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O'Brien JM, Dinh D, Roberts L, Teh A, Brennan A, Duffy SJ, Clark D, Ajani A, Oqueli E, Sebastian M, Reid C, Econ CH, Freeman M, Chandrasekhar J. Associations Between Metabolic Syndrome and Long-Term Mortality in Patients who underwent Percutaneous Coronary Intervention: An Australian Cohort Analysis. Am J Cardiol 2024; 219:25-34. [PMID: 38447892 DOI: 10.1016/j.amjcard.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 02/06/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
Metabolic syndrome (MetS) provides significant risk for coronary disease, however long-term prognosis after percutaneous coronary intervention (PCI) has been understudied. We assessed the prevalence and outcomes of patients with MetS from an Australian PCI cohort. We retrospectively examined data from the Melbourne Interventional Group multicenter PCI registry using a modified definition for MetS including ≥3 of the following: hypertension, diabetes mellitus, dyslipidemia, and body mass index ≥30 kg/m2. Thirty-day outcomes and long-term mortality were compared with patients without MetS. Cox regression methods were used to assess the multivariable effect of MetS on long-term mortality. Of 41,146 patients, 12,228 (34%) had MetS. Patients with MetS experienced greater 30-day myocardial infarction (2.2% vs 1.8%, p = 0.013), whereas patients without MetS had a trend for greater 30-day mortality (3.0% vs 3.4%, p = 0.051) and greater in-hospital major bleeding (1.7% vs 2.4%, p <0.001). After a median follow-up of 5.62 years (Q1 2.03, Q3 8.89), patients with MetS experienced greater mortality (24% vs 19%, p <0.001). After adjustment, MetS was not an independent predictor of long-term mortality (hazard ratio 0.95 confidence interval 0.86 to 1.05, p = 0.35). In sensitivity analyses, MetS-Diabetic patients had the highest, and MetS-NonDiabetic obese patients had the lowest long-term mortality. One in 3 patients who underwent all-comer PCI presented with MetS and experienced greater long-term mortality compared with others. However, this association was lost after adjustment for baseline confounders, highlighting that MetS is a marker of risk after PCI. Our findings support the obesity paradox and confirm robust associations between diabetes mellitus and long-term mortality.
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Affiliation(s)
- Joseph M O'Brien
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
| | - Andrew Teh
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine
| | - Stephen J Duffy
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine
| | - David Clark
- Department of Cardiology, Austin Health, Heidelberg, Victoria Australia; Department of Cardiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Department of Cardiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Service, Ballarat, Victoria, Australia
| | - Martin Sebastian
- Department of Cardiology, Barwon Health, University Hospital Geelong, Geelong, Victoria Australia
| | - Christopher Reid
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Cert Health Econ
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine; Royal Melbourne Hospital, Curtin University, Perth, Western Australia, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia.
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Brandt MC, Alber H, Berger R, Binder RK, Mascherbauer J, Niessner A, Schmid M, Frick M. Same-day discharge after percutaneous coronary procedures-Consensus statement of the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology. Wien Klin Wochenschr 2024; 136:61-74. [PMID: 38743084 PMCID: PMC11093795 DOI: 10.1007/s00508-024-02348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. Recent technical advances such as radial access, third generation drug-eluting stents and highly effective antiplatelet therapy have substantially improved the safety profile of coronary procedures. Despite several practice guidelines and a clear patient preference of early hospital discharge, the percentage of coronary procedures performed in an outpatient setting in Austria remains low, mostly due to safety concerns. METHODS The aim of this consensus statement is to provide a practical framework for the safe and effective implementation of coronary outpatient clinics in Austria. Based on a structured literature review and an in-depth analysis of available practice guidelines a consensus statement was developed and peer-reviewed within the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology. RESULTS Based on the available literature same-day discharge coronary procedures show a favorable safety profile with no increase in the risk of major adverse events compared to an overnight stay. This document provides a detailed consensus in various clinical settings. The most important prerequisite for same-day discharge is, however, adequate selection of suitable patients and a structured peri-interventional and postinterventional management plan. CONCLUSION Based on the data analysis this consensus document provides detailed practice guidelines for the safe operation of daycare cathlab programs in Austria.
