA, using MVPA < 150 minutes per week at 3 months as the dependent variable. RESULTS We analyzed 577 patients (median age 64 y, 13.5% female, and 20.6% acute coronary syndrome). Increased MVPA was significantly associated with participation in outpatient cardiac rehabilitation (odds ratio 3.67; 95% confidence interval, 1.22-11.0), left main trunk stenosis (13.0; 2.49-68.2), diabetes mellitus (0.42; 0.22-0.81), and hemoglobin (1.47, per 1 SD; 1.09-1.97). Decreased MVPA was significantly associated with depression (0.31; 0.14-0.74) and Self-Efficacy for Walking (0.92, per 1 point; 0.86-0.98). CONCLUSIONS Identifying patient factors associated with changes in MVPA may provide insight into behavioral changes and help with individualized PA promotion.
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Affiliation(s)
- Kuya Funaki
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | | | - Hiroaki Fujiyama
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya,Japan
| | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi,Japan
| | - Chikako Tanaka
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi,Japan
| | - Daisuke Sakui
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu,Japan
| | - Yasutaka Hara
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu,Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | - Sumio Yamada
- Department of Cardiology, Aichi Medical University, Nagakute,Japan
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17
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Park S, Park SJ, Park DW. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Revascularization of Left Main Coronary Artery Disease. Korean Circ J 2023; 53:113-133. [PMID: 36914602 PMCID: PMC10011221 DOI: 10.4070/kcj.2022.0333] [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: 12/26/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023] Open
Abstract
Owing to a large-jeopardized myocardium, left main coronary artery disease (LMCAD) represents the substantial high-risk anatomical subset of obstructive coronary artery disease. For several decades, coronary artery bypass grafting (CABG) has been the "gold standard" treatment for LMCAD. Along with advances in CABG, percutaneous coronary intervention (PCI) has also dramatically evolved over time in conjunction with advances in the stent or device technology, adjunct pharmacotherapy, accumulated experiences, and practice changes, establishing its position as a safe, reasonable treatment option for such a complex disease. Until recently, several randomized clinical trials, meta-analyses, and observational registries comparing PCI and CABG for LMCAD have shown comparable long-term survival with tradeoffs between early and late risk-benefit of each treatment. Despite this, there are still several unmet issues for revascularization strategy and management for LMCAD. This review article summarized updated knowledge on evolution and clinical evidence on the treatment of LMCAD, with a focus on the comparison of state-of-the-art PCI with CABG.
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Affiliation(s)
- Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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18
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Tarantini G, Fovino LN, Varbella F, Trabattoni D, Caramanno G, Trani C, De Cesare N, Esposito G, Montorfano M, Musto C, Picchi A, Sheiban I, Gasparetto V, Ribichini FL, Cardaioli F, Saccà S, Cerrato E, Napodano M, Martinato M, Azzolina D, Andò G, Mugnolo A, Caruso M, Rossini R, Passamonti E, Teles RC, Rigattieri S, Gregori D, Tamburino C, Burzotta F. A large, prospective, multicentre study of left main PCI using a latest-generation zotarolimus-eluting stent: the ROLEX study. EUROINTERVENTION 2023; 18:e1108-e1119. [PMID: 36043326 PMCID: PMC9909455 DOI: 10.4244/eij-d-22-00454] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Data on left main (LM) percutaneous coronary interventions (PCI) have mostly been obtained in studies using drug-eluting stent (DES) platforms without dedicated large-vessel devices and with limited expansion capability. AIMS Our study aimed to investigate the safety and efficacy of LM PCI with the latest-generation Resolute Onyx DES. METHODS ROLEX (Revascularization Of LEft main with resolute onyX) is a prospective, multicentre study (ClinicalTrials.gov: NCT03316833) enrolling patients with unprotected LM coronary artery disease and a SYNTAX score <33 undergoing PCI with the Resolute Onyx zotarolimus-eluting coronary stent, that includes dedicated extra-large vessel platforms. The primary endpoint (EP) was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR), at 1 year. All events were adjudicated by an independent clinical event committee. An independent core lab analysed all procedural angiograms. RESULTS A total of 450 patients (mean age 71.8 years, SYNTAX score 24.5±7.2, acute coronary syndrome in 53%) were enrolled in 26 centres. Of these, 77% of subjects underwent PCI with a single-stent and 23% with a 2-stent technique (8% double kissing [DK] crush, 6% culotte, 9% T/T and small protrusion [TAP] stenting). Intravascular imaging guidance was used in 45% (42% intravascular ultrasound [IVUS], 3% optical coherence tomography [OCT]). At 1 year, the primary EP incidence was 5.1% (cardiac death 2.7%, TVMI 2.7%, ID-TLR 2.0%). The definite/probable stent thrombosis rate was 1.1%. In a prespecified adjusted subanalysis, the primary EP incidence was significantly lower in patients undergoing IVUS/OCT-guided versus angio-guided PCI (2.0 vs 7.6%; hazard ratio [HR] 0.28, 95% confidence interval [CI]: 0.13-0.58; p<0.001). CONCLUSIONS In this large, multicentre, prospective registry, LM PCI with the Resolute Onyx DES showed good safety and efficacy at 1 year, particularly when guided by intracoronary imaging.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmine Musto
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Picchi
- Cardiovascular Department, Azienda USL Toscana SudEst, Misericordia Hospital, Grosseto, Italy
| | - Imad Sheiban
- Division of Cardiology, Peschiera del Garda Hospital, Verona, Italy
| | | | - Flavio L Ribichini
- Division of Cardiovascular Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Andò
- Division of Cardiology, University of Messina, Messina, Italy
| | | | - Marco Caruso
- Division of Cardiology, University of Palermo, Palermo, Italy
| | - Roberta Rossini
- Division of Cardiology, ASST Papa Giovanni XXIII Hospital, Cuneo, Italy
| | - Enrico Passamonti
- Division of Cardiology, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Corrado Tamburino
- Cardiology, CAST-Policlinico Hospital, Cardio-Thorax-Vascular and Transplant Department, University of Catania, Catania, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
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19
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Xu N, Jiang L, Yao Y, Xu J, Liu R, Wang H, Song Y, Gao L, Gao Z, Zhao X, Xu B, Han Y, Yuan J. Five-year outcomes of biodegradable versus second-generation durable polymer drug-eluting stents used in complex percutaneous coronary intervention. Chin Med J (Engl) 2023; 136:322-330. [PMID: 36848178 PMCID: PMC10106121 DOI: 10.1097/cm9.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND There are few data comparing clinical outcomes of complex percutaneous coronary intervention (CPCI) when using biodegradable polymer drug-eluting stents (BP-DES) or second-generation durable polymer drug-eluting stents (DP-DES). The purpose of this study was to investigate the safety and efficacy of BP-DES and compare that with DP-DES in patients with and without CPCI during a 5-year follow-up. METHODS Patients who exclusively underwent BP-DES or DP-DES implantation in 2013 at Fuwai Hospital were consecutively enrolled and stratified into two categories based on CPCI presence or absence. CPCI included at least one of the following features: unprotected left main lesion, ≥2 lesions treated, ≥2 stents implanted, total stent length >40 mm, moderate-to-severe calcified lesion, chronic total occlusion, or bifurcated target lesion. The primary endpoint was major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction, and total coronary revascularization (target lesion revascularization, target vessel revascularization [TVR], and non-TVR) during the 5-year follow-up. The secondary endpoint was total coronary revascularization. RESULTS Among the 7712 patients included, 4882 (63.3%) underwent CPCI. Compared with non-CPCI patients, CPCI patients had higher 2- and 5-year incidences of MACE and total coronary revascularization. Following multivariable adjustment including stent type, CPCI was an independent predictor of MACE (adjusted hazard ratio [aHR]: 1.151; 95% confidence interval [CI]: 1.017-1.303, P = 0.026) and total coronary revascularization (aHR: 1.199; 95% CI: 1.037-1.388, P = 0.014) at 5 years. The results were consistent at the 2-year endpoints. In patients with CPCI, BP-DES use was associated with significantly higher MACE rates at 5 years (aHR: 1.256; 95% CI: 1.078-1.462, P = 0.003) and total coronary revascularization (aHR: 1.257; 95% CI: 1.052-1.502, P = 0.012) compared with that of DP-DES, but there was a similar risk at 2 years. However, BP-DES had comparable safety and efficacy profiles including MACE and total coronary revascularization compared with DP-DES in patients with non-CPCI at 2 and 5 years. CONCLUSIONS Patients underwent CPCI remained at a higher risk of mid- to long-term adverse events regardless of the stent type. The effect of BP-DES compared with DP-DES on outcomes was similar in CPCI and non-CPCI patients at 2 years but had inconsistent effects at the 5-year clinical endpoints.
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Affiliation(s)
- Na Xu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Jiang
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Yao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingjing Xu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ru Liu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Huanhuan Wang
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Song
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lijian Gao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhan Gao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xueyan Zhao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yaling Han
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theatre Command, Shenyang, Liaoning 110016, China
| | - Jinqing Yuan
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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20
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Al Hageh C, Chacar S, Ghassibe-Sabbagh M, Platt DE, Henschel A, Hamdan H, Gauguier D, El Murr Y, Alefishat E, Chammas E, O’Sullivan S, Abchee A, Nader M, Zalloua PA. Elevated Lp(a) Levels Correlate with Severe and Multiple Coronary Artery Stenotic Lesions. Vasc Health Risk Manag 2023; 19:31-41. [PMID: 36703868 PMCID: PMC9871050 DOI: 10.2147/vhrm.s394134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Backgrounds and Aims The role of Lipoprotein(a) (Lp(a)) in increasing the risk of cardiovascular diseases is reported in several populations. The aim of this study is to investigate the correlation of high Lp(a) levels with the degree of coronary artery stenosis. Methods Two hundred and sixty-eight patients were enrolled for this study. Patients who underwent coronary artery angiography and who had Lp(a) measurements available were included in this study. Binomial logistic regressions were applied to investigate the association between Lp(a) and stenosis in the four major coronary arteries. The effect of LDL and HDL Cholesterol on modulating the association of Lp(a) with coronary artery disease (CAD) was also evaluated. Multinomial regression analysis was applied to assess the association of Lp(a) with the different degrees of stenosis in the four major coronary arteries. Results Our analyses showed that Lp(a) is a risk factor for CAD and this risk is significantly apparent in patients with HDL-cholesterol ≥35 mg/dL and in non-obese patients. A large proportion of the study patients with elevated Lp(a) levels had CAD even when exhibiting high HDL serum levels. Increased HDL with low Lp(a) serum levels were the least correlated with stenosis. A significantly higher levels of Lp(a) were found in patients with >50% stenosis in at least two major coronary vessels arguing for pronounced and multiple stenotic lesions. Finally, the derived variant (rs1084651) of the LPA gene was significantly associated with CAD. Conclusion Our study highlights the importance of Lp(a) levels as an independent biological marker of severe and multiple coronary artery stenosis.
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Affiliation(s)
- Cynthia Al Hageh
- Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Stephanie Chacar
- Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Michella Ghassibe-Sabbagh
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Daniel E Platt
- Computational Biology Center, IBM TJ Watson Research Centre, Yorktown Hgts, NY, USA
| | - Andreas Henschel
- Department of Electrical Engineering and Computer, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hamdan Hamdan
- Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Dominique Gauguier
- Université Paris Cité, INSERM UMR 1124, Paris, 75006, France,McGill University and Genome Quebec Innovation Centre, Montreal, QC, H3A 0G1, Canada
| | - Yara El Murr
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Elie Chammas
- School of Medicine, Lebanese University, Beirut, Lebanon
| | - Siobhán O’Sullivan
- Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Antoine Abchee
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Moni Nader
- Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Pierre A Zalloua
- Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates,Harvard T.H. Chan School of Public Health, Boston, MA, USA,Correspondence: Pierre A Zalloua; Moni Nader, College of Medicine and Health Sciences, Khalifa University for Science and Technology, PO Box 127788, Abu Dhabi, United Arab Emirates, Email ;
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21
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Daoulah A, Elfarnawany A, Al Garni T, Hersi AS, Alshehri M, Almahmeed W, Yousif N, Abuelatta R, Alasmari A, Elsheikh-Mohamed NE, Alzahrani B, Ghani MA, Amin H, Hashmani S, Hiremath N, Alshali KZ, Elmahrouk Y, Kazim HM, Refaat W, Selim E, Jamjoom A, Feteih MN, El-Sayed O, Al-Faifi SM, Dahdouh Z, Aithal J, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Hussien AF, Abdulhabeeb IAM, Ahmad O, Ramadan M, Alqahtani AH, Abumelha BK, Qenawi W, Shawky A, Ghonim AA, Elmahrouk A, Alhamid S, Maghrabi M, Haddara MM, Aljohar A, Hurley WT, Alshahrani SS, Lotfi A. Outcomes of Myocardial Revascularization in Diabetic Patients With Left Main Coronary Artery Disease: A Multicenter Observational Study From Three Gulf Countries. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:52-61. [PMID: 35961856 DOI: 10.1016/j.carrev.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Real-world data for managing patients with diabetes and left main coronary artery (LMCA) disease are scarce. We compared percutaneous coronary intervention (PCI) outcomes versus coronary artery bypass grafting (CABG) in diabetes and LMCA disease patients. METHODS We retrospectively studied patients with LMCA presented to 14 centers from 2015 to 2019. The study included 2138 patients with unprotected LMCA disease; 1468 (68.7 %) had diabetes. Patients were grouped into; diabetes with PCI (n = 804) or CABG (n = 664) and non-diabetes with PCI (n = 418) or CABG (n = 252). RESULTS In diabetes, cardiac (34 (5.1 %) vs. 22 (2.7 %); P = 0.016), non-cardiac (13 (2 %) vs. 6 (0.7 %); P = 0.027) and total hospital mortality (47 (7.1 %) vs. 28 (3.5 %); P = 0.0019), myocardial infarction (45 (6.8 %) vs. 11 (1.4 %); P = 0.001), cerebrovascular events (25 (3.8 %) vs. 12 (1.5 %); P = 0.005) and minor bleeding (65 (9.8 %) vs. 50 (6.2 %); P = 0.006) were significantly higher in CABG patients compared to PCI; respectively. The median follow-up time was 20 (10-37) months. In diabetes, total mortality was higher in CABG (P = 0.001) while congestive heart failure was higher in PCI (P = 0.001). There were no differences in major adverse cerebrovascular events and target lesion revascularization between PCI and CABG. Predictors of mortality in diabetes were high anatomical SYNTAX, peripheral arterial disease, chronic kidney disease, and cardiogenic shock. CONCLUSIONS In this multicenter retrospective study, we found no significant difference in clinical outcomes during the short-term follow-up between PCI with second-generation DES and CABG except for lower total mortality and a higher rate of congestive heart failure in PCI group of patients. Randomized trials to characterize patients who could benefit from each treatment option are needed.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.
| | - Amr Elfarnawany
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Bahrain
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | | | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | | | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Bahrain
| | - Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Niranjan Hiremath
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Khalid Z Alshali
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Maun N Feteih
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Osama El-Sayed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Salem M Al-Faifi
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, United Arab Emirates
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulwali Abohasan
- Department of Cardiology, Prince Sultan Cardiac Center, Qassim, Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | | | | | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
| | | | - Bader K Abumelha
- Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Sameer Alhamid
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohamed Maghrabi
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mamdouh M Haddara
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - William T Hurley
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Saif S Alshahrani
- Department of Emergency Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, United States
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22
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Kinnaird T, Gallagher S, Farooq V, Protty M, Back L, Devlin P, Anderson R, Sharp A, Ludman P, Copt S, Mamas MA, Curzen N. Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017. Circ Cardiovasc Interv 2023; 16:e012350. [PMID: 36649390 DOI: 10.1161/circinterventions.122.012350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain. METHODS Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment-elevation, cardiogenic shock, and with an emergency indication for PCI. RESULTS Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01-1.03]), female sex (odds ratio, 1.47 [1.19-1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02-2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45-0.70]), and year of PCI (odds ratio, 0.63 [0.46-0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events. CONCLUSIONS Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.
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Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.).,Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom (T.K., M.A.M.)
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Vasim Farooq
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Majd Protty
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Liam Back
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Peadar Devlin
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Andrew Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, United Kingdom (P.L.)
| | - Samuel Copt
- Division of Statistics, Biosensors SA, Morges, Switzerland (S.C.)
| | - Mamas A Mamas
- Department of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.).,Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom (T.K., M.A.M.)
| | - Nick Curzen
- Department of Cardiology, University Hospital NHS Trust, Southampton, United Kingdom (N.C.)
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23
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Xu YJ, Yang PJ, Chen ZQ, Liu P, Wen W, Li XW, Guo JQ, Deng YZ. Five-year follow-up on two revascularization methods used on patients with left main artery disease and/or multivessel coronary artery disease. Technol Health Care 2022; 31:1093-1103. [PMID: 36617804 DOI: 10.3233/thc-220629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are the main treatment methods for left main artery disease (LMAD) and triple-vessel coronary artery disease (TVCAD). OBJECTIVE This study aimed to evaluate the five-year post-treatment effects of CABG and PCI in patients with severe coronary vasculopathy. METHODS A total of 430 patients with LMAD and/or triple-vessel coronary artery disease from November 2014 to July 2015 were enrolled retrospectively in the affiliated cardiovascular hospital of Shanxi Medical University and divided into the CABG group and PCI group. The living conditions of the patients were obtained through medical records and telephonic follow-ups five years after the surgery date. The independent risk factors for major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed using logistic regression analysis. The effects of the two treatment methods were followed up and evaluated to measure the predictive ability of the Global Risk Classification (GRC) scoring system for MACCE after five years. RESULTS There were 212 cases in the CABG group and 218 cases in the PCI group. Smoking (P= 0.047), diabetes (P= 0.031), LVEF (P= 0.020), LMAD (P= 0.008), and anterior descending branch lesions (P= 0.038) were significantly correlated with MACCE. The prevalence of MACCE in the CABG group and PCI group had no significant difference (P= 0.549). The GRC scoring system received an AUC of 0.701 for predicting MACCE. CONCLUSION For patients with severe coronary artery disease, there was no significant difference in the prevalence of MACCE between the CABG and the PCI groups. Several independent risk factors for MACCE were found. The GRC scoring system showed a strong predictive ability for MACCE after five years of revascularization.
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Affiliation(s)
- Yi-Jun Xu
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Peng-Jie Yang
- Department of Thoracic Surgery, The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Zhi-Qiang Chen
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Peng Liu
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Wen Wen
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Xiao-Wei Li
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Jia-Qi Guo
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Yong-Zhi Deng
- Department of Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
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24
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Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients. Eur J Trauma Emerg Surg 2022; 49:1295-1302. [DOI: 10.1007/s00068-022-02168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/04/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Background
In-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown.
Purpose
To assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center.
Methods
All trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale.
Results
In total, 433 patients (median age 50 years, 67% male, 89% ASA 1–2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.
Conclusion
Coronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.
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25
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Cho S, Kang DY, Kim JS, Park DW, Kim IS, Kang TS, Ahn JM, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Lee SJ, Hong SJ, Ahn CM, Kim BK, Ko YG, Choi D, Jang Y, Hong MK, Park SJ. Tratamiento antiagregante plaquetario doble tras la intervención coronaria percutánea del tronco coronario izquierdo. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Abstract
Traditionally, the treatment of left main coronary artery disease is recommended coronary artery bypass grafting because of its superior long-term outcomes compared with medical treatment and plain old balloon angioplasty. However, improvement of percutaneous coronary intervention technique and introduction of drug-eluting stent led to change of treatment strategy of left main coronary artery disease through cumulative data for revascularization that based on clinical evidence.
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Affiliation(s)
- Jinho Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
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27
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Sadeh M, Agay N, Brauer M, Chudnovsky A, Ziv A, Dankner R. Is health-related quality of life 1-year after coronary artery bypass graft surgery associated with living in a greener environment? ENVIRONMENTAL RESEARCH 2022; 212:113364. [PMID: 35487257 DOI: 10.1016/j.envres.2022.113364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Greenery in the residential environment and in the hospital has been associated with improved surgical outcomes and recovery. We investigated the association between the level of residential greenness of patients with coronary disease and their heart disease-related Quality of Life (HRQoL) 1-year after a coronary artery bypass grafting (CABG) surgery. METHODS Participants in a prospective cohort study who underwent CABG surgery at seven cardiothoracic units throughout Israel during the years 2004-2007 filled in the MacNew HRQoL one day before and one year after surgery. Successful recovery was defined as ≥0.5 increase in the MacNew score between baseline and follow-up. Exposure to residential greenness in 90 m and 300 m buffers around the patient's home was assessed with Linear Spectral Unmixing analysis of Landsat 30 m imagery. RESULTS The cohort comprised of 861 patients (22% female) with a mean age of 65.5 years, and 59.2% classified as low-income. In the total cohort, higher residential greenness was associated with an improvement in emotional HRQoL (OR = 1.33 (95%CI: 0.99-1.79)), adjusting for demographic and socio-economic factors, living in the periphery/center, presence of diabetes, attending cardiac rehabilitation following surgery, BMI, and change in physical fitness and depression over the 1-year follow-up. Although no association was found between greenness and change in the physical or social subscales, a positive association was specifically observed among the low-income patients for the global HRQoL score, OR = 1.42 (95%CI: 0.97-2.10), as compared to the higher-income patients, p for interaction = 0.03. CONCLUSIONS Residential greenness is associated with improvement in HRQoL 1-year after CABG surgery, but not the physical and social scales, only in low-income patients. Ensuring greenery in the living environment may act as a social intervention that supports human health and disease recovery.
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Affiliation(s)
- Maya Sadeh
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Nirit Agay
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Brauer
- School of Population & Public Health, University of British Columbia, Canada
| | - Alexandra Chudnovsky
- AIR-O Lab, Porter School of Environment and Earth Sciences, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Israel
| | - Arnona Ziv
- Unit for Data Management and Computerization, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Rachel Dankner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
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Kheifets M, Vons SA, Bental T, Vaknin-Assa H, Greenberg G, Samara A, Codner P, Wittberg G, Talmor Barkan Y, Perl L, Kornowski R, Levi A. Temporal Trends in Complex Percutaneous Coronary Interventions. Front Cardiovasc Med 2022; 9:913588. [PMID: 35811722 PMCID: PMC9263118 DOI: 10.3389/fcvm.2022.913588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Accumulated experience combined with technological advancements in percutaneous coronary interventions (PCI) over the past four decades, has led to a gradual increase in PCI utilization and complexity. We aimed to investigate the temporal trends in PCI complexity and the outcomes of complex PCI (C-PCI) in our institution. Methods We analyzed 20,301 consecutive PCI procedures performed over a 12-year period. C-PCI was defined as a procedure involving at least one of the following: Chronic total occlusion (CTO), left main (LM), bifurcation or saphenous vein graft (SVG) PCI. Four periods of 3-year time intervals were defined (2008–10, 2011–2013, 2014–2016, 2017–2019), and temporal trends in the rate and outcomes of C-PCI within these intervals were studied. Endpoints included mortality and major adverse cardiac events [MACE: death, acute myocardial infarction (MI), and target vessel revascularization (TVR)] at 1 year. Results A total of 5,647 (27.8%) C-PCI procedures were performed. The rate of C-PCI has risen significantly since 2,017 (31.2%, p < 0.01), driven mainly by bifurcation and LM interventions (p < 0.01). At 1-year, rates of death, acute MI, TVR and MACE, were all significantly higher in the C-PCI group (8.8 vs. 5.1%, 5.6 vs. 4.5%, 5.5 vs. 4.0%, 17.2 vs. 12.2%, p < 0.001 for all, respectively), as compared to the non-complex group. C-PCI preformed in the latter half of the study period (2014–2019) were associated with improved 1-year TVR (4.4% and 4.8% vs. 6.7% and 7.1%, p = 0.01, respectively) and MACE (13.8% and 13.5% vs. 17.3% and 18.2%, p = 0.001, respectively) rates compared to the earlier period (2007–2013). Death rate had not significantly declined with time. Conclusion In the current cohort, we have detected a temporal increase in PCI complexity coupled with improved 1-year clinical outcomes in C-PCI.
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Affiliation(s)
- Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Abigail Vons
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abed Samara
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Wittberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor Barkan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dual antiplatelet therapy after percutaneous coronary intervention for left main coronary artery disease. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 76:245-252. [PMID: 35907438 DOI: 10.1016/j.rec.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES There are scarce data on the optimal duration and prognostic impact of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents for left main coronary artery (LMCA) disease. The aim of this study was to investigate the practice pattern and long-term prognostic effect of DAPT duration in patients undergoing PCI with second-generation drug-eluting stents for LMCA disease. METHODS Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1827 patients undergoing PCI with second-generation drug-eluting stents for LMCA disease with valid information on DAPT duration were included. The efficacy outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and the safety outcome was TIMI major bleeding. RESULTS DAPT duration was <6 months (n=273), 6 to 12 months (n=477), 12 to 24 months (n=637), and ≥ 24 months (n=440). The median follow-up duration was 3.9 [interquartile range, 3.01-5.00] years. Prolonged DAPT duration was associated with lower incidences of MACE. In multigroup propensity score analysis, adjusted HR for MACE were significantly higher for DAPT <6 months and DAPT 6 to 12 months than for DAPT 12 to 24 months (HR, 4.51; 95%CI, 2.96-6.88 and HR 1.92; 95%CI, 1.23-3.00). There was no difference in HR for major bleeding among the assessed groups. CONCLUSIONS DAPT duration following PCI for LMCA disease is highly variable. Although the duration of DAPT should be considered in the context of the clinical situation of each patient, <12 months of DAPT was associated with higher incidence of MACE. Registration identifiers: NCT01341327; NCT03908463.
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Outcomes of Left Main Revascularization after Percutaneous Intervention or Bypass Surgery. J Interv Cardiol 2022; 2022:6496777. [PMID: 35494423 PMCID: PMC9019449 DOI: 10.1155/2022/6496777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study is aimed at comparing the clinical outcomes of unprotected left main coronary artery disease (ULMCAD) treatment with contemporary percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a “real-world” population. Methods and Results Overall, 558 consecutive patients with ULMCAD (mean age 71 ± 9 years, male gender 81%) undergoing PCI or CABG were compared. The primary endpoint was the composite of death, nonfatal myocardial infarction, or stroke. Diabetes was present in 29% and acute coronary syndrome in 56%; mean EuroSCORE was 11 ± 8. High coronary complexity (SYNTAX score >32) was present in 50% of patients. The primary composite endpoint was similar after PCI and CABG up to 4 years (15.5 ± 3.1% vs. 17.1 ± 2.6%; p=0.585). The primary end point was also comparable in a two propensity score matched cohorts. Ischemia-driven revascularization was more frequently needed in PCI than in CABG (5.5% vs. 1.5%; p=0.010). By multivariate analysis, diabetes mellitus (HR 2.00; p=0.003) and EuroSCORE (HR 3.71; p < 0.001) were the only independent predictors associated with long-term outcome. Conclusions In a “real-world” population with ULMCAD, a contemporary revascularization strategy by PCI or CABG showed similar long-term clinical outcome regardless of the coronary complexity.
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Hanson L, Vogrin S, Noaman S, Dinh D, Zheng W, Lefkovits J, Brennan A, Reid C, Stub D, Duffy SJ, Layland J, Freeman M, van Gaal W, Cox N, Chan W. Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery. Am J Cardiol 2022; 168:39-46. [PMID: 35115134 DOI: 10.1016/j.amjcard.2021.12.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/01/2022]
Abstract
Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.
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Park S, Park SJ, Park DW. Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. JACC: ASIA 2022; 2:119-138. [PMID: 36339118 PMCID: PMC9627854 DOI: 10.1016/j.jacasi.2021.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
For several decades, coronary artery bypass grafting has been regarded as the standard choice of revascularization for significant left main coronary artery (LMCA) disease. However, in conjunction with remarkable advancement of device technology and adjunctive pharmacology, percutaneous coronary intervention (PCI) offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected patients with LMCA disease. Several landmark randomized clinical trials showed that PCI with drug-eluting stents for LMCA disease is a safe option with similar long-term survival rates to coronary artery bypass grafting surgery, especially in those with low and intermediate anatomic risk. Although it is expected that the updated evidence from recent randomized clinical trials will determine the next guidelines for the foreseeable future, there are still unresolved and unmet issues of LMCA revascularization and PCI strategy. This paper provides a comprehensive review on the evolution and an update on the management of LMCA disease. With advancements in PCI, clinical outcomes after left main PCI have progressively improved. Unmet needs still exist between clinical practice and the current evidence for left main PCI. Better decision making of revascularization choice and PCI optimization should be emphasized to improve outcomes of LMCA disease. Further research will provide further evidence to resolve conflicting issues on left main PCI.
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Watanabe Y, Mitomo S, Naganuma T, Matsuoka S, Chieffo A, Montorfano M, Tahara S, Okutsu M, Kuroita N, Nakamura S, Nakamura S, Colombo A. Impact of Left Main Calcium With Chronic Kidney Disease on Outcomes After Percutaneous Coronary Intervention for Left Main Narrowings (from the Milan and New-Tokyo Registry). Am J Cardiol 2022; 168:31-38. [PMID: 35144770 DOI: 10.1016/j.amjcard.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022]
Abstract
Limited data are available about the association between coronary artery calcification and chronic kidney disease severity on clinical outcomes after percutaneous coronary intervention (PCI). This study aimed to assess the association between coronary artery calcification and chronic kidney disease severity on clinical outcomes after PCI. We identified 1,391 patients treated with drug-eluting stent for unprotected left main distal bifurcation lesions (ULMD), including 604 without calcified lesions (noncalcified left main group) and 787 with calcified ULMD (calcified left main group) in Japan and Italy. We divided the calcified group into the following 2 groups: estimated glomerular filtration rate (eGFR) ≥30 (n = 687) and <30 (n = 100) and compared the clinical outcomes. The primary end point was target lesion failure (TLF) at 3 years. TLF was defined as a composite of cardiac death, target lesion revascularization, and myocardial infarction. TLF occurred more frequently in the calcified group (adjusted hazard ratio 1.36, 95% confidence interval 1.08 to 1.71, p = 0.01), especially in calcified ULMD with eGFR <30 (adjusted hazard ratio relative to the other 2 groups 2.59, 95% confidence interval 1.60 to 4.18, p <0.001). In conclusion, the calcified ULMD treated with PCI was associated with poorer clinical outcomes than noncalcified ULMD, especially in those with eGFR <30.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Satoshi Matsuoka
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Satoko Tahara
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Masaaki Okutsu
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kuroita
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Shotaro Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Clinical and Research Center, Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan, Italy
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Mohammad MA, Persson J, Buccheri S, Odenstedt J, Sarno G, Angerås O, Völz S, Tödt T, Götberg M, Isma N, Yndigegn T, Tydén P, Venetsanos D, Birgander M, Olivecrona GK. Trends in Clinical Practice and Outcomes After Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery. J Am Heart Assoc 2022; 11:e024040. [PMID: 35350870 PMCID: PMC9075483 DOI: 10.1161/jaha.121.024040] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The use of percutaneous coronary intervention (PCI) to treat unprotected left main coronary artery disease has expanded rapidly in the past decade. We aimed to describe nationwide trends in clinical practice and outcomes after PCI for left main coronary artery disease. Methods and Results Patients (n=4085) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) as undergoing PCI for left main coronary artery disease from 2005 to 2017 were included. A count regression model was used to analyze time‐related differences in procedural characteristics. The 3‐year major adverse cardiovascular and cerebrovascular event rate defined as death, myocardial infarction, stroke, and repeat revascularization was calculated with the Kaplan‐Meier estimator and Cox proportional hazard model. The number of annual PCI procedures grew from 121 in 2005 to 589 in 2017 (389%). The increase was greater for men (479%) and individuals with diabetes (500%). Periprocedural complications occurred in 7.9%, decreasing from 10% to 6% during the study period. A major adverse cardiovascular and cerebrovascular event occurred in 35.7% of patients, falling from 45.6% to 23.9% (hazard ratio, 0.56; 95% CI, 0.41–0.78; P=0.001). Radial artery access rose from 21.5% to 74.2% and intracoronary diagnostic procedures from 14.0% to 53.3%. Use of bare‐metal stents and first‐generation drug‐eluting stents fell from 19.0% and 71.9%, respectively, to 0, with use of new‐generation drug‐eluting stents increasing to 95.2%. Conclusions Recent changes in clinical practice relating to PCI for left main coronary artery disease are characterized by a 4‐fold rise in procedures conducted, increased use of evidence‐based adjunctive treatment strategies, intracoronary diagnostics, newer stents, and more favorable outcomes.
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Affiliation(s)
- Moman A Mohammad
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine Department of Clinical Sciences Karolinska InstitutetDanderyd University Hospital Stockholm Sweden
| | - Sergio Buccheri
- Division of Cardiology Uppsala UniversityUppsala University hospital Uppsala Sweden
| | - Jacob Odenstedt
- Department of Cardiology Gothenburg UniversitySahlgrenska University Hospital Gothenburg Sweden
| | - Giovanna Sarno
- Division of Cardiology Uppsala UniversityUppsala University hospital Uppsala Sweden
| | - Oskar Angerås
- Department of Cardiology Gothenburg UniversitySahlgrenska University Hospital Gothenburg Sweden
| | - Sebastian Völz
- Department of Cardiology Gothenburg UniversitySahlgrenska University Hospital Gothenburg Sweden
| | - Tim Tödt
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Matthias Götberg
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Nazim Isma
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Troels Yndigegn
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Patrik Tydén
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Dimitrios Venetsanos
- Department of Cardiology Karolinska Institutet Solna and Karolinska University Hospital Stockholm Sweden
| | - Mats Birgander
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Göran K Olivecrona
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
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Nakano S, Kohsaka S, Chikamori T, Fukushima K, Kobayashi Y, Kozuma K, Manabe S, Matsuo H, Nakamura M, Ohno T, Sawano M, Toda K, Ueda Y, Yokoi H, Gatate Y, Kasai T, Kawase Y, Matsumoto N, Mori H, Nakazato R, Niimi N, Saito Y, Shintani A, Watanabe I, Watanabe Y, Ikari Y, Jinzaki M, Kosuge M, Nakajima K, Kimura T. JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease. Circ J 2022; 86:882-915. [DOI: 10.1253/circj.cj-21-1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shintaro Nakano
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University
| | | | - Ken Kozuma
- Cardiology, Teikyo University School of Medicine
| | - Susumu Manabe
- Cardiac Surgery, International University of Health and Welfare Mita Hospital
| | | | - Masato Nakamura
- Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Koichi Toda
- Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Hiroyoshi Yokoi
- Cardiovascular Center, International University of Health and Welfare Fukuoka Sanno Hospital
| | - Yodo Gatate
- Cardiology, Self-Defense Forces Central Hospital
| | | | | | | | - Hitoshi Mori
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Yuichi Saito
- Cardiovascular Medicine, Chiba University School of Medicine
| | - Ayumi Shintani
- Medical Statistics, Osaka City University Graduate School of Medicine
| | - Ippei Watanabe
- Cardiovascular Medicine, Toho University School of Medicine
| | | | - Yuji Ikari
- Cardiology, Tokai University School of Medicine
| | | | | | - Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Skorupski WJ, Kałużna-Oleksy M, Lesiak M, Araszkiewicz A, Skorupski W, Grajek S, Mitkowski P, Pyda M, Grygier M. Short- and Long-Term Outcomes of Left Main Coronary Artery Stenting in Patients Disqualified from Coronary Artery Bypass Graft Surgery. J Pers Med 2022; 12:jpm12030348. [PMID: 35330348 PMCID: PMC8953089 DOI: 10.3390/jpm12030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022] Open
Abstract
The study aims to evaluate the short- and long-term outcomes of left main percutaneous coronary interventions (LM PCI) in patients disqualified from coronary artery bypass graft surgery (CABG). We included 459 patients (mean age: 68.4 ± 9.4 years, 24.4% females), with at least 1-year follow-up; 396 patients in whom PCI was offered as an alternative to CABG (Group 1); and 63 patients who were disqualified from CABG by the Heart Team (Group 2). The SYNTAX score (29.1 ± 9.5 vs. 23.2 ± 9.7; p < 0.001) and Euroscore II value (2.72 ± 2.01 vs. 2.15 ± 2.16; p = 0.007) were significantly higher and ejection fraction was significantly lower (46% vs. 51.4%; p < 0.001) in Group 2. Patients in Group 2 more often required complex stenting techniques (33.3% vs. 16.2%; p = 0.001). The procedure success rates were very high and did not differ between groups (100% vs. 99.2%; p = 0.882). We observed no difference in periprocedural complication rates (12.7% vs. 7.8%; p = 0.198), but the long-term all-cause mortality rate was higher in Group 2 (26% vs. 21%; p = 0.031). LM PCI in patients disqualified from CABG is an effective and safe procedure with a low in-hospital complication rate. Long-term results are satisfactory.
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Yoon YH, Ahn JM, Lee JB, Kang DY, Park H, Jeong YJ, Lee J, Kim JH, Yang Y, Hyun J, Lee PH, Park DW, Park SJ. Time-Dependent Impact of Sex on the Long-Term Outcomes After Left Main Revascularization. J Am Heart Assoc 2022; 11:e021720. [PMID: 35189706 PMCID: PMC9075067 DOI: 10.1161/jaha.121.021720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There are still limited data about the differential effect of sex on long‐term outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery disease. This extended follow‐up study of the MAIN‐COMPARE (Ten‐Year Outcomes of Stents Versus Coronary‐Artery Bypass Grafting for Left Main Coronary Artery Disease) registry evaluated clinical outcomes beyond 10 years. Methods and Results Of 2240 patients with unprotected left main coronary artery disease (PCI=1102 and CABG=1138), all‐cause mortality, the composite of death, Q‐wave myocardial infarction, or stroke, and target vessel revascularization were separately evaluated in both sexes. Of 2240 patients, 631 (28.2%) were women and 1609 (71.8%) were men. Women had lower 10‐year incidences of death and serious composite outcomes than men. The adjusted 10‐year risks of adverse outcomes were similar in men. However, the adjusted 10‐year risks were different according to a prespecified period in women. In the short‐term (0–1 year) period, PCI had a significantly lower risk for serious composite outcomes (adjusted hazard ratio [HR], 0.41; 95% CI, 0.19–0.91; P=0.03) compared with CABG. The adjusted risks for death and serious composite outcomes were significantly higher after PCI than after CABG, during the midterm (1–5 years) period (death; adjusted HR, 3.99; 95% CI, 2.01–7.92; P<0.001 and composite outcome; adjusted HR, 2.93; 95% CI, 1.59–5.39; P=0.001). Beyond 5 years, adjusted risks were similar after PCI and CABG in women. Conclusions In this 10‐year extended follow‐up study of patients undergoing left main coronary artery revascularization, we observed a time‐dependent impact of sex on the long‐term outcomes after PCI and CABG, especially in women, with significant interactions. However, these results warrant confirmation on larger series of studies. Registration URl: https://www.clinicaltrials.gov; Unique identifier: NCT02791412.
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Affiliation(s)
- Yong-Hoon Yoon
- Department of Cardiology Chungnam National University Sejong HospitalChungnam National University School of Medicine Sejong Korea
| | - Jung-Min Ahn
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology & Biostatistics Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Do-Yoon Kang
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Hanbit Park
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Yeong Jin Jeong
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Junghoon Lee
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Ju Hyeon Kim
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Yujin Yang
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Junho Hyun
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Pil Hyung Lee
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Duk-Woo Park
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
| | - Seung-Jung Park
- Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea
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Moroni F, Beneduce A, Giustino G, Briede I, Park SJ, Daemen J, Claude Morice M, Nakamura S, Meliga E, Cerrato E, Makkar RR, D'Ascenzo F, Lucarelli C, Capranzano P, Tchetche D, Templin C, Kirtane A, Buzman P, Alfieri O, Valgimigli M, Mehran R, Colombo A, Montorfano M, Chieffo A. Sex Differences in Outcomes After Percutaneous Coronary Intervention or Coronary Artery Bypass Graft for Left Main Disease: From the DELTA Registries. J Am Heart Assoc 2022; 11:e022320. [PMID: 35189691 PMCID: PMC9075069 DOI: 10.1161/jaha.121.022320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Controversy exists over whether sex has significant interaction with revascularization strategy for unprotected left main coronary artery disease. Higher mortality has been reported among women treated with percutaneous coronary intervention compared with coronary artery bypass grafting. Methods and Results The DELTA (Drug‐Eluting Stents for Left Main Coronary Artery Disease) and DELTA‐2 registries are international, multicentric registries evaluating the outcomes of subjects undergoing coronary revascularization for unprotected left main coronary artery disease. The primary outcome was a composite of death, myocardial infarction, or cerebrovascular accidents. The population consisted of 6253 patients, including 1689 (27%) women. Women were older and more likely to have diabetes and chronic kidney disease than men (P<0.05). At a median follow‐up of 29 months (interquartile range 12–49), a significant interaction between sex and revascularization strategy was observed for the primary end point (pint=0.012) and all‐cause death (pint=0.037). Among women, compared with percutaneous coronary intervention, coronary artery bypass grafting was associated with lower risk of the primary end point (event rate 9.5% versus 15.3%; adjusted hazard ratio [AHR], 0.53; 95% CI, 0.35–0.79, P<0.001) and all‐cause death (event rate 5.6% versus 11.7% AHR, 0.50; 95% CI, 0.30–0.82) and no significant differences were observed in men. Conclusions In women undergoing coronary revascularization for unprotected left main coronary artery disease, coronary artery bypass grafting was associated with lower risk of death, myocardial infarction, or cerebrovascular accidents whereas no significant differences between coronary artery bypass grafting and percutaneous coronary intervention were observed in men. Further dedicated studies are needed to determine the optimal revascularization strategy in women with unprotected left main coronary artery disease.
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Affiliation(s)
| | - Alessandro Beneduce
- Interventional Cardiology Unit San Raffaele Scientific Institute Milan Italy
| | | | - Ieva Briede
- Latvian Centre of CardiologyPauls Stradins Clinical University Hospital Riga Latvia
| | - Seung-Jung Park
- The Heart InstituteUniversity of Ulsan College of MedicineAsan Medical CenterUniversity of Ulsan Seoul Republic of Korea
| | - Joost Daemen
- Erasmus Medical CenterThoraxcenter Rotterdam the Netherlands
| | | | - Sunao Nakamura
- Interventional Cardiology Unit New Tokyo Hospital Chiba Japan
| | | | - Enrico Cerrato
- San Luigi Gonzaga University HospitalOrbassano and Infermi Hospital, Rivoli Turin Italy
| | - Raj R Makkar
- Cedars-Sinai Heart InstituteCedars-Sinai Medical Center Los Angeles California
| | - Fabrizio D'Ascenzo
- Department of Internal Medicine Division of Cardiology University of TurinCittà della Salute e della Scienza Turin Italy
| | - Carla Lucarelli
- Department of Biomedical Sciences Humanitas University Rozzano Milan Italy
| | - Piera Capranzano
- Department of Cardiology Ferrarotto Hospital University of Catania Catania Italy
| | | | | | - Ajay Kirtane
- Columbia University Medical Center and Cardiovascular Research Foundation New York City New York
| | | | - Ottavio Alfieri
- Cardiac Surgery Unit IRCCS Ospedale San Raffaele Milan Italy
| | - Marco Valgimigli
- Department of Cardiology Bern University HospitalInselspitalUniversity of Bern Bern Switzerland
| | | | - Antonio Colombo
- Department of Biomedical Sciences Humanitas University Rozzano Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit San Raffaele Scientific Institute Milan Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit San Raffaele Scientific Institute Milan Italy
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Park SJ, Park DW. International variation in modality and outcomes of left main revascularisation: does it really matter? EUROINTERVENTION 2022; 17:1048-1049. [PMID: 35089133 PMCID: PMC9725086 DOI: 10.4244/eij-e-21-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Park H, Ahn JM, Kang DY, Kim SO, Ko E, Kim TO, Lee PH, Lee SW, Park SW, Park DW, Park SJ. Very Long-term Safety and Effectiveness of Drug-Eluting or Bare-Metal Stents for Left Main Coronary Disease. CJC Open 2021; 3:1199-1206. [PMID: 34888503 PMCID: PMC8636232 DOI: 10.1016/j.cjco.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Limited data are available on the long-term outcomes of drug-eluting stents (DES) vs bare-metal stents (BMS) in patients with left main coronary artery (LMCA) disease. Methods In this observational cohort of the Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty vs Surgical Revascularization (MAIN-COMPARE) registry, we evaluated patients with unprotected LMCA stenosis who received DES or BMS between January 2000 and June 2006. The primary outcome was a composite of all-cause death or myocardial infarction (MI) at 10 years. Adjusted outcomes were compared using propensity scores and inverse probability of treatment weighting. Results A total of 1102 patients underwent DES (n = 784) or BMS (n = 318) during the study period. At 10 years, the adjusted rate of the primary outcome was significantly lower in DES group than in the BMS group (27.9% vs 37.0%; hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.53-0.94; P = 0.02). The adjusted 10-year mortality rate was significantly lower in DES group than in the BMS group (20.6% vs 29.6%; HR, 0.65; 95% CI, 0.46-0.91; P = 0.01), whereas the 10-year rate of MI was similar between the 2 groups (9.9% vs 11.0%; HR, 0.93; 95% CI, 0.54-1.59; P = 0.78). DES use was associated with a significant reduction in the rate of target-lesion revascularization (10.2% vs 21.8%; HR, 0.41; 95% CI, 0.27-0.61; P < 0.001). Conclusions In this 10-year follow-up study in patients with LMCA disease, DES use was associated with a significant reduction in the rate of the composite of death or MI, mortality, and target-lesion revascularization, when compared with BMS.
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon-Ok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Oh Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Hyung Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Wook Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 508] [Impact Index Per Article: 169.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Kim TO, Ahn JM, Kang DY, Park H, Kim SO, Lee PH, Lee J, Kim JH, Jeong YJ, Yang Y, Hyun J, Kim HJ, Kim JB, Choo SJ, Chung CH, Lee JW, Park SJ, Park DW. Long-Term Outcomes After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents or Coronary Artery Bypass Grafting for Multivessel Coronary Disease. Am J Cardiol 2021; 160:21-30. [PMID: 34610874 DOI: 10.1016/j.amjcard.2021.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
More evidence is required with respect to the comparative effectiveness of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DESs) versus coronary artery bypass grafting (CABG) in contemporary clinical practice. This prospective observational registry-based study compared the outcomes of 6,647 patients with multivessel disease who underwent PCI with second-generation DES (n = 3,858) or CABG (n = 2,789) between January 2006 and June 2018 and for whom follow-up data were available for at least 2 to 13 years (median 4.8). The primary outcome was a composite of death, spontaneous myocardial infarction, or stroke. Baseline differences were adjusted using propensity scores and inverse probability weighting. In the overall cohort, there were no significant between-group differences in the adjusted risks for the primary composite outcome (hazard ratio [HR] for PCI vs CABG 1.03, 95% confidence interval [CI] 0.86 to 1.25, p = 0.73) and all-cause mortality (HR 0.95, 95% CI 0.76 to 1.20, p = 0.68). This relative treatment effect on the primary outcome was similar in patients with diabetes (HR 1.15, 95% CI 0.91 to 1.46, p = 0.25) and without diabetes (HR 0.95, 95% CI 0.73 to 1.22, p = 0.67) (p for interaction = 0.24). The adjusted risk of the primary outcome was significantly greater after PCI than after CABG in patients with left main involvement (HR 1.39, 95% CI 1.01 to 1.90, p = 0.044), but not in those without left main involvement (HR 0.94, 95% CI 0.76 to 1.16, p = 0.56) (p = 0.03 for interaction). In this prospective real-world long-term registry, we observed that the risk for the primary composite of death, spontaneous myocardial infarction, or stroke was similar between PCI with contemporary DES and CABG.
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Affiliation(s)
- Tae Oh Kim
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hanbit Park
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seon Ok Kim
- Division of Biostatics, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junghoon Lee
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyeon Kim
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeong Jin Jeong
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yujin Yang
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junho Hyun
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol-Hyun Chung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Lee
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Chiarito M, Kini A, Roumeliotis A, Cao D, Power D, Sartori S, Reisman A, Zhang Z, Mtisi T, Nicolas J, Nardin M, Stefanini G, Baber U, Giustino G, Sweeny J, Mehran R, Sharma S, Dangas G. Prevalence and Impact of High Bleeding Risk in Patients Undergoing Left Main Artery Disease PCI. JACC Cardiovasc Interv 2021; 14:2447-2457. [PMID: 34794650 DOI: 10.1016/j.jcin.2021.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence and prognostic impact of high bleeding risk (HBR), as determined by the Academic Research Consortium HBR criteria, in real-world patients undergoing left main (LM) percutaneous coronary intervention (PCI). BACKGROUND LM PCI is often reserved for patients at increased risk for periprocedural adverse events. Patients at HBR represent a relevant percentage of this cohort, but their outcomes after LM PCI are still poorly investigated. METHODS All patients undergoing LM PCI between 2014 and 2017 at a tertiary care center were prospectively enrolled. Patients were defined as having HBR if they met at least 1 major or 2 minor Academic Research Consortium HBR criteria. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months. RESULTS Among 619 enrolled patients, 55.3% were at HBR. The rate of the primary endpoint was 4-fold higher in patients at HBR compared with those without HBR (20.5% vs 4.9%; HR: 4.43; 95% CI: 2.31-8.48), driven by an increased risk for all-cause death (HR: 3.88; 95% CI: 1.88-8.02) and MI (HR: 6.18; 95% CI: 1.83-20.9). Rates of target vessel or lesion revascularization and stent thrombosis were comparable in the 2 groups. Bleeding occurred more frequently in patients at HBR (HR: 3.77; 95% CI: 1.83-7.76). Consistent findings were observed after Cox multivariable regression adjustment. CONCLUSIONS Among patients undergoing LM PCI, those with HBR are at increased risk for all-cause death, MI, and bleeding. Conversely, rates of repeat revascularization and stent thrombosis were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.
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Affiliation(s)
- Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Reisman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tafadzwa Mtisi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Watanabe Y, Mitomo S, Naganuma T, Chieffo A, Montorfano M, Nakamura S, Colombo A. The importance of proximal optimization technique with intravascular imaging guided for stenting unprotected left main distal bifurcation lesions: The Milan and New-Tokyo registry. Catheter Cardiovasc Interv 2021; 98:E814-E822. [PMID: 34520089 DOI: 10.1002/ccd.29954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study evaluated the 5-years outcomes of intracoronary imaging-guided proximal optimization technique (POT) for percutaneous coronary intervention (PCI) in patients with unprotected left main distal bifurcation lesions (ULMD). BACKGROUND The long-term effects of POT with intracoronary imaging guide in PCI for ULMD have been unclear. METHODS Between January 2005 and December 2015, we identified 1832 consecutive patients who underwent DES implantation for ULM distal bifurcation lesions. Of them, 780 (56.1%) patients underwent POT with intravascular imaging guidance (optimal expansion group). Residual 611 (43.9%) patients did not undergo either POT or intravascular imaging or both (suboptimal expansion group). Analysis using propensity score adjustment was performed. The primary endpoint was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. RESULTS TLF rate at 5 years was significantly lower in optimal expansion group than that in suboptimal expansion group [adjusted HR 0.65, 95% CI (0.48-0.87), p = 0.004]. Cardiac mortality was significantly lower in optimal expansion group than that in suboptimal expansion group [adjusted HR 0.46, 95% CI (0.27-0.79), p = 0.004]. The multivariable analysis identified POT with intravascular imaging guide [adjusted HR 0.65, 95% CI (0.48-0.87), p = 0.004] as an independent predictor of TLF. CONCLUSIONS Intravascular imaging guided POT was strongly associated with the reduced risk of TLF at 5 years after PCI for ULMD, mainly driven by reducing cardiac mortality.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, Maria Cecilia Hospital GVM, Cotignola, Italy
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46
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Watanabe Y, Mitomo S, Naganuma T, Nakamura S, Colombo A. Clinical outcomes after current generation drug-eluting stent implantation for ostial left circumflex lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:57-61. [PMID: 34764029 DOI: 10.1016/j.carrev.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are no available data about clinical outcomes of simple stenting for ostial left circumflex (LCX) lesions using current generation drug-eluting stents (cDES). OBJECTIVE We assessed clinical outcomes after simple stenting using cDES for ostial LCX lesions. METHODS We identified 81 consecutive patients who underwent PCI using cDES for ostial LCX lesions at New Tokyo Hospital, Matsudo, Japan between January 2010 and December 2016. An ostial LCX lesion was defined as a lesion with more than 75% stenosis by visual assessment and within 3 mm of the left main (LM) stem. The primary endpoint was target lesion failure (TLF). TLF was defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI). Additionally, we also assessed the revascularization for LM to left anterior descending artery (LAD) after ostial LCX stenting. RESULTS The TLF rate at 3 years after PCI was 24.5%. Furthermore, the rate of TLR and revascularization for LM-LAD after ostial LCX stenting were significantly higher in patients who were previously undergone stent implantation in ostial segment of LAD. CONCLUSION Clinical outcomes after cDES implantation for ostial LCX lesion could be acceptable. However, it could have better to be avoided in patients who previously received stent implantation in ostial segment of LAD.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan; Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy.
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy; Villa Maria Cecilia Hospital GVM, Lugo, Italy
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47
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Park H, Kang DY, Kim SO, Lee J, Kim JH, Hyun J, Lee PH, Ahn JM, Park SJ, Park DW. Ten-year outcomes of early generation sirolimus- versus paclitaxel-eluting stents in patients with left main coronary artery disease. Catheter Cardiovasc Interv 2021; 98:E705-E714. [PMID: 34420257 DOI: 10.1002/ccd.29930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022]
Abstract
To compare 10-year outcomes after implantation of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) for left main coronary artery (LMCA) stenosis. Very long-term outcome data of patients with LMCA disease treated with drug-eluting stents (DES) have not been well described. In 10-year extended follow-up of the MAINCOMPARE registry, we evaluated 778 patients with unprotected LMCA stenosis who were treated with SES (n = 607) or PES (n = 171) between January 2000 and June 2006. The primary composite outcome (a composite of death, myocardial infarction [MI] or target-vessel revascularization [TVR]) was compared with an inverse-probability-of-treatment-weighting (IPTW) adjustment. Clinical events have linearly accumulated over 10 years. At 10 years, there were no significant differences between SES and PES in the observed rates of the primary composite outcome (42.0% vs. 47.4%; hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.66-1.10), and definite stent thrombosis (ST) (1.9% vs. 1.8%; HR 1.02, 95% CI 0.28-3.64). In the IPTW-adjusted analyses, there were no significant differences between SES and PES in the risks for the primary composite outcome (HR 0.89, 95% CI 0.65-1.14) or definite ST (adjusted HR 1.05, 95% CI 0.29-3.90). In patients who underwent DES implantation, high overall adverse clinical event rates (with a linearly increasing event rate over time) were observed during extended follow-up. At 10 years, there were no measurable differences in outcomes between patients treated with SES vs. PES for LMCA disease. The incidence of stent thrombosis was quite low and comparable between the groups.
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seon Ok Kim
- Division of Clinical Epidemiology and Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Junghoon Lee
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ju Hyeon Kim
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Junho Hyun
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Pil Hyung Lee
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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48
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Kang DY, Ahn JM, Yun SC, Park H, Cho SC, Kim TO, Park S, Lee PH, Lee SW, Park SW, Park DW, Park SJ. Long-Term Clinical Impact of Intravascular Ultrasound Guidance in Stenting for Left Main Coronary Artery Disease. Circ Cardiovasc Interv 2021; 14:e011011. [PMID: 34665659 DOI: 10.1161/circinterventions.121.011011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Do-Yoon Kang
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Cheol Yun
- Division of Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanbit Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Cheol Cho
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Oh Kim
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sangwoo Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Hyung Lee
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology (D.-Y.K., J.-M.A., H.P., S.-C.C., T.O.K., S.P., P.H.L., S.-W.L., S.-W.P., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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49
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Daoulah A, Alasmari A, Hersi AS, Alshehri M, Garni TA, Abuelatta R, Amin H, Almahmeed W, Aljohar A, Abumelha BK, Alzahrani B, Ghani MA, Yousif N, Hashmani S, Al-Faifi SM, Kazim HM, Refaat W, Dahdouh Z, Khaliel F, Aithal J, Elmahrouk A, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Alqahtani AM, Abdelaziz AF, Altnji I, Hussien AF, Abdulhabeeb IAM, Ahmad O, Haddara MM, Alqahtani AH, Alshahrani SS, Qenawi W, Izzeldin MH, El-Sayed O, Jamjoom A, Moghairi AA, Amri HA, Ibrahim WM, Alarbash MM, Hussain T, Shamsi F, Selim E, Ramadan M, Al-Sergani H, Mohamed T, Khalifa AA, Hiremath N, Ibrahim AAT, Abdallah H, Elprince A, Diab A, Seoud DEA, Alghamdi AA, Alebrahim KE, Basudan D, Nasser FOMA, Ali IAA, Shawky AM, Ghonim A, Khushail AA, Feteih MN, Abualnaja S, Alhaddadi B, Alhamid S, Ahmed WA, Jafary ZM, Ahnia S, Gasem J, Alaydarous S, Khatab T, Mohamed A, Maghrabi M, Samadi FA, Kannout TH, Mahrous N, Almaleh Y, Riyami ABA, Yousef A, Ahmed MA, Ahmed RA, Tawfik W, Almegreb N, Faden MS, Haq E, AlOtaibi SN, Eldesoky A, Clarkson FA, Lotfi A. Percutaneous Coronary Intervention Vs Coronary Artery Bypass Surgery for Unprotected Left Main Coronary Disease: G-LM Registry. Curr Probl Cardiol 2021; 47:101002. [PMID: 34587490 DOI: 10.1016/j.cpcardiol.2021.101002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
Coronary artery bypass surgery (CABG) has been the standard of care for revascularization for patients with obstructive unprotected left main coronary disease (ULMCA). There have been multiple randomized and registry data demonstrating the technical and clinical efficacy of PCI in certain patients with ULMCA. The purpose of this study is to evaluate clinical outcomes of ULMCA PCI as compared to CABG in patients requiring revascularization in three Gulf countries. All ULMCA cases treated by PCI with DES versus CABG were retrospectively identified from 14 centers in 3 Arab Gulf countries (KSA, UAE, and Bahrain) from January 2015 to December 2019. In total, 2138 patients were included: 1222 were treated with PCI versus 916 with CABG. Patients undergoing PCI were older, and had higher comorbidities and mean European System for Cardiac Operative Risk Evaluation (EuroSCORE). Aborted cardiac arrest and cardiogenic shock were reported more in the PCI group at hospital presentation. In addition, lower ejection fractions were reported in the PCI group. In hospital mortality and major adverse cardiovascular and cerebrovascular events (MACCE) occurred more in patients undergoing CABG than PCI. At median follow-up of 15 months (interquartile range, 30), no difference was observed in freedom from revascularization, MACCE, or total mortality between those treated with PCI and CABG. While findings are similar to Western data registries, continued follow-up will be needed to ascertain whether this pattern continues into latter years.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Bader K Abumelha
- Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | | | - Salem M Al-Faifi
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Hameedullah M Kazim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Feras Khaliel
- Department of Cardiac Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yaz Clinic, Khalifa City, Abu Dhabi, UAE
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia; Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed M Ibrahim
- Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, kingdom of Saudi Arabia
| | - Abdulrahman M Alqahtani
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed F Abdelaziz
- Department of Cardiothoracic and Vascular Surgery, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Issam Altnji
- Department of cardiology, King Fahad Specialist Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Adnan Fathey Hussien
- Department of cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, king Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mamdouh M Haddara
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Saif S Alshahrani
- Department of Emergency Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Mohamed H Izzeldin
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Osama El-Sayed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | | | - Hussein Al Amri
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Mohsen M Alarbash
- Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
| | - Tajammul Hussain
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Fahad Shamsi
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Hani Al-Sergani
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Tahir Mohamed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulwahab Al Khalifa
- Department of Cardiothoracic Surgery, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | | | | | - Hassane Abdallah
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Amr Elprince
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ahmed Diab
- Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Diaa Eldin A Seoud
- Department of Cardiac Surgery, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed A Alghamdi
- Department of Cardiac Surgery, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Khaled E Alebrahim
- Department of Cardiac Surgery, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Duna Basudan
- Department of Hematology, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | | | | | - Abeer M Shawky
- Department of Cardiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Ghonim
- Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah Al Khushail
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Maun N Feteih
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Seraj Abualnaja
- Department of cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Bandar Alhaddadi
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, kingdom of Saudi Arabia
| | - Sameer Alhamid
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Waleed A Ahmed
- Department of Internal Medicine, Security Forces Hospital, Mecca, Kingdom of Saudi Arabia
| | - Zainab M Jafary
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Samir Ahnia
- Department of Cardiology, king Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Jala Gasem
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Shahad Alaydarous
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Tamer Khatab
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Ataaelrahman Mohamed
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohamed Maghrabi
- Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Faisal Al Samadi
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Tareef H Kannout
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Najeeb Mahrous
- Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yahya Almaleh
- Department of Emergency Medicine, Private Clinic, Riyadh, Kingdom of Saudi Arabia
| | - Adil B Al Riyami
- Unit of Cardiology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Mohammed Ali Ahmed
- Department of Internal Medicine, Ibn Sina Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Ruqayyah Ali Ahmed
- Department of Internal Medicine, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Wael Tawfik
- Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia; Department of Cardiology, Benha University, Benha, Egypt
| | - Nasser Almegreb
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saud Arabia
| | - Mazen S Faden
- Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ejazul Haq
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Salah N AlOtaibi
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Akram Eldesoky
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | | | - Amir Lotfi
- Department of Cardiovascular Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
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50
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D’Ascenzo F, De Filippo O, Elia E, Doronzo MP, Omedè P, Montefusco A, Pennone M, Salizzoni S, Conrotto F, Gallone G, Angelini F, Franchin L, Bruno F, Boffini M, Gaudino M, Rinaldi M, De Ferrari GM. Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:476-485. [PMID: 32392283 PMCID: PMC8686114 DOI: 10.1093/ehjqcco/qcaa041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 08/30/2023]
Abstract
AIMS A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined. METHODS AND RESULTS Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial's subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71-1.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60-0.79), mainly driven by MI (OR 0.48, 95% CI 0.36-0.65) and revascularization (OR 0.53, 95% CI 0.45-0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59-0.97 for values < 32 and OR 0.63, 95% CI 0.47-0.84 for values ≥ 33) while was not evident for 'younger' patients (OR 0.83, 95% CI 0.65-1.07 vs. OR 0.65, 95% CI 0.51-0.84 for 'older' patients). CONCLUSION For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score.
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Affiliation(s)
- Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Edoardo Elia
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Mattia Paolo Doronzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Mauro Pennone
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della
Salute e della Scienza, Corso Bramante 88, 10126,
Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della
Salute e della Scienza, Corso Bramante 88, 10126,
Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Cornell Medicine,
1300 York Ave, New York, NY 10065, USA
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della
Salute e della Scienza, Corso Bramante 88, 10126,
Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute
e della Scienza, Corso Bramante 88, 10126, Turin,
Italy
| |
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