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Gonzalez PE, Hebbe A, Hussain Y, Khera R, Banerjee S, Plomondon ME, Waldo SW, Pfau SE, Curtis JP, Shah SM. Real-World Experience and Outcomes With Percutaneous Coronary Intervention for Protected Versus Unprotected Left Main Coronary Artery Disease: Insights from the Veteran Affairs Clinical Assessment Reporting and Tracking Program. Am J Cardiol 2024; 222:39-50. [PMID: 38677666 DOI: 10.1016/j.amjcard.2024.04.039] [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: 12/14/2023] [Revised: 02/22/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
The practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary US clinical practice. Data were collected from all Veteran Affairs catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients who underwent left main PCI, of whom 1,306 pairs of PLM and ULM PCI were included in a propensity-matched cohort. Selected temporal trends were also assessed. The primary outcome was major adverse cardiovascular event (MACE) outcomes at 1 year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke, or urgent revascularization. Patients who underwent ULM PCI compared with patients who underwent PLM PCI were older (age 71.5 vs 69.2 years, p <0.001), more clinically complex, and more likely to present with acute coronary syndrome. In the propensity-matched cohort, radial access was used more often for ULM PCI (21% [273] vs 14% [185], p <0.001) and ULM PCI was more likely to involve the left main bifurcation (22% vs 14%, p = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17], p <0.001). The 1-year MACEs occurred more frequently with ULM PCI than PLM PCI (22% [289] vs 16% [215], p ≤0.001) and all-cause mortality was also higher (16% [213] vs 10% [125], p ≤0.001). In the matched cohort, there was a low incidence of rehospitalization for MI (4% [48] ULM vs 4% [48] PLM, p = 1.000) or revascularization (7% [94] ULM vs 6% [84] PLM, p = 0.485). In this real-world experience, patients who underwent PLM PCI had better 1-year outcomes than those who underwent ULM PCI; however, in both groups, there was a high rate of mortality and MACEs at 1 year despite a relatively low rate of MI or revascularization.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Annika Hebbe
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia
| | - Yasin Hussain
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia
| | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven E Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
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Kawamoto T, Otsuki H, Arashi H, Jujo K, Oka T, Mori F, Tanaka H, Sakamoto T, Ishii Y, Terajima Y, Yagi M, Takagi A, Haruta S, Yamaguchi J. Adverse clinical events after percutaneous coronary intervention in very elderly patients with acute coronary syndrome. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01020-6. [PMID: 38839727 DOI: 10.1007/s12928-024-01020-6] [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: 02/05/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
The number of very elderly patients with acute coronary syndrome (ACS) is increasing. Therefore, owing to the need for evidence-based treatment decisions in this population, this study aimed to examine the clinical outcomes during 1 year after percutaneous coronary intervention (PCI) in very elderly patients with ACS. This prospective multicenter observational study comprised 1337 patients with ACS treated with PCI, classified into the following four groups according to age: under 60, <60 years; sexagenarian, ≥60 and <69 years; septuagenarian, ≥70 and <80 years; and very elderly, ≥80 years. The primary endpoint was a composite of the first occurrence of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and bleeding within 1 year after PCI. We used the sexagenarian group as a reference and compared outcomes with those of the other groups. The incidence of the primary endpoint was significantly higher in the very elderly group than in the sexagenarian group (36 [12.7%] vs. 24 [6.9%], respectively; hazard ratio, 1.94; 95% confidence interval: 1.16-3.26; p = 0.012). The higher incidence of the primary endpoint was primarily driven by a higher incidence of all-cause death. When the multivariable analysis was used to adjust for patient characteristics and comorbidities, no difference was observed in the primary endpoint between the very elderly and sexagenarian groups (p = 0.96). The incidence of adverse events after PCI, particularly all-cause death, in very elderly patients with ACS was high. However, if several confounders are adjusted, comparable outcomes may be expected within 1 year after PCI among this population.
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Affiliation(s)
- Takanori Kawamoto
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hisao Otsuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
- Department of Cardiology, Saitama Medical Center, Saitama, Japan
- Department of Cardiology, Nishiarai Heart Center, Tokyo, Japan
| | - Toshiaki Oka
- Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Fumiaki Mori
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Kanagawa, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tomohiro Sakamoto
- Department of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yasuhiro Ishii
- Department of Cardiology, Ogikubo Hospital, Tokyo, Japan
| | - Yutaka Terajima
- Department of Cardiology, Saiseikai Kazo Hospital, Saitama, Japan
| | - Masahiro Yagi
- Department of Cardiology, Cardiovascular Center of Sendai, Miyagi, Japan
| | - Atsushi Takagi
- Department of Cardiology, Saiseikai Kawaguchi Hospital, Saitama, Japan
| | - Shoji Haruta
- Department of Cardiology, Tokyo Women's Medical University Yachiyo Medical Center, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Koshy AN, Stone GW, Sartori S, Dhulipala V, Giustino G, Spirito A, Farhan S, Smith KF, Feng Y, Vinayak M, Salehi N, Tanner R, Hooda A, Krishnamoorthy P, Sweeny JM, Khera S, Dangas G, Filsoufi F, Mehran R, Kini AS, Fuster V, Sharma SK. Outcomes Following Percutaneous Coronary Intervention in Patients With Multivessel Disease Who Were Recommended for But Declined Coronary Artery Bypass Graft Surgery. J Am Heart Assoc 2024; 13:e033931. [PMID: 38818962 PMCID: PMC11255644 DOI: 10.1161/jaha.123.033931] [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: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Patients may prefer percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery, despite heart team recommendations. The outcomes in such patients have not been examined. We sought to examine the results of PCI in patients who were recommended for but declined CABG. METHODS AND RESULTS Consecutive patients with stable ischemic heart disease and unprotected left main or 3-vessel disease or Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score >22 who underwent PCI after heart team review between 2013 and 2020 were included. Patients were categorized into 3 groups according to heart team recommendations on the basis of appropriate use criteria: (1) PCI-recommended; (2) CABG-eligible but refused CABG (CABG-refusal); and (3) CABG-ineligible. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. The study included 3687 patients undergoing PCI (PCI-recommended, n=1718 [46.6%]), CABG-refusal (n=1595 [43.3%]), and CABG-ineligible (n=374 [10.1%]). Clinical and procedural risk increased across the 3 groups, with the highest comorbidity burden in CABG-ineligible patients. Composite events within 1 year after PCI occurred in 55 (4.1%), 91 (7.0%), and 41 (14.8%) of patients in the PCI-recommended, CABG-refusal, and CABG-ineligible groups, respectively. After multivariable adjustment, the risk of the primary composite outcome was significantly higher in the CABG-refusal (hazard ratio [HR], 1.67 [95% CI, 1.08-3.56]; P=0.02) and CABG-ineligible patients (HR, 3.26 [95% CI, 1.28-3.65]; P=0.004) groups compared with the reference PCI-recommended group, driven by increased death and stroke. CONCLUSIONS Cardiovascular event rates after PCI were significantly higher in patients with multivessel disease who declined or were ineligible for CABG. Our findings provide real-world data to inform shared decision-making discussions.
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Affiliation(s)
- Anoop N. Koshy
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Department of CardiologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Cardiology and The University of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Kenneth F. Smith
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Yihan Feng
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Negar Salehi
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Richard Tanner
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Joseph M. Sweeny
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Farzan Filsoufi
- Department of Cardiac SurgeryIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Annapoorna S. Kini
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
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4
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Gonzalez PE, Hebbe A, Hussain Y, Khera R, Banerjee S, Plomondon ME, Waldo SW, Pfau SE, Curtis JP, Shah SM. Outcomes of Percutaneous Coronary Intervention for Protected versus Unprotected Left Main Coronary Artery Disease: Insights from the VA CART Program. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.27.23297698. [PMID: 37961093 PMCID: PMC10635229 DOI: 10.1101/2023.10.27.23297698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI), as well as the differences between these types of PCI, are not well defined in real-world clinical practice. Methods Data collected from all Veteran Affairs (VA) catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients undergoing left main PCI, of which 1,306 pairs of PLM and ULM PCI were included in a propensity matched cohort. Patients and procedural characteristics were compared between PLM and ULM PCI. Temporal trends were also assessed. Peri-procedural and one-year major adverse cardiovascular events (MACE) were compared using cumulative incidence plots. The primary outcome was MACE outcomes at 1-year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke or urgent revascularization. Results ULM PCI patients in comparison to PLM PCI were older (71.5 vs 69.2; P < 0.001), more clinically complex and more likely to present with ACS. In the propensity matched cohort, radial access was used more often for ULM PCI (21% [273] vs. 14% [185], P < 0.001), and ULM PCI was more likely to involve the LM bifurcation (22% vs 14%; P = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17]; P <0.001). One-year MACE occurred more frequently with ULM PCI compared to PLM PCI (22% [289] vs. 16% [215]; P = < 0.001) and all-cause mortality was also higher (16% [213] vs. 10% [125]; P = < 0.001). In the matched cohort there was a low incidence of rehospitalization for MI (4% [48] ULM vs. 4% [48] PLM; P = 1.000) or revascularization (7% [94] ULM vs. 6% [84] PLM; P = 0.485). Conclusions Veterans undergoing PLM PCI had better one-year outcomes than those undergoing ULM PCI, but in both groups there was a high rate of mortality and MACE at one-year despite a relatively low rate of MI or revascularization.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Annika Hebbe
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Yasin Hussain
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Section of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven E Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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5
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Masuda S, Serruys PW, Kageyama S, Kotoku N, Ninomiya K, Garg S, Soo A, Morel MA, Puskas JD, Narula J, Schneider U, Doenst T, Tanaka K, de Mey J, La Meir M, Bartorelli AL, Mushtaq S, Pompilio G, Andreini D, Onuma Y. Treatment recommendation based on SYNTAX score 2020 derived from coronary computed tomography angiography and invasive coronary angiography. Int J Cardiovasc Imaging 2023; 39:1795-1804. [PMID: 37368152 PMCID: PMC10519866 DOI: 10.1007/s10554-023-02884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
The diagnostic performance of the SYNTAX score 2020 (SS-2020) when calculated using CCTA remains unknown. This study aimed to compare treatment recommendations based on the SS-2020 derived from coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA). This interim analysis included 57 of the planned 114 patients with de-novo three-vessel disease, with or without left main coronary artery disease, enrolled in the ongoing FASTTRACK CABG trial. The anatomical SYNTAX scores derived from ICA or CCTA were evaluated by two separate teams of blinded core-lab analysts. Treatment recommendations were based on a maximal individual absolute risk difference in all-cause mortality between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) of 4.5% ([predicted PCI mortality] - [predicted CABG mortality]). The level of agreement was evaluated with Bland-Altman plots and Cohen's Kappa. The mean age was 66.2 ± 9.2 years and 89.5% of patients were male. Mean anatomical SYNTAX scores derived from ICA and CCTA were 35.1 ± 11.5 and 35.6 ± 11.4 (p = 0.751), respectively. The Bland-Altman analysis showed mean differences of - 0.26 and - 0.93, with standard deviation of 3.69 and 5.23, for 5- and 10-year all-cause mortality, respectively. The concordance in recommended treatment for 5- and 10-year mortalities were 84.2% (48/57 patients) and 80.7% (46/57 patients), with Cohen's κ coefficients of 0.672 and 0.551. There was moderate to substantial agreement between treatment recommendations based on the SS-2020 derived using CCTA and ICA, suggesting that CCTA could be used as an alternative to ICA when making decisions regarding the modality of revascularization.
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Affiliation(s)
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland.
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | | | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Alan Soo
- Department of Cardiothoracic Surgery, University Hospital Galway, Galway, Ireland
| | | | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, USA
| | - Jagat Narula
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Kaoru Tanaka
- Department of Radiology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Belgium, Belgium
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Saima Mushtaq
- Department of Periooperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Belgium, Belgium
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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6
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Salisbury AC, Grantham JA, Brown WM, Ballard WL, Allen KB, Kirtane AJ, Argenziano M, Yeh RW, Khabbaz K, Lasala J, Kachroo P, Karmpaliotis D, Moses J, Lombardi WL, Nugent K, Ali Z, Gosch KL, Spertus JA, Kandzari DE. Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery. JACC Cardiovasc Interv 2023; 16:261-273. [PMID: 36792252 DOI: 10.1016/j.jcin.2023.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes. OBJECTIVES This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG). METHODS Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months. RESULTS A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 ± 12.2 before and 15.0 ± 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons' estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 19.7; P < 0.0001). CONCLUSIONS Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons' estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients' health status improved significantly through 6 months.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | - Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Michael Argenziano
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - John Lasala
- Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Puja Kachroo
- Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Dimitri Karmpaliotis
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Jeffrey Moses
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | | | - Karen Nugent
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Ziad Ali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
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7
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A Practical Approach to Left Main Coronary Artery Disease. J Am Coll Cardiol 2022; 80:2119-2134. [DOI: 10.1016/j.jacc.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]
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8
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Choi K, Locker C, Fatima B, Schaff HV, Stulak JM, Lahr BD, Villavicencio MA, Dearani JA, Daly RC, Crestanello JA, Greason KL, Khullar V. Coronary Artery Bypass Grafting in Octogenarians-Risks, Outcomes, and Trends in 1283 Consecutive Patients. Mayo Clin Proc 2022; 97:1257-1268. [PMID: 35738944 DOI: 10.1016/j.mayocp.2022.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the risks, outcomes, and trends in patients older than 80 years undergoing coronary artery bypass grafting (CABG). METHODS We retrospectively studied 1283 consecutive patients who were older than 80 years and underwent primary isolated CABG from January 1, 1993, to October 31, 2019, in our clinic. Kaplan-Meier survival probability and quartile estimates were used to analyze patients' survival. Logistic regression models were used for analyzing temporal trends in CABG cases and outcomes. A multivariable Cox proportional hazards regression model was developed to study risk factors for mortality. RESULTS Operative mortality was overall 4% (n=51) but showed a significant decrease during the study period (P=.015). Median follow-up was 16.7 (interquartile range, 10.3-21.1) years, and Kaplan-Meier estimated survival rates at 1 year, 5 years, 10 years, and 15 years were 90.2%, 67.9%, 31.1%, and 8.2%, respectively. Median survival time was 7.6 years compared with 6.0 years for age- and sex-matched octogenarians in the general US population (P<.001). Multivariable Cox regression analysis identified older age (P<.001), recent atrial fibrillation or flutter (P<.001), diabetes mellitus (P<.001), smoking history (P=.006), cerebrovascular disease (P=.04), immunosuppressive status (P=.01), extreme levels of creatinine (P<.001), chronic lung disease (P=.02), peripheral vascular disease (P=.02), decreased ejection fraction (P=.03) and increased Society of Thoracic Surgeons predicted risk score (P=.01) as significant risk factors of mortality. CONCLUSION Although CABG in octogenarians carries a higher surgical risk, it may be associated with favorable outcomes and increase in long-term survival. Further studies are warranted to define subgroups benefiting more from surgical revascularization.
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Affiliation(s)
- Kukbin Choi
- Department of Cardiovascular Surgery, Rochester, MN
| | - Chaim Locker
- Department of Cardiovascular Surgery, Rochester, MN
| | | | | | | | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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9
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Takahashi K, Serruys PW, Fuster V, Farkouh ME, Spertus JA, Cohen DJ, Park SJ, Park DW, Ahn JM, Onuma Y, Kent DM, Steyerberg EW, van Klaveren D. External Validation of the FREEDOM Score for Individualized Decision Making Between CABG and PCI. J Am Coll Cardiol 2022; 79:1458-1473. [PMID: 35422242 DOI: 10.1016/j.jacc.2022.01.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although randomized trials have established that coronary artery bypass grafting (CABG) is, on average, the most effective revascularization strategy compared with percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease (MVD), individual patients differ in many characteristics that can affect the benefits and harms of treatment. The FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus) score was developed to predict different outcomes with CABG vs PCI on the basis of 8 patient characteristics and the smoking-treatment interaction. OBJECTIVES This study aimed to assess the ability of the 5-year major adverse cardiovascular event (MACE) model to predict treatment benefit of CABG vs PCI in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) and BEST (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials. METHODS This study identified 702 patients with diabetes and MVD to mirror the FREEDOM participants. Discrimination was assessed by C-index, and calibration was assessed by calibration plots in the PCI and CABG arms, respectively. The ability of the FREEDOM score to predict treatment benefit of CABG vs PCI was assessed. RESULTS Overall, CABG was associated with a lower rate of 5-year MACE compared with PCI (12.4% vs 20.3%; log-rank P = 0.021) irrespective of a history of smoking (Pinteraction = 0.975). Both discrimination and calibration were helpful in the PCI arm (C-index: 0.69; slope: 0.96, intercept: -0.24), but moderate in the CABG arm (C-index: 0.61; slope: 0.61; intercept: -0.53). The FREEDOM score showed some heterogeneity of treatment benefit. CONCLUSIONS The FREEDOM score could identify some heterogeneity of treatment benefit of CABG vs PCI for 5-year MACE. Until further prospective validations are performed, these results should be taken into consideration when using the FREEDOM score in patients with diabetes and MVD. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972) (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease [BEST]; NCT00997828) (Future Revascularization Evaluation in Patients with Diabetes Mellitus [FREEDOM]; NCT00086450).
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Affiliation(s)
- Kuniaki Takahashi
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.
| | - Valentin Fuster
- The Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - John A Spertus
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, Seoul, Korea
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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10
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Achim A, Marc M, Ruzsa Z. Surgical Turned-Downed CHIP Cases—Can PCI Save the Day? Front Cardiovasc Med 2022; 9:872398. [PMID: 35463754 PMCID: PMC9021524 DOI: 10.3389/fcvm.2022.872398] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023] Open
Abstract
Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.
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Affiliation(s)
- Alexandru Achim
- “Niculae Stancioiu” Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
- Division of Invasive Cardiology, 2nd Department of Internal Medicine, University of Szeged, Szeged, Hungary
- *Correspondence: Alexandru Achim
| | - Madalin Marc
- “Niculae Stancioiu” Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Zoltan Ruzsa
- Division of Invasive Cardiology, 2nd Department of Internal Medicine, University of Szeged, Szeged, Hungary
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11
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d'Entremont MA, Yagi R, Salia SJS, Zhang S, Shaban L, Bene-Alhasan Y, Papatheodorou S, Couture ÉL, Huynh T, Nguyen M, Hamaya R. The effect of diabetes on surgical versus percutaneous left main revascularization outcomes: a systematic review and meta-analysis. J Cardiothorac Surg 2022; 17:61. [PMID: 35365159 PMCID: PMC8973812 DOI: 10.1186/s13019-022-01795-w] [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: 12/16/2021] [Accepted: 03/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background The optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era. Methods We performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for effect measure modification (EMM) by diabetes for adverse events. We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4356 patients, mean follow-up of 4.9 years) and six observational studies (9360 patients, mean follow-up of 5.2 years). Results In RCTs among DM patients, DES-based PCI, compared to CABG, was associated with a 30% increased relative risk (RR) (RR 1.30, 95% CI 1.09–1.56, I2 = 0%), while among non-DM patients, there was a 25% increased relative risk (RR 1.25, 95% CI 1.07–1.44, I2 = 0%) for the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization (MACCE). There was no evidence of EMM (p-value for interaction = 0.70). The mean weighted SYNTAX score was 25.7. In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (RR 1.13, 95% CI 0.91–1.40, I2 = 0%). Conclusions CABG was superior to PCI for LMCAD in RCTs in DM patients for MACCE. Heart teams may consider DM as one of the many components in the clinical decision-making process, but may not want to consider DM as a primary deciding factor between DES-based PCI and CABG for LMCAD with low to intermediate anatomical complexity in the other coronary arteries. Study registration CRD42021246931 (PROSPERO). Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01795-w.
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Affiliation(s)
- Marc-André d'Entremont
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ryuichiro Yagi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Saiseikai Central Hospital, Tokyo, Japan
| | | | - Shuqi Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lamyaa Shaban
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Étienne L Couture
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Thao Huynh
- McGill Health University Center, Montreal, QC, Canada
| | - Michel Nguyen
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Rikuta Hamaya
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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12
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Salisbury AC, Kirtane AJ, Ali ZA, Grantham JA, Lombardi WL, Yeh RW, Genereux P, Allen KB, Brown WM, Nugent K, Gosch KL, Karmpaliotis D, Spertus JA, Kandzari DE. The Outcomes of Percutaneous revascularizaTIon for Management of sUrgically ineligible patients with Multivessel or left main coronary artery disease (OPTIMUM) registry: Rationale and design. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:83-91. [PMID: 35120846 DOI: 10.1016/j.carrev.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Guidelines endorse coronary artery bypass as the preferred revascularization strategy for patients with left main and/or multivessel coronary artery disease (CAD). However, many patients are deemed excessively high risk for surgery after Heart Team evaluation. No prospective studies have examined contemporary treatment patterns, rationale for surgical decision-making, completeness of revascularization with percutaneous coronary intervention (PCI), and outcomes in this high-risk population with advanced CAD. METHODS We designed the Outcomes of Percutaneous RevascularizaTIon for Management of SUrgically Ineligible Patients with Multivessel or Left Main Coronary Artery Disease (OPTIMUM) registry, a prospective, multicenter study of patients with "surgical anatomy" determined to be at prohibitive risk for bypass surgery. The primary outcome is comparison of observed to predicted 30-day mortality, with secondary outcomes of patient-reported health status and the association between completeness of revascularization and clinical outcomes. Patient characteristics driving surgical risk determinations will be reported, and peri-operative risk will be assessed using validated scoring methods. Angiograms will be assessed by an independent core laboratory, and clinical events will be adjudicated. RESULTS Clinical outcomes assessments will include 30-day and 1-year cardiovascular events, health status at 1, 6 and 12-months, and 5-year mortality. CONCLUSIONS OPTIMUM is the first prospective, multicenter study to examine treatment strategies and outcomes among multivessel CAD patients deemed ineligible for surgical revascularization after Heart Team assessment. This registry will provide unique insights into the clinical decision-making, revascularization practices, safety, effectiveness, and health status outcomes in this high-risk population.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America.
| | - Ajay J Kirtane
- Columbia University and New York Presbyterian Hospital, New York, NY, United States of America
| | - Ziad A Ali
- Columbia University and New York Presbyterian Hospital, New York, NY, United States of America
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | | | - Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - W Morris Brown
- Piedmont Heart Institute, Atlanta, GA, United States of America
| | - Karen Nugent
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America
| | - Dimitri Karmpaliotis
- Columbia University and New York Presbyterian Hospital, New York, NY, United States of America
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America
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13
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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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14
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Albaghdadi MS, Young MN, Chowdhury MM, Assmann S, Hamza T, Siami S, Villarreal M, Strong M, Menard M, Farber A, Rosenfield K. Clinical practice patterns and ascertainment bias for cardiovascular events in a randomized trial: A survey of investigators in the BEST-CLI trial. Vasc Med 2021; 26:180-186. [PMID: 33825577 DOI: 10.1177/1358863x21995897] [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: 11/16/2022]
Abstract
Ascertainment bias is a well-recognized source of bias in research, but few studies have systematically analyzed sources of ascertainment bias in randomized trials in which blinding is not possible and endpoint assessment is not protocolized. In the current study, we sought to evaluate differences in the clinical practice patterns of trial investigators with respect to bias in the ascertainment of pre-revascularization patient risk and the incidence of secondary endpoints post-revascularization. We conducted a cross-sectional survey of active investigators (n = 936) from the Best Endovascular Versus Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI) trial. The total survey response rate was 19.6% (183/936). Vascular surgeons were more likely than nonsurgical interventionalists to order tests for cardiac complications after both surgical bypass (p < 0.001) and endovascular revascularization (p = 0.038). Post-procedure, investigators were more likely to order additional testing for cardiac complications in open surgery versus endovascular cases (7% vs 16% never, 41% vs 65% rarely, 43% vs 17% sometimes, 9% vs 2% always, respectively; p < 0.0001). Significant variation in practice patterns exist in the pre- and post-procedure assessment of cardiac risk and events for patients with CLI undergoing revascularization. Variation in the ascertainment of risk and outcomes according to the type of revascularization procedure and physician specialty should be considered when interpreting the results of clinical studies, such as the BEST-CLI trial. ClinicalTrials.gov Identifier: NCT02060630.
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Affiliation(s)
- Mazen S Albaghdadi
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Michael N Young
- Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mohammed M Chowdhury
- Department of Vascular and Endovascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Susan Assmann
- HealthCore-New England Research Institutes, Inc., Watertown, MA, USA
| | - Taye Hamza
- HealthCore-New England Research Institutes, Inc., Watertown, MA, USA
| | - Sandra Siami
- HealthCore-New England Research Institutes, Inc., Watertown, MA, USA
| | - Maria Villarreal
- Department of Vascular Surgery, Boston Medical Center, Boston University, Boston, MA, USA
| | - Michael Strong
- Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Menard
- Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alik Farber
- Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth Rosenfield
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Kunkel KJ, Dabbagh MF, Zaidan M, Alaswad K. Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention. Interv Cardiol Clin 2021; 10:207-219. [PMID: 33745670 DOI: 10.1016/j.iccl.2020.12.002] [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] [Indexed: 01/09/2023]
Abstract
The use of mechanical circulatory devices to support high-risk elective percutaneous coronary intervention (PCI) has become more common as the group of patients considered inoperable or high risk for surgical revascularization has grown. Most of the data examining outcomes in high-risk PCI are observational and retrospective. Limited prospective randomized studies have been unable to show improved clinical outcomes with routine mechanical circulatory support (MCS) in patients with a high burden of coronary artery disease and reduced ejection fraction. The role for MCS in high-risk PCI continues to evolve as understanding of the appropriate groups for this therapy evolves.
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Affiliation(s)
- Katherine J Kunkel
- Interventional Cardiology, Henry Ford Hospital, 2799 West Grand Boulevard, K-2, Detroit, MI 48202, USA.
| | - Mohammed Ferras Dabbagh
- Division of Cardiology, Henry Ford Hospital, 2799 West Grand Boulevard, K-14, Detroit, MI 48202, USA
| | - Mohammad Zaidan
- Interventional Cardiology, Henry Ford Hospital, 2799 West Grand Boulevard, K-2, Detroit, MI 48202, USA
| | - Khaldoon Alaswad
- Interventional Cardiology, Henry Ford Hospital, 2799 West Grand Boulevard, K-2, Detroit, MI 48202, USA
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16
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Shields MC, Ouellette M, Kiefer N, Kohan L, Taylor AM, Ailawadi G, Ragosta M. Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:1223-1229. [PMID: 33533551 DOI: 10.1002/ccd.29508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES In this study we evaluated the clinical characteristics and outcomes of surgically ineligible patients with coronary artery disease (CAD) who underwent multivessel percutaneous coronary intervention (PCI). BACKGROUND Patients with multivessel CAD who are surgically ineligible and undergo PCI are not well represented in large trials. METHODS Out of 1,061 consecutive patients who underwent a non-emergent PCI for unprotected left main or multivessel CAD at the University of Virginia Medical Center, 137 patients were determined to be surgically ineligible for coronary artery bypass graft (CABG) surgery by a heart team. The clinical characteristics and reasons for surgical ineligibility were collected. The coronary angiograms were reviewed and the SYNTAX score calculated. The Society of Thoracic Surgeons (STS) score was calculated. Outcomes were determined at 30 days and 1-year. RESULTS The mean age of the cohort was 71 and 59% were women. Hypertension, hyperlipidemia, tobacco abuse, and diabetes were common comorbidities. The average SYNTAX score was 22. The most commonly cited reasons for surgical ineligibility were advanced age, frailty, severe lung disease, ejection fraction ≤ 30% and STS score ≥ 8%. Outcomes at 30 days were excellent and better than those predicted by STS for surgery. Frailty and STS score predicted one-year outcomes. CONCLUSIONS Patients undergoing PCI for multivessel disease who are surgically ineligible have multiple risk factors and comorbidities. Frailty, lung disease, poor left ventricular function, and high STS score represent common reasons for surgical ineligibility. Frailty and the STS score better predict one-year outcomes after PCI compared to the SYNTAX score.
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Affiliation(s)
- Mary C Shields
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Michelle Ouellette
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Nicholas Kiefer
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Luke Kohan
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Angela M Taylor
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Gorav Ailawadi
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Michael Ragosta
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
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17
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Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9339. [PMID: 33327401 PMCID: PMC7764849 DOI: 10.3390/ijerph17249339] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022]
Abstract
Diabetes mellitus is an important risk factor for the development of cardiovascular diseases. Peripheral arterial disease affecting lower limb arteries is one of the clinical manifestations of atherosclerosis. The frailty syndrome (Frailty) is a problem associated with diminution of physiological reserves. The ankle-brachial index is a commonly used tool for diagnosing peripheral arterial disease (PAD). The usefulness of the ankle-brachial index (ABI) is limited in people with diabetes because of calcification of the middle layer of arteries. In this population, toe-brachial index should be measured. Frailty may be associated with worse prognosis for patients undergoing revascularization. Amputation may be an important factor leading to the development of Frailty. The risk of amputation and the prognosis after revascularization may be modified by some medications and blood glucose levels. The purpose of this paper is to review the literature about the association between PAD, especially in patients living with diabetes and Frailty.
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Affiliation(s)
- Grzegorz K. Jakubiak
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Specialistic Hospital No. 2 in Bytom, 41-902 Bytom, Poland;
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Grzegorz Cieślar
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland;
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland;
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18
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Acute pulmonary embolism following recent hospitalization or surgery. J Thromb Thrombolysis 2020; 52:189-199. [PMID: 33156442 DOI: 10.1007/s11239-020-02322-1] [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] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Recent hospitalization or surgery is a leading risk factor for PE, yet there are minimal data examining its effect on treatment and outcomes. We conducted a retrospective review of institutional billing codes for hospitalized patients with acute PE from August 2012 to August 2018. Patients were stratified based on whether they had a recent major medical encounter (MME), defined as surgery or hospitalization within 90 days. Primary outcomes included in-hospital mortality and 30- and 90-day readmission rates. Secondary outcomes included length of stay (LOS), use of advanced therapies, major bleeding, discharge anticoagulation and recurrent venous thromboembolism (VTE) at 90 days. Outcomes were adjusted for confounders using multivariable regression modeling. 2063 patients were hospitalized for an acute PE; 633 (30.7%) had a recent MME. Patients with a recent MME had a higher average Charlson Comorbidity Index (4.6 vs. 4.0, p < 0.01). Both 30- and 90-day readmission rates were higher in patients with a recent MME (21.7% vs. 14.4%; adjusted OR 1.06 [1.00, 1.12], p = 0.037; 30.8% vs 18.7%; adjusted OR 1.11 [1.11, 1.62], p = 0.003, respectively). After adjustment, there were no between-group differences in in-hospital mortality, LOS, use of advanced therapies, major bleeding, or recurrent VTE at 90 days. In-hospital mortality was higher for patients with a recent medical hospitalization compared to those with a recent surgery (10.2% vs. 5.6%, adjusted OR 1.08 [1.01, 1.15] p = 0.032). Despite recent hospitalization and/or surgery and greater number of comorbidities, patients admitted with a PE and recent MME had similar in-hospital outcomes, but experienced higher readmission rates. In-hospital mortality was higher in those with a recent medical compared to surgical encounter. Clinicians should optimize post-discharge transitional care in this subset of patients.
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19
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Ibrahimov F, Yilmaz Y, Ismayilov I, Musayev K, Musayev OO, Alasgarli S, Shahbazova S, Isgenderova M, Jahangirov T. Comparing 5-year Outcomes of Aorta-Coronary Bypass Surgery and Percutaneous Coronary Intervention Performed with New-Generation Drug-Eluting Stents in Non-Diabetic Patients with Multivessel Acute Coronary Syndrome Patients and Intermediate Syntax Score. Medeni Med J 2020; 35:121-127. [PMID: 32733761 PMCID: PMC7384501 DOI: 10.5222/mmj.2020.80270] [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: 02/26/2020] [Accepted: 06/30/2020] [Indexed: 11/05/2022] Open
Abstract
Objective Our main objective is to determine the difference between patients undergoing CABG and PCI with new-generation drug-eluting stents who were non-diabetic during the course of a multivessel acute coronary syndrome (ACS) and intermediate SYNTAX score. Methods Between 2012 and 2014, we retrospectively evaluated 1011 non-diabetic patients with ACS in a single center. The patients were followed up up to 5-years. All- cause mortality, cardiac death, myocardial infarction, stroke, revascularization and stent thrombosis were recorded accordingly. Results A total of 516 (51%) patients were included in the PCI group and 495 patients (49%) in the CABG group. Stroke occurrence (PCI group: 0.8%, and CABG group: 2.6%, p=0.022), requirement for recurrent revascularizations (PCI group: 13.6%, and CABG group: 8.1%, p=0.005) and the MACE percentage (PCI group: 20.3%, and CABG group: 14.5%, p=0.015) were statistically significant between two groups. However, there was no statistical significance difference between two groups in terms of primary endpoints including death, MI, and stroke (PCI group: 10.9%, and CABG group: 8.3%, p=0.165) and all-cause mortality PCI group 6.2%, and CABG group: 4.7%, p=0.298). Conclusion There was no difference in all-cause mortality and myocardial infarction between the PCI and the CABG groups during 5-year follow-up. The frequency of repeated revascularizations was lower in the CABG group than the PCI group. In contrast, the stroke rates were higher in the CABG group.
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Affiliation(s)
- Firdovsi Ibrahimov
- Azerbaijan Medical University, Department of Cardiology, Baku, Azerbaijan
| | - Yusuf Yilmaz
- Istanbul Medeniyet University, Department of Cardiology, Istanbul, Turkey
| | | | - Kamran Musayev
- Central Hospital of Baku, Department of Cardiovascular Surgery, Baku, Azerbaijan
| | | | - Shahana Alasgarli
- Central Hospital of Baku, Department of Cardiology, Baku, Azerbaijan
| | - Shafa Shahbazova
- Central Hospital of Baku, Department of Cardiology, Baku, Azerbaijan
| | | | - Tofig Jahangirov
- J. Abdullayev's Research Institute of Cardiology, Department of Cardiology, Baku, Azerbaijan
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20
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Riley RF, Henry TD, Mahmud E, Kirtane AJ, Brilakis ES, Goyal A, Grines CL, Lombardi WL, Maran A, Rab T, Tremmel JA, Truesdell AG, Yeh RW, Zhao DX, Jaffer FA. SCAI
position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease. Catheter Cardiovasc Interv 2020; 96:346-362. [DOI: 10.1002/ccd.28994] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education The Christ Hospital Cincinnati Ohio USA
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center University of California San Diego La Jolla California USA
| | - Ajay J. Kirtane
- Center for Interventional Vascular Therapy Columbia University Medical Center New York New York USA
| | | | | | | | | | - Anbukarasi Maran
- Medical University of South Carolina North Charleston South Carolina USA
| | | | | | | | - Robert W. Yeh
- Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - David X. Zhao
- Wake Forest University School of Medicine Winston‐Salem North Carolina USA
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21
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Valle JA, Tamez H, Abbott JD, Moussa ID, Messenger JC, Waldo SW, Kennedy KF, Masoudi FA, Yeh RW. Contemporary Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in the United States: An Analysis of the National Cardiovascular Data Registry Research to Practice Initiative. JAMA Cardiol 2020; 4:100-109. [PMID: 30601910 DOI: 10.1001/jamacardio.2018.4376] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Recent data support percutaneous revascularization as an alternative to coronary artery bypass grafting in unprotected left main (ULM) coronary lesions. However, the relevance of these trials to current practice is unclear, as patterns and outcomes of ULM percutaneous coronary intervention (PCI) in contemporary US clinical practice are not well studied. Objective To define the current practice of ULM PCI and its outcomes and compare these with findings reported in clinical trials. Design, Setting, and Participants This cross-sectional multicenter analysis included data collected from 1662 institutions participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry between April 2009 and July 2016. Data were collected from 33 128 patients undergoing ULM PCI and 3 309 034 patients undergoing all other PCI. Data were analyzed from June 2017 to May 2018. Main Outcomes and Measures Patient and procedural characteristics and their temporal trends were compared between ULM PCI and all other PCI. In-hospital major adverse clinical events (ie, death, myocardial infarction, stroke, and emergent coronary artery bypass grafting) were compared using hierarchical logistic regression. Characteristics and outcomes were also compared against clinical trial cohorts. Results Of the 3 342 162 included patients, 2 223 570 (66.5%) were male, and the mean (SD) age was 64.2 (12.1) years. Unprotected left main PCI represented 1.0% (33 128 of 3 342 162) of all procedures, modestly increasing from 0.7% to 1.3% over time. The mean (SD) annualized ULM PCI volume was 0.5 (1.5) procedures for operators and 3.2 (6.1) procedures for facilities, with only 1808 of 10 971 operators (16.5%) and 892 of 1662 facilities (53.7%) performing an average of 1 or more ULM PCI annually. After adjustment, major adverse clinical events occurred more frequently with ULM PCI compared with all other PCI (odds ratio, 1.46; 95% CI, 1.39-1.53). Compared with clinical trial populations, patients in the CathPCI Registry were older with more comorbid conditions, and adverse events were more frequent. Conclusions and Relevance Use of ULM PCI has increased over time, but overall use remains low. These findings suggest that ULM PCI occurs infrequently in the United States and in an older and more comorbid population than that seen in clinical trials.
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Affiliation(s)
- Javier A Valle
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado.,University of Colorado School of Medicine, Aurora
| | - Hector Tamez
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - J Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Issam D Moussa
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Stephen W Waldo
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado.,University of Colorado School of Medicine, Aurora
| | | | | | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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22
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Nonemergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported with Impella® Heart Pump in Patients Ineligible for Surgical Revascularization. J Interv Cardiol 2019; 2019:9691753. [PMID: 31772553 PMCID: PMC6739763 DOI: 10.1155/2019/9691753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 03/07/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella® heart pump support. Background ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. Methods Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) rates as well as 30-day survival and MACCE rates between CABG ineligible and CABG eligible patients. Results A total of 331 patients were included (293 Impella 2.5®, 38 Impella CP®); 227 were ineligible for CABG and 104 were eligible. Baseline characteristics were remarkable for a trend toward higher rate of chronic obstructive pulmonary disease in the ineligible patients. In-hospital mortality (3.52% vs. 5.77%; p=0.383) and MACCE (6.61% vs. 7.69%; p=0.816) rates as well as 30-day survival (92.0% vs. 93.4%; Log-Rank p-value =0.781) and MACCE (88.1% vs. 90.1%; Log-Rank p-value=0.648) rates were not different between the two groups. Conclusions The results of our study suggest that prophylactic Impella support appears to mitigate the risks inherent to surgical ineligibility in patients undergoing a nonemergent ULMCA PCI. Our results require further investigation.
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23
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Matsumura-Nakano Y, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Yamaji K, Shizuta S, Sakata R, Hanyu M, Shimamoto M, Komiya T, Kimura T. Surgical Ineligibility and Long-Term Outcomes in Patients With Severe Coronary Artery Disease. Circ J 2019; 83:2061-2069. [PMID: 31434812 DOI: 10.1253/circj.cj-19-0440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In patients with severe coronary artery disease (CAD) requiring coronary revascularization, the prevalence of surgical ineligibility and its clinical effect on long-term outcomes remain unclear.Methods and Results:Among 15,939 patients with first coronary revascularization in the CREDO-Kyoto percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2, we identified 3,982 patients with triple-vessel or left main disease (PCI: n=2,188, and CABG: n=1,794). Surgical ineligibility as documented in hospital charts was present in 142 (6.5%) of 2,188 PCI-patients, which was mainly related to comorbidities and advanced age. The cumulative 5-year incidence of the primary outcome measure (all-cause death/myocardial infarction/stroke) was much higher in PCI-patients with surgical ineligibility than in PCI-patients without surgical ineligibility and in CABG-patients (52.5%, 27.6%, and 24.0%, respectively, log-rank P<0.001). After adjusting for confounders, the excess risk of PCI-patients with surgical ineligibility relative to CABG-patients was substantial (hazard ratio [HR] 1.97, 95% CI 1.51-2.58, P<0.001), while the excess risk of PCI-patients without surgical ineligibility relative to CABG-patients was modest, but remained significant (HR 1.37, 95% CI 1.19-1.59, P<0.001). CONCLUSIONS Among patients with severe CAD, PCI-patients with surgical ineligibility had worse long-term outcomes as compared with those without surgical ineligibility and CABG-patients.
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Affiliation(s)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | | | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital
| | | | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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24
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Damluji AA, Huang J, Bandeen-Roche K, Forman DE, Gerstenblith G, Moscucci M, Resar JR, Varadhan R, Walston JD, Segal JB. Frailty Among Older Adults With Acute Myocardial Infarction and Outcomes From Percutaneous Coronary Interventions. J Am Heart Assoc 2019; 8:e013686. [PMID: 31475601 PMCID: PMC6755849 DOI: 10.1161/jaha.119.013686] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Frailty is a predictor of adverse outcomes after acute myocardial infarction (AMI). Methods and Results We estimated the prevalence of frailty among adults age ≥75 years admitted with AMI and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with primary diagnoses of AMI. We classified individuals as frail or not using the validated Claims‐based Frailty Index. We described patients’ characteristics and receipt of percutaneous coronary intervention stratified by frailty status. The primary outcome was hospital mortality. From 2000 to 2016, we identified 469 390 encounters for older patients admitted with AMI. The median age was 82 years, 53% were women, and 75% were white. The prevalence of frailty was 19%. Frail patients were less likely to receive percutaneous coronary intervention than nonfrail (15% versus 33%, P<0.001) and much less likely to receive coronary artery bypass surgery (1% versus 9%, P<0.001). There were far fewer interventions in individuals over age 85 years. Frailty was associated with higher mortality during AMI admission (unadjusted odds ratio [OR] 1.43, CI 1.39–1.46). While there was a differential benefit of the interventions because of frailty, frail patients had reduced hospital mortality with percutaneous coronary intervention (frail: OR 0.59, CI 0.55–0.63; nonfrail: OR 0.49, CI 0.47–0.50, P for interaction <0.001) and with coronary artery bypass surgery (frail: OR 0.77, CI 0.65–0.93; nonfrail: OR 0.74, CI 0.71–0.77, P for interaction <0.001) relative to no intervention. Conclusions In the United States, frailty is common among older patients admitted with AMI. While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research Inova Heart and Vascular Institute Falls Church VA.,Division of Cardiology Johns Hopkins University Baltimore MD
| | - Jin Huang
- Division of Geriatric Medicine and Gerontology Johns Hopkins University Baltimore MD
| | - Karen Bandeen-Roche
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Daniel E Forman
- Geriatric Cardiology Section University of Pittsburgh PA.,Geriatric Research, Education, and Clinical Center VA Pittsburgh Healthcare System Pittsburgh PA
| | | | - Mauro Moscucci
- Inova Center of Outcomes Research Inova Heart and Vascular Institute Falls Church VA.,University of Michigan Health System Ann Arbor MI
| | - Jon R Resar
- Division of Cardiology Johns Hopkins University Baltimore MD
| | - Ravi Varadhan
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Jeremy D Walston
- Geriatric Research, Education, and Clinical Center VA Pittsburgh Healthcare System Pittsburgh PA
| | - Jodi B Segal
- Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
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25
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Ly HQ, Nosair M, Cartier R. Surgical Turndown: “What’s in a Name?” for Patients Deemed Ineligible for Surgical Revascularization. Can J Cardiol 2019; 35:959-966. [DOI: 10.1016/j.cjca.2019.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 12/22/2022] Open
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26
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Long-term outcomes in surgically ineligible patients managed with percutaneous coronary revascularization or medical therapy. Cardiovasc Interv Ther 2018; 34:249-259. [DOI: 10.1007/s12928-018-0554-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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27
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Affiliation(s)
| | - Kirk N Garratt
- From Christiana Care Health System, Newark, DE (W.S.W., K.N.G.)
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28
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Montone RA, Niccoli G. Percutaneous coronary intervention in patients refused from surgery: a different entity? Minerva Cardioangiol 2018. [DOI: 10.23736/s0026-4725.18.04656-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Pi Y, Roe MT, Holmes DN, Chiswell K, Garvey JL, Fonarow GC, de Lemos JA, Garratt KN, Xian Y. Utilization, Characteristics, and In-Hospital Outcomes of Coronary Artery Bypass Grafting in Patients With ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003490. [DOI: 10.1161/circoutcomes.116.003490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/26/2017] [Indexed: 01/16/2023]
Abstract
Background—
There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment–elevation myocardial infarction (STEMI) patients in contemporary practice.
Methods and Results—
Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates. Patients undergoing CABG during the index admission were categorized by the most common scenarios: (1) CABG only as the primary reperfusion strategy; (2) CABG after primary percutaneous coronary intervention; and (3) CABG after fibrinolytic therapy. A total of 15 145 patients (6.3% of the STEMI population) underwent CABG during the index hospitalization, with a decrease in utilization from 8.3% in 2007 to 5.4% in 2014 (trend
P
value <0.001). The hospital-level use of CABG in STEMI varied widely from 0.5% to 36.2% (median, 5.3%; interquartile range [IQR], 3.5%–7.8%;
P
value <0.001). Of all patients undergoing CABG, 45.8% underwent CABG only, 38.7% had CABG after percutaneous coronary intervention, and 8.2% CABG after fibrinolytic therapy. The median time intervals from cardiac catheterization/percutaneous coronary intervention to CABG were 23.3 hours (IQR, 3.0–70.3 hours) in CABG only, 49.7 hours (IQR, 3.2–70.3 hours) in CABG after percutaneous coronary intervention, and 56.6 hours (IQR, 22.7–96.0 hours) in CABG after fibrinolytic therapy. The Acute Coronary Treatment and Intervention Outcomes Network mortality risk scores differed modestly (median, 33; IQR, 28–40 versus median, 32; IQR, 27–38) between CABG and non-CABG patients. Patients undergoing CABG had similar in-hospital mortality rate (5.4% versus 5.1%) as those not treated with CABG.
Conclusions—
CABG is performed infrequently in STEMI patients during the index hospitalization, with rates declining in contemporary US practice over time. There was marked hospital-level variation in the use of CABG, and CABG was typically performed within 1 to 3 days after angiography. Observed mortality rates appear low, suggesting that CABG might be safely performed in select STEMI patients in a timely fashion.
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Affiliation(s)
- Yi Pi
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - Matthew T. Roe
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - DaJuanicia N. Holmes
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - Karen Chiswell
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - J. Lee Garvey
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - Gregg C. Fonarow
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - James A. de Lemos
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - Kirk N. Garratt
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
| | - Ying Xian
- From the Duke Clinical Research Institute, Durham, NC (Y.P., M.T.R., D.N.H., K.C., Y.X.); China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China (Y.P.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Division of
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Butman SM. Percutaneous coronary intervention after a surgeon says, "no way". Catheter Cardiovasc Interv 2017; 90:102-103. [PMID: 28707446 DOI: 10.1002/ccd.27170] [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: 05/25/2017] [Accepted: 06/04/2017] [Indexed: 11/09/2022]
Abstract
The rate of surgical turndowns (1.5-2.5%) in this report that went on to PCI is relatively consistent across centers. Unprotected left main intervention in patients turned down for surgery has high hospital mortality. With certain caveats, the HEART Team approach to these unique patients may be the answer.
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Kirtane AJ, Doshi D, Leon MB, Lasala JM, Ohman EM, O'Neill WW, Shroff A, Cohen MG, Palacios IF, Beohar N, Uriel N, Kapur NK, Karmpaliotis D, Lombardi W, Dangas GD, Parikh MA, Stone GW, Moses JW. Treatment of Higher-Risk Patients With an Indication for Revascularization: Evolution Within the Field of Contemporary Percutaneous Coronary Intervention. Circulation 2016; 134:422-31. [PMID: 27482004 DOI: 10.1161/circulationaha.116.022061] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
Abstract
Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.
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Affiliation(s)
- Ajay J Kirtane
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.).
| | - Darshan Doshi
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Martin B Leon
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - John M Lasala
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - E Magnus Ohman
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - William W O'Neill
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Adhir Shroff
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Mauricio G Cohen
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Igor F Palacios
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Nirat Beohar
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Nir Uriel
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Navin K Kapur
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Dimitri Karmpaliotis
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - William Lombardi
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - George D Dangas
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Manish A Parikh
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Gregg W Stone
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Jeffrey W Moses
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
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Gupta A, Yeh RW, Tamis-Holland JE, Patel SH, Guyton RA, Klein LW, Rab T, Kirtane AJ. Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2016; 9:2077-2085. [DOI: 10.1016/j.jcin.2016.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 12/01/2022]
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Sukul D, Seth M, Dixon SR, Zainea M, Slocum NK, Pielsticker EJ, Gurm HS. Clinical outcomes of percutaneous coronary intervention in patients turned down for surgical revascularization. Catheter Cardiovasc Interv 2016; 90:94-101. [DOI: 10.1002/ccd.26781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Devraj Sukul
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
| | - Simon R. Dixon
- Division of Cardiology, Department of Medicine; Beaumont Hospital; Royal Oak Michigan
| | | | | | | | - Hitinder S. Gurm
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
- Veterans Affairs Medical Center; Ann Arbor Michigan
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Mediratta N, Poullis M. Smoking status and 30-day mortality in patients undergoing pulmonary resections. Asian Cardiovasc Thorac Ann 2016; 24:663-9. [PMID: 27365496 DOI: 10.1177/0218492316657252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Smoking status has not been shown to have a significant effect on 30-day mortality after potentially curative resectional surgery for non-small-cell lung cancer, and this is reflected in the guidelines of the National Institute for Health and Care Excellence in the United Kingdom. METHODS A validated prospective thoracic surgery database of consecutive patients undergoing potentially curative resection at a single institution was analyzed. Univariate and propensity analyses of 30-day mortality were performed. RESULTS Univariate analysis identified 30-day mortality as significantly lower in current smokers (n = 852, 2.6%) than ex-smokers (n = 1587, 4.9%; p < 0.001). Propensity 1:1 matching of male patients resulted in 727 current smokers being matched to 727 ex-smokers. The overall balance test (χ(2 )= 6.1, degrees of freedom = 8, p = 0.6), indicated a good match. After propensity matching, the mortality rate was significantly higher in current smokers (p = 0.01). CONCLUSIONS Current smokers and ex-smokers are statistically different with regard to risk factors for death. This results in a skewed population of current and ex-smokers undergoing resection for non-small-cell lung cancer. Development of a risk model for 30-day mortality revealed that current smokers have a lower predicted 30-day mortality than ex-smokers, a finding that is counterintuitive. Propensity matching balanced the current and ex-smoker groups to correct for group differences. Analysis after propensity matching identified current smoking as a significant factor determining 30-day mortality.
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Shen J, Huang YM, Wang M, Hong XZ, Song XN, Zou X, Pan YH, Ling W, Zhu MH, Zhang XX, Sui Y, Zhao HL. Renin-angiotensin system blockade for the risk of cancer and death. J Renin Angiotensin Aldosterone Syst 2016; 17:1470320316656679. [PMID: 27402638 PMCID: PMC5843874 DOI: 10.1177/1470320316656679] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 01/19/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The effects of renin-angiotensin system blockade with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) on cancer remain inconsistent. METHODS We searched existing databases from 1960 to August 2015, for randomised controlled trials and observational studies (case-control studies and cohort studies) of ARB/ACEI therapy with a minimal one year of follow-up. Outcomes were incidence and mortality of cancer. RESULTS We included 14 randomised controlled trials and 17 observational studies of 3,957,725 participants (350,329 ARB/ACEI users). The users had a lower incidence of cancer in the observational studies (RR 0.82, 95% CI 0.73-0.93) but not in the randomised controlled trials (RR 1.00, 95% CI 0.92-1.08). The protection persisted for lung cancer (RR 0.85, 95% CI 0.75-0.97) but not for other sites of cancer. The relative risk of cancer associated with renin-angiotensin system blockade was reduced along with time of follow-up. Mortality reduction with ARB/ACEI was marginally significant in the observational studies (RR 0.71, 95% CI 0.55-0.93) but not in the randomised controlled trials (RR 0.99, 95% CI 0.89-1.09). CONCLUSIONS The significant benefits of renin-angiotensin system blockade observed in case-control studies and cohort studies might diminish in randomised controlled trials. Clinical design, site of cancer and duration of follow-up may affect the clinical outcomes.
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Affiliation(s)
- Jian Shen
- Center for Diabetic Systems Medicine, Guilin Medical University, China Department of Pathology, Affiliated Hospital of Guilin Medical University, China
| | - Yan-Mei Huang
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Min Wang
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Xue-Zhi Hong
- Department of Rheumatology and Immunology, Affiliated Hospital of Guilin Medical University, China
| | - Xin-Nan Song
- Department of Anesthetics, Affiliated Hospital of Guilin Medical University, China
| | - Xia Zou
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Yan-Hong Pan
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Wei Ling
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Min-Hui Zhu
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Xiao-Xi Zhang
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Yi Sui
- Center for Diabetic Systems Medicine, Guilin Medical University, China
| | - Hai-Lu Zhao
- Center for Diabetic Systems Medicine, Guilin Medical University, China
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Modified inflammation-based score as an independent malignant predictor in patients with pulmonary focal ground-glass opacity: a propensity score matching analysis. Sci Rep 2016; 6:19105. [PMID: 26752624 PMCID: PMC4707538 DOI: 10.1038/srep19105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/02/2015] [Indexed: 12/18/2022] Open
Abstract
Pulmonary focal Ground-glass Opacities (fGGOs) would frequently be identified after widely implementation of low-dose computed tomography (LDCT) screening. Because of the high false-positive rate of LDCT, antibiotics should be regarded as advocates in clinical management for detected fGGOs. Retrospectively review consecutive patients with fGGOs between August 2006 and August 2012. Then, relative Glasgow prognostic score (GPS) were constructed in three different systems, traditional GPS system (tGPS), modified GPS system 1 (m1GPS), and modified GPS system 2 (m2GPS). Moreover, propensity score matching (PSM) was employed in balancing baseline covariates. After PSM, patients were matched and included in benign and malignant groups as 1:1 ratio. All reported parameters were balanced in both groups and no statistical differences could be detected. Finally, m1GPS exhibited remarkable different distribution between benign and malignant fGGOs. In detail, m1GPS 1 was more frequently observed in benign fGGOs nodules, while m1GPS 2 in malignant fGGOs nodules. Modified inflammation-based score was identified as an independent predictor of malignancies in patients with pulmonary fGGOs. Patients with m1GPS 1 were more likely to be benign fGGOs, while victims with m1GPS 2 more likely to be malignant.
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Wasfy JH, Singal G, O'Brien C, Blumenthal DM, Kennedy KF, Strom JB, Spertus JA, Mauri L, Normand SLT, Yeh RW. Enhancing the Prediction of 30-Day Readmission After Percutaneous Coronary Intervention Using Data Extracted by Querying of the Electronic Health Record. Circ Cardiovasc Qual Outcomes 2015; 8:477-85. [PMID: 26286871 DOI: 10.1161/circoutcomes.115.001855] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 06/22/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early readmission after percutaneous coronary intervention is an important quality metric, but prediction models from registry data have only moderate discrimination. We aimed to improve ability to predict 30-day readmission after percutaneous coronary intervention from a previously validated registry-based model. METHODS AND RESULTS We matched readmitted to non-readmitted patients in a 1:2 ratio by risk of readmission, and extracted unstructured and unconventional structured data from the electronic medical record, including need for medical interpretation, albumin level, medical nonadherence, previous number of emergency department visits, atrial fibrillation/flutter, syncope/presyncope, end-stage liver disease, malignancy, and anxiety. We assessed differences in rates of these conditions between cases/controls, and estimated their independent association with 30-day readmission using logistic regression conditional on matched groups. Among 9288 percutaneous coronary interventions, we matched 888 readmitted with 1776 non-readmitted patients. In univariate analysis, cases and controls were significantly different with respect to interpreter (7.9% for cases and 5.3% for controls; P=0.009), emergency department visits (1.12 for cases and 0.77 for controls; P<0.001), homelessness (3.2% for cases and 1.6% for controls; P=0.007), anticoagulation (33.9% for cases and 22.1% for controls; P<0.001), atrial fibrillation/flutter (32.7% for cases and 28.9% for controls; P=0.045), presyncope/syncope (27.8% for cases and 21.3% for controls; P<0.001), and anxiety (69.4% for cases and 62.4% for controls; P<0.001). Anticoagulation, emergency department visits, and anxiety were independently associated with readmission. CONCLUSIONS Patient characteristics derived from review of the electronic health record can be used to refine risk prediction for hospital readmission after percutaneous coronary intervention.
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Affiliation(s)
- Jason H Wasfy
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Gaurav Singal
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Cashel O'Brien
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Daniel M Blumenthal
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Kevin F Kennedy
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Jordan B Strom
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - John A Spertus
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Laura Mauri
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Sharon-Lise T Normand
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.)
| | - Robert W Yeh
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
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Wasfy JH, Borden WB, Secemsky EA, McCabe JM, Yeh RW. Public reporting in cardiovascular medicine: accountability, unintended consequences, and promise for improvement. Circulation 2015; 131:1518-27. [PMID: 25918041 DOI: 10.1161/circulationaha.114.014118] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason H Wasfy
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - William B Borden
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - Eric A Secemsky
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - James M McCabe
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - Robert W Yeh
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.).
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White HD, Westerhout CM, Alexander KP, Roe MT, Winters KJ, Cyr DD, Fox KAA, Prabhakaran D, Hochman JS, Armstrong PW, Ohman EM. Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:231-42. [DOI: 10.1177/2048872615581502] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/09/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | | | - Karen P Alexander
- Duke Clinical Research Institute, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, USA
| | - Matthew T Roe
- Duke Clinical Research Institute, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, USA
| | | | | | - Keith AA Fox
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | - Judith S Hochman
- Division of Cardiology, Department of Medicine, Langone Medical Center, New York University, USA
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Canada
| | - E Magnus Ohman
- Duke Clinical Research Institute, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, USA
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Saffioti S, Burzotta F, Coluccia V, Trani C, Bruno P, Massetti M, Crea F. Usefulness of EuroSCORE systems for risk stratification. J Cardiovasc Med (Hagerstown) 2015; 16:90-9. [DOI: 10.2459/jcm.0000000000000065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Propensity score matching and randomization. J Clin Epidemiol 2015; 68:760-8. [PMID: 25660052 DOI: 10.1016/j.jclinepi.2015.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 12/07/2014] [Accepted: 01/05/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We used elective total joint replacement (TJR) as a case study to demonstrate selection bias toward offering this procedure to younger and healthier patients. STUDY DESIGN AND SETTING Longitudinal data from 2,202 men were integrated with hospital data and mortality records. Study participants were followed from recruitment (1996-1999) until TJR, death, or 2007 (end of follow-up). A propensity score (PS) was constructed to quantify each subject's likelihood of undergoing TJR. TJR recipients were later matched to their non-TJR counterparts by PS and year of hospitalization. Ten-year mortality from index admission was compared between cases and controls. RESULTS Overall, 819 (37.2%) had TJR. Those were younger, healthier, and belonged to higher socioeconomic classes compared with those who were not proposed for surgery. Of the TJR recipients, 718 were matched to 1,109 controls. Cases and controls had similar characteristics and similar years of follow-up from recruitment till index admission. Nonetheless, controls were more likely to die (39.5%) compared with 14.5% in TJR cases (P < 0.001). CONCLUSION Selection for elective procedures may introduce bias in prognostic features not accounted for by PS matching. Caution must be exercised when long-term outcomes are compared between surgical and nonsurgical groups in a population at risk for that surgical procedure.
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Spertus JA. ASCERTing the Value of Coronary Artery Bypass Graft in Stable Angina Patients. J Am Coll Cardiol 2015; 65:12-14. [DOI: 10.1016/j.jacc.2014.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
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Garratt KN. Challenges and Importance of Finding Hidden Confounders When Conducting Comparative Effectiveness Studies Using Registry Data. Circulation 2014; 130:2269-71. [DOI: 10.1161/circulationaha.114.013678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Waldo SW, Secemsky EA, O'Brien C, Kennedy KF, Pomerantsev E, Sundt TM, McNulty EJ, Scirica BM, Yeh RW. Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. Circulation 2014; 130:2295-301. [PMID: 25391519 DOI: 10.1161/circulationaha.114.011541] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Decisions to proceed with surgical versus percutaneous revascularization for multivessel coronary artery disease are often based on subtle clinical information that may not be captured in contemporary registries. The present study sought to evaluate the association between surgical ineligibility documented in the medical record and long-term mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. METHODS AND RESULTS All subjects undergoing nonemergent percutaneous coronary intervention for unprotected left main or multivessel coronary artery disease were identified at 2 academic medical centers from 2009 to 2012. Documentation of surgical ineligibility was assessed through review of electronic medical records. Cox proportional hazard models adjusted for known mortality risk factors were created to assess long-term mortality in patients with and without documentation of surgical ineligibility. Among 1013 subjects with multivessel coronary artery disease, 218 (22%) were deemed ineligible for coronary artery bypass graft surgery. The most common explicitly cited reasons for surgical ineligibility in the medical record were poor surgical targets (24%), advanced age (16%), and renal insufficiency (16%). After adjustment for known risk factors, documentation of surgical ineligibility remained independently associated with an increased risk of in-hospital (odds ratio, 6.26; 95% confidence interval, 2.16-18.15; P<0.001) and long-term mortality (hazard ratio, 2.98; 95% confidence interval, 1.88-4.72, P<0.001) after percutaneous coronary intervention. CONCLUSIONS Documented surgical ineligibility is common and associated with significantly increased long-term mortality among patients undergoing percutaneous coronary intervention with unprotected left main or multivessel coronary disease, even after adjustment for known risk factors for adverse events during percutaneous revascularization.
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Affiliation(s)
- Stephen W Waldo
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Eric A Secemsky
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Cashel O'Brien
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Kevin F Kennedy
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Eugene Pomerantsev
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Thoralf M Sundt
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Edward J McNulty
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Benjamin M Scirica
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.)
| | - Robert W Yeh
- From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.).
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Yeh RW, Wimmer NJ. Blood transfusion in myocardial infarction: opening old wounds for comparative-effectiveness research. J Am Coll Cardiol 2014; 64:820-2. [PMID: 25145527 DOI: 10.1016/j.jacc.2014.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/12/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Robert W Yeh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Neil J Wimmer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- James M McCabe
- From the Division of Cardiology, University of Washington, Seattle (J.M.M.); Division of Cardiovascular Medicine, Lahey Clinic, Burlington, MA (F.S.R.); and Tufts Medical School, Boston, MA (F.S.R.).
| | - Frederic S Resnic
- From the Division of Cardiology, University of Washington, Seattle (J.M.M.); Division of Cardiovascular Medicine, Lahey Clinic, Burlington, MA (F.S.R.); and Tufts Medical School, Boston, MA (F.S.R.).
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Fanari Z, A Weiss S, Weintraub WS. Comparative effectiveness of revascularization strategies in stable ischemic heart disease: current perspective and literature review. Expert Rev Cardiovasc Ther 2014; 11:1321-36. [PMID: 24138520 DOI: 10.1586/14779072.2013.840136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple randomized controlled trials and observational studies have compared the impact of the two modalities on the patients' quality of life, mortality and morbidity, as well as the cost-effectiveness of these modalities in different clinical setting. CABG is the preferred strategy for revascularizations in patients with multi-vessel disease, especially in those with higher risk secondary to associated diabetes, left ventricular dysfunction or more complex lesions. PCI is a reasonable revascularization modality in patients with ischemia and single or low-risk multi-vessel disease and those with unprotected left main with low complexity anatomy. Compared with PCI, CABG is associated with less repeat revascularization, better quality of life and improved survival in high-risk patients. Although CABG is associated with higher cost, it is probably associated with a reasonable cost per quality-adjusted life-year gained in many patients. Therefore, CABG will often be a cost-effective strategy, especially in patients with high angiographic complexity and/or diabetes.
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Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2013; 63:747-62. [PMID: 24291279 DOI: 10.1016/j.jacc.2013.09.070] [Citation(s) in RCA: 758] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 12/16/2022]
Abstract
Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty-slow walking speed, weakness, inactivity, exhaustion, and shrinking-as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.
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Affiliation(s)
- Jonathan Afilalo
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Karen P Alexander
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michael J Mack
- Division of Cardiothoracic Surgery, Baylor Health Care System, The Heart Hospital Baylor Plano, Plano, Texas
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Philip Green
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, VA Boston Healthcare Center, Boston, Massachusetts
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Elmayergi N, Nguyen T, Hiebert B, Philipp RK, Jassal DS, Tam JW, Hussain F. A "no-option" left main PCI registry: outcomes and predictors of in hospital mortality-utility of the logistic EuroSCORE. Catheter Cardiovasc Interv 2013. [PMID: 23197480 DOI: 10.1002/ccd.24769] [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: 11/12/2022]
Abstract
BACKGROUND Although high-risk left main PCI populations have been previously described, there is little data describing outcomes and the role of the logistic EuroSCORE in surgical turndown cohorts or patients in extremis due to acute infarction or cardiogenic shock from left main ischemia. METHODS Consecutive patients with unprotected LM PCI who were surgical turndowns or in extremis were included in this retrospective cohort from 2004 to 2009 at two tertiary centers. Predictors of in-hospital mortality were identified utilizing routine and stepwise logistic regression. RESULTS There were a total of 56 patients with mean age of 69 (±13). There were 23 (41%) patients with cardiogenic shock. The mean logistic EuroSCORE was 23.5% ± 21%. In-hospital death occurred in 12 (21%) patients, largely restricted to the shock subgroup (11/12). Univariate predictors of mortality included peak CK levels (P = 0.01), transfusion (P = 0.01), cardiogenic shock (P < 0.002), male gender (P = 0.027), and logistic EuroSCORE (P = 0.01). Stepwise logistic regression yielded logistic EuroSCORE (P = 0.04, OR: 1.25 (95% CI: 1.01-1.56) for every 5% increase) and peak CK level (P = 0.001, OR: 1.23 (95% CI: 1.09-1.40) for every 500 unit increase) as independent predictors of in-hospital mortality. The AUC ROC for logistic EuroSCORE was 0.73; and for logistic EuroSCORE plus peak CK level was 0.89. CONCLUSION PCI appears to be a reasonable option in the high risk "no option" LM population, with the logistic EuroSCORE and peak CK levels being independent predictors of in-hospital mortality. Specifically, the logistic EuroSCORE and peak CK level combined discriminate in-hospital mortality with a high degree of certainty.
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Affiliation(s)
- Nader Elmayergi
- Department of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
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