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Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Rudolf Berger
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Martin Schmid
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Matthias Frick
- Department of Internal Medicine I and Cardiology, Teaching Hospital Feldkirch, Feldkirch, Austria
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Ahn J, Yu H, Rha SW, Choi BG, Park S, Park EJ, Kang DO, Choi CU. Long-term clinical outcomes following successful percutaneous coronary intervention in patients with extremely long coronary chronic total occlusion lesions. Catheter Cardiovasc Interv 2023; 102:878-884. [PMID: 37681968 DOI: 10.1002/ccd.30829] [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: 07/10/2023] [Revised: 08/20/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Lesion length is related to worse clinical outcomes following percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO). However, the data to confirm the association between extremely long lesions and clinical hard endpoints have been limited. Therefore, we investigated the impact of extremely long CTO lesions (≥50 mm, treated lesion length) on the long-term clinical outcomes following successful PCI. METHODS A total of 333 consecutive patients with CTO who underwent successful PCI with drug-eluting stents (DESs) were allocated to either the extremely long or the short CTO group according to their CTO lesion length. The 5-year clinical outcomes were compared between the two groups. The incidence of myocardial infarction, cardiac death (CD), revascularization, and major adverse cardiovascular events (MACE) was higher in the extremely long CTO group. The 5-year clinical outcomes were analyzed using the Cox hazard ratio (HR) model. RESULTS In the entire study population, the extremely long CTO lesion was an independent predictor for higher rate of revascularization, MACE, CD, or mortality. CONCLUSIONS In our study, CTO patients with extremely long lesions (≥50 mm) who underwent successful PCI were associated with a higher risk of worse long-term clinical outcomes, including hard clinical endpoints such as CD and mortality even in the DESs era.
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Affiliation(s)
- Jihun Ahn
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - HyeYon Yu
- School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Bujak K, Vidal-Cales P, Gabani R, Rinaldi R, Gomez-Lara J, Ortega-Paz L, Jimenez-Diaz V, Jimenez-Kockar M, Jimenez-Quevedo P, Diletti R, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, De Miguel-Castro A, Iñiguez A, Nombela-Franco L, Ielasi A, Tespili M, Lenzen M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Gasior M, Serruys PW, Sabate M, Brugaletta S. Relationship between stent length and very long-term target lesion failure following percutaneous coronary intervention for ST-elevation myocardial infarction in the drug-eluting stents era: insights from the EXAMINATION-EXTEND study. Am Heart J 2023; 264:72-82. [PMID: 37279839 DOI: 10.1016/j.ahj.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/07/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Little data exist on the relationship between total stent length (TSL) and cardiovascular outcomes at very-long follow-up in patients with ST-elevation myocardial infarction (STEMI) in the 2nd generation drug-eluting stents (DES) era. AIM To analyze the relationship between TSL and 10-year target-lesion failure (TLF) in STEMI patients treated with percutaneous coronary intervention enrolled in the EXAMINATION-EXTEND. METHODS The EXAMINATION-EXTEND was an extended-follow-up study of the EXAMINATION trial, which randomized 1:1 STEMI patients to receive DES or bare metal stent (BMS). The primary endpoint was TLF, defined as a composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), or definite/probable stent thrombosis (ST). Relationship between stent length and TLF was evaluated in the whole study group in a multiple-adjusted Cox regression model with TSL as a quantitative variable. Subgroup analysis was also performed according to stent type, diameter, and overlap. RESULTS A total of 1,489 patients with a median TSL of 23 mm (Q1-Q318-35 mm) were included. TSL was associated with TLF at 10 years (adjusted HR per 5 mm increase of 1.07; 95% CI, 1.01-1.14; P = .02). This effect was mainly driven by TLR and was consistent regardless of stent type, diameter, or overlap. There was no significant relationship between TSL and TV-MI or ST. CONCLUSIONS In STEMI patients, there is a direct relationship between TSL implanted in the culprit vessel and the risk of TLF at 10 years, mainly driven by TLR. The use of DES did not modify this association.
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Affiliation(s)
- Kamil Bujak
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Pablo Vidal-Cales
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Riccardo Rinaldi
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | | | | | | | - Roberto Diletti
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | - Mattie Lenzen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Mariusz Gasior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Manel Sabate
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Yang S, Hwang D, Zhang J, Park J, Yun JP, Lee JM, Nam C, Shin E, Doh J, Chen S, Kakuta T, Toth GG, Piroth Z, Johnson NP, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim H, Ito T, Matsuo A, Azzalini L, Leesar MA, Neleman T, van Mieghem NM, Diletti R, Daemen J, Collison D, Collet C, De Bruyne B, Koo B. Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications. J Am Heart Assoc 2023; 12:e030572. [PMID: 37642032 PMCID: PMC10547308 DOI: 10.1161/jaha.123.030572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jinlong Zhang
- Department of CardiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jun Pil Yun
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Chang‐Wook Nam
- Department of MedicineKeimyung University Dongsan Medical CenterDaeguSouth Korea
| | - Eun‐Seok Shin
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanSouth Korea
| | - Joon‐Hyung Doh
- Department of MedicineInje University Ilsan Paik HospitalGoyangSouth Korea
| | - Shao‐Liang Chen
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University GrazGrazAustria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of CardiologyBudapestHungary
| | - Nils P. Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing AtherosclerosisUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNJ
| | - Barry F Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical SciencesLittle RockAR
| | - Yohei Hokama
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Nobuhiro Tanaka
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Hong‐Seok Lim
- Department of CardiologyAjou University School of MedicineSuwonSouth Korea
| | - Tsuyoshi Ito
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Akiko Matsuo
- Department of CardiologyKyoto Second Red Cross HospitalKyotoJapan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWA
| | - Massoud A. Leesar
- Division of Cardiovascular DiseasesUniversity of AlabamaBirminghamAL
| | - Tara Neleman
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Roberto Diletti
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Joost Daemen
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Damien Collison
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National HospitalGlasgowUnited Kingdom
| | | | - Bernard De Bruyne
- Cardiovascular Center AalstAalstBelgium
- Department of CardiologyUniversity of LausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
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Polavarapu RS, Pamidimukkala V, Polavarapu A, Siripuram Y, Ravella KC, Rachaputi MBR, Polavarapu N, Pulivarthi KC, Byrapaneni S, Gangasani S, Noronha M, Chinta SR. Ultra-thin everolimus-eluting stents in atherosclerotic lesions: Three years follow-up with subgroup analysis of ultra-long stents. Indian Heart J 2023; 75:279-284. [PMID: 36972762 PMCID: PMC10421990 DOI: 10.1016/j.ihj.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To assess the long-term (3 years) safety and efficacy of Tetrilimus everolimus-eluting stent (EES) and subgroup analysis of outcomes of ultra-long (44/48 mm) Tetrilimus EES implantation in patients with long coronary lesions. MATERIAL AND METHODS In this observational, single-centre, single-arm, investigator-initiated registry, 558 patients who underwent implantation of Tetrilimus EES for the treatment of coronary artery disease were retrospectively included. The primary endpoint was occurrence of any major adverse cardiac event (MACE) at 12 months follow-up (composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and we hereby report 3 years follow-up data. Stent thrombosis was assessed as a safety endpoint. A subgroup analysis of patients with long coronary lesions is also reported. RESULTS A total of 558 patients (57.0 ± 10.2 years) received 766 Tetrilimus EES (1.3 ± 0.5 stents/patient) to treat 695 coronary lesions. In subgroup analysis of 143 patients implanted with ultra-long EES, 155 lesions were intervened successfully with only one Tetrilimus EES (44/48 mm) implanted per lesion. At 3 years, event rates of 9.1% MACE with predominance of MI (4.4%), followed by 2.9% TLR and 1.7% cardiac death, and only 1.0% stent thrombosis were reported in overall population, while in a subgroup of patients implanted with ultra-long EES, 10.4% MACE and 1.5% stent thrombosis were reported. CONCLUSIONS Three years clinical outcomes showed favourable long-term safety and excellent performance of Tetrilimus EES in high-risk patients and complex coronary lesions in routine clinical practice, including a subgroup of patients with long coronary lesions, with acceptable primary and safety endpoints.
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Affiliation(s)
| | - Vijaya Pamidimukkala
- Department of Neurosciences, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Anurag Polavarapu
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Yudhistar Siripuram
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | | | | | - Naren Polavarapu
- Department of General Medicine, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | | | - Sravanthi Byrapaneni
- Department of Oncology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Sirichandana Gangasani
- Department of General Medicine, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Michael Noronha
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Srinivasa Rao Chinta
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
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7
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Liu ES, Yang TH, Tai TH, Chiang CH, Cheng CC, Huang WC, Mar GY, Kuo FY. Long-term outcomes after stent implantation in very small vessel coronary artery disease. Clin Cardiol 2023; 46:431-440. [PMID: 36824027 PMCID: PMC10106663 DOI: 10.1002/clc.24000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Percutaneous coronary interventions (PCI) in very small vessel lesions represent an intriguing aspect of coronary artery disease (CAD). Uncertainty still exists in stent implantation in very small caliber vessels. This study aimed to evaluate the long-term outcomes of patients treated with 2.0-mm drug-eluting stent (DES). METHOD This retrospective observational study included 134 patients undergoing PCI with 2.0-mm zotarolimus DES from December 2016 to May 2020. The primary endpoint was major adverse cardiovascular events (MACE) at 2-year follow-up, which was composed of all-cause mortality, target vessel myocardial infarction, and ischemia-driven target lesion revascularization. Multiple logistic regression analysis was used to identify the independent predictors of MACE, and odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULT The lesions were diffuse (mean length 20.9 ± 5.51 mm) and belong to type B2/C lesions (90.3%). On follow-up, the MACE rate was 20.1% and mostly driven by late lumen loss demanding revascularization (11.9%). In multivariable analysis, chronic kidney disease (CKD) (OR: 4.291, 95% CI: 1.574-11.704, p = 0.004) and calcified lesions (OR: 3.688, 95% CI: 1.311-10.371, p = 0.013) were the independent predictors of subsequent cardiovascular events, whereas statin was associated with better outcomes (OR: 0.335, 95% CI: 0.119-0.949, p = 0.040). CONCLUSION 2.0-mm DES is a feasible option for treating very small vessel CAD in complex lesions. Patients with CKD and calcified lesions carry the hazard of worse outcomes, and careful consideration should be taken before stenting in this high-risk population.
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Affiliation(s)
- En-Shao Liu
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tse-Hsuan Yang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ta-Hsin Tai
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan
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8
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Chen Y, Gao YF, Wang YF, Wang CJ, Du Y, Ding YH. Influence of Stent Length on Periprocedural Outcomes After Primary Percutaneous Coronary Intervention in Patients with ST Segment Elevation Myocardial Infarction. Clin Interv Aging 2022; 17:1687-1695. [PMID: 36467316 PMCID: PMC9717423 DOI: 10.2147/cia.s389302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/19/2022] [Indexed: 08/26/2023] Open
Abstract
PURPOSE A longer stent is associated with adverse events after percutaneous coronary intervention (PCI). However, little information is available on the relationship between stent length and periprocedural prognosis in patients with ST segment elevation myocardial infarction (STEMI). We aimed to assess the target vessel stent length influence on angiographic outcomes and in-hospital major adverse cardiovascular event (MACE) during primary PCI in patients with STEMI. PATIENTS AND METHODS This single-center retrospective observational study included 246 patients with STEMI admitted to the Zhejiang Provincial People's Hospital between January 2019 and December 2021, who underwent primary PCI and successful stent implantation. The exclusion criteria included left main lesion, multiple diseased vessel-stenting, bleeding disorders, contrast allergy, and incomplete data. Patients were divided into two groups based on the median stents length: group A (≤29 mm, n=125) and group B (>29mm, n=121). Periprocedural outcomes were slow flow/no-reflow (SF-NR) and in-hospital MACE, which included acute heart failure, malignant arrhythmia, cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and urgent revascularization. Multivariate logistic analyses were used to explore the correlation between stent length and SF-NR. RESULTS A total of 246 patients (82.9% males) with a mean age of 59.9±12.6 years were included in the analysis. The incidence of SF-NR was significantly higher in group B than in group A (36.4% vs 23.2%, p=0.024). However, the in-hospital MACE incidence rate was similar between the two groups (7.2% vs 7.4%, p=0.943). Multivariate logistic regression analysis showed that stent length and diameter, and peak troponin I level were independent risk factors for SF-NR. CONCLUSION Excessive stent length is an independent risk factor for SF-NR, without any significant influence on the risk of MACE during hospitalization.
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Affiliation(s)
- Yan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Ya-Fang Gao
- Graduate Department, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Yun-Fan Wang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Cheng-Jian Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ying Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ya-Hui Ding
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
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9
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Agostoni P, Kortsmit J, Colombo A. Accurate stent placement in challenging percutaneous coronary interventions using the stent positioning assist system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:123-129. [DOI: 10.1016/j.carrev.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
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10
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Coronary Angioplasty and Stenting in Acute Coronary Syndromes Using Very Low Contrast Volume and Radiation Dosage Improves Renal and Cardiovascular Outcomes. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Aim: To demonstrate that in patients with acute coronary syndrome (ACS), using Cordis 6F Infiniti diagnostic catheters for angioplasty may represent a safe alternative associated with lower contrast volume and radiation dosage, improving cardiovascular and renal outcomes.
Material and Methods: In 1,800 patients with ACS (2,331 lesions/2,603 stents), angioplasty was performed with Cordis 6F Infiniti Thrulumen diagnostic catheters. Primary angioplasty was performed in 545 cases, and only balloon angioplasty in 67 patients. All procedures were performed through the femoral route, and switch-over to the radial route was made in 5 cases due to associated aortic/iliac obstructive lesions. Iodixanol was used in 76% of cases, and tirofiban in 99% of cases with adjusted dosages based on creatinine values. The mean contrast volume used per patient was 28 mL (± 6 mL) including the angiogram prior to the angioplasty.
Results: The median fluoroscopy time was 4.4 min (IQR 3–6.8), the mean fluoroscopy time was 5.59 min (± 0.28), the median dose-area product or kerma-area product was 1,507 µGym2 (IQR 918–2,611), median total or cumulative dose including backscatter was 2,702 µGym2 (IQR 1,805–4,217), and the median cumulative skin dose was 468 mGy (IQR 296–722). Groin hematoma was seen in 7 cases, proximal mild edge dissection in the deployed stent in 3 cases, and acute in-hospital stent thrombosis in 7 cases. In total, 33 deaths were registered and 19 of these patients had cardiogenic shock, of which 11 subjects were late presenters. Three patients died after discharge due to possible acute stent thrombosis.
Conclusions: Angioplasty and stenting can be performed safely in patients with acute coronary syndromes using Cordis 6F diagnostic catheters. The procedure was associated with a very low volume of contrast and radiation dose, leading to improved clinical outcomes..
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11
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Shoaib A, Spratt JC, Curzen N, Wilson S, Rashid M, Ahmad F, Ludman P, Kinnaird T, Mamas MA. Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length. Catheter Cardiovasc Interv 2021; 99:234-244. [PMID: 34797596 DOI: 10.1002/ccd.30015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Long lesions are known to have worse outcomes following percutaneous coronary intervention (PCI), but there are limited data assessing the association between lesion length and clinical outcomes in PCI procedures undertaken in chronic total occlusions (CTO). METHODS AND RESULTS We formed a longitudinal cohort (2006-2018, n = 27,205) of stable angina patients who underwent PCI to CTO in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographical, procedural, and outcome data were analyzed in three groups by treated segment length, < 30 mm (n = 11,782), 30-59 mm (n = 10,415), ≥ 60 mm (n = 5008). Prevalence of previous myocardial infarction and PCI were higher in patients in 30-59 mm group or ≥ 60 mm group compared with < 30 mm group. Following multivariable analysis, no significant difference was observed in in-patient death (OR = 30-59 mm group = 1.10, CI:0.55-2.19, p = 0.78) (OR ≥ 60 mm group = 0.82, CI: 0.33-2.05, p = 0.67), and 1-year death (OR = 30-59 mm group = 1.06, CI: 0.81-1.37, p = 0.69) (OR ≥ 60 mm group =1.01, CI: 0.70-1.43, p = 0.99) (< 30 mm group = reference) but in-patient MACE was higher in > = 60 mm group (OR: 1.52, CI: 1.15-2.01, p = 0.06) but similar in 30-59 mm group (OR: 1.16, CI: 0.91-1.48, p = 0.22) compared with < 30 mm group. The adjusted rates of procedural complications were higher in ≥ 60 mm group (OR: 1.61, CI: 1.40-1.85, p < 0.001) but were similar in 30-59 mm group (OR: 1.06, CI: 0.94-1.20, p < 0.31) compared with < 30 mm group. For every 10 mm increase, there was an increased adjusted risk of in-patient procedural complications and coronary perforation but not in-patient MACE or death. CONCLUSION Patients with very long CTO lesions have higher risk of procedural complications and in-patient MACE but similar risk of short or long-term mortality compared with short CTO lesions.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK.,Victoria Heart Institute Foundation, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | | | - Nick Curzen
- University of Southampton, Southampton, & University Hospital Southampton NHS Trust, Southampton, UK
| | - Simon Wilson
- St Georges' Hospitals, NHS Foundation trust, London, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Fatima Ahmad
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
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12
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Hara H, Ono M, Kawashima H, Kogame N, Mack MJ, Holmes DR, Morice MC, Davierwala PM, Mohr FW, Thuijs DJFM, Head SJ, Kappetein AP, Onuma Y, Serruys PW. Impact of stent length and diameter on 10-year mortality in the SYNTAXES trial. Catheter Cardiovasc Interv 2021; 98:E379-E387. [PMID: 33951265 DOI: 10.1002/ccd.29721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We investigated the impact of total stent length (TSL) and average nominal stent diameter (ASD) on 10-year mortality after percutaneous coronary intervention (PCI) in the SYNTAXES trial. BACKGROUND TSL and ASD in patients treated with PCI are associated with major adverse cardiovascular events. However, the treatment effect of PCI with extensive and/or small stenting as compared with coronary artery bypass grafting (CABG) for complex coronary artery disease has not been fully evaluated. METHODS Impacts on mortality of extensive stenting defined as TSL >100 mm and small stenting as ASD <3 mm were analyzed in 893 PCI patients and were compared to 865 CABG patients. RESULTS TSL as a continuous variable was significantly associated with 10-year mortality (adjusted hazard ratio [HR], 1.05 [1.01-1.09] per 10 mm increase). PCI patients with extensive stenting had a higher 10 year mortality than CABG patients (adjusted HR, 1.97 [1.41-2.74]) or not- extensive stenting PCI (adjusted HR, 1.94 [1.36-2.77]). Although ASD did not have a significant association with 10 year mortality (adjusted HR, 0.97 [0.85-1.11] per 0.25 mm increase), PCI with small stents was associated with a higher 10 year mortality, compared to CABG (adjusted HR, 1.66 [1.23-2.26]) and PCI performed with large stents (adjusted HR, 1.74 [1.19-2.53]). Patients treated with not-extensive and large stents had similar mortality rates (24.0 versus 23.8%) as those treated with CABG. CONCLUSIONS Extensive and small stenting were associated with higher 10 year mortality, compared with CABG. When patients have to be treated with extensive or small stenting, revascularization with CABG should be preferred.
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Affiliation(s)
- Hironori Hara
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway
| | - Masafumi Ono
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway
| | - Hideyuki Kawashima
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, Texas, USA
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France
| | - Piroze M Davierwala
- Heart Centre Leipzig, University Department of Cardiac Surgery, Leipzig, Germany
| | - Friedrich W Mohr
- Heart Centre Leipzig, University Department of Cardiac Surgery, Leipzig, Germany
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway.,NHLI, Imperial College London, London
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13
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Greco A, Capodanno D. Differences in coronary artery disease and outcomes of percutaneous coronary intervention with drug-eluting stents in women and men. Expert Rev Cardiovasc Ther 2021; 19:301-312. [PMID: 33706641 DOI: 10.1080/14779072.2021.1902806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite common perceptions, coronary artery disease (CAD) is not a male-specific condition, and sex-based differences do occur in many aspects, including clinical outcomes after percutaneous coronary intervention (PCI) with stent implantation. New-generation drug-eluting stents (DES) significantly improved post-PCI outcomes. However, no sex-specific guidelines on PCI and the use of DES are available as current evidence was derived from clinical trials enrolling predominantly male patients. AREAS COVERED This review aims at exploring sex-based disparities in CAD characteristics and manifestations, and comparing PCI outcomes and the efficacy and safety profiles of DES according to sex. In addition, a critical approach to trials' interpretation with an analysis of sources of bias is provided to inform future research and clinical practice. EXPERT OPINION Sex gap in clinical outcomes after PCI with DES implantation is narrowing due to improved performances of new-generation DES. However, scientific research and biomedical engineering are striving to optimize DES profiles and generate new iterations of devices. At the same time, gender initiatives and sex-specific trials are accruing to overcome current issues in the field. Advances in these areas will foster improvements in early and long-term clinical outcomes of both women and men.
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Affiliation(s)
- Antonio Greco
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
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14
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Kong M, Han JK, Kang HJ, Koo BK, Chae IH, Kim HS, Kang HJ, Koo BK, Chae IH, Kim HS. Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry. EUROINTERVENTION 2021; 16:1318-1325. [PMID: 31543496 PMCID: PMC9724862 DOI: 10.4244/eij-d-19-00296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DES). METHODS AND RESULTS We analysed 9,217 patients who underwent stenting for a single lesion from the GRAND-DES registry, a patient-level pooled registry including five Korean multicentre DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). A total of 8,035 patients were classified into the short stenting group (≤40 mm), and 1,182 into the long stenting group (>40 mm). The primary endpoint was target lesion failure (TLF). Long stenting (>40 mm) was significantly associated with higher TLF (IPTW adjusted HR 1.88, 95% CI: 1.67-2.13; p<0.001), and definite or probable stent thrombosis (IPTW adjusted HR 2.20, 95% CI: 1.51-3.20; p<0.001). In the landmark analysis, the incidence of TLF was significantly higher with long stenting during the first 30 days after PCI (log-rank p=0.001) and also after 30 days (log-rank p<0.001). Long stenting was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that of late stent thrombosis (log-rank p=0.887). CONCLUSIONS In the contemporary second-generation DES era, stenting longer than 40 mm continues to be associated with less favourable clinical outcomes such as TLF and stent thrombosis.
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Affiliation(s)
- Min Kong
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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15
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Takahashi K, Chichareon P, Modolo R, Kogame N, Chang CC, Tomaniak M, Moschovitis A, Curzen N, Haude M, Jung W, Holmvang L, Garg S, Tijssen JG, Wykrzykowska JJ, de Winter RJ, Hamm C, Steg PG, Stoll HP, Onuma Y, Valgimigli M, Vranckx P, Windecker S, Serruys PW. Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: a post hoc analysis of the GLOBAL LEADERS trial. EUROINTERVENTION 2020; 16:634-644. [DOI: 10.4244/eij-d-19-00498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Ejiri K, Sawano M, Numasawa Y, Noma S, Ito H, Fukuda K, Kohsaka S. Association of Second-Generation Drug-Eluting Stent Length With 2-Year Adverse Clinical Outcomes Among Japanese Patients With Ischemic Heart Disease. JAMA Netw Open 2020; 3:e2012546. [PMID: 32756926 PMCID: PMC7407091 DOI: 10.1001/jamanetworkopen.2020.12546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This cohort study examines the association between second-generation drug-eluting stent length and cardiovascular and bleeding events in Japanese patients with ischemic heart disease.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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17
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Warisawa T, Howard JP, Cook CM, Ahmad Y, Doi S, Nakayama M, Goto S, Yakuta Y, Karube K, Seike F, Uetani T, Murai T, Kikuta Y, Shiono Y, Kawase Y, Shun-Shin MJ, Kaihara T, Higuma T, Ishibashi Y, Matsuda H, Nishina H, Matsuo H, Escaned J, Akashi YJ, Davies JE. Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional cardiologists. Cardiovasc Interv Ther 2020; 36:289-297. [PMID: 32430763 DOI: 10.1007/s12928-020-00673-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
The physiological pattern of coronary artery disease as determined by pressure-wire (PW)-pullback is important for decision-making of revascularization and risk stratification of patients. However, it remains unclear whether inter-observer differences in interpreting PW-pullback data are subject to the expertise of physicians. This study sought to investigate the subjectivity of this assessment among non-experts. Expert interventional cardiologists classified 545 PW-pullback traces into physiologically focal or physiologically diffuse disease pattern. Defining expert-consensus as the reference standard, we evaluated ten non-expert doctors' classification performance. Observers were stratified equally by two ways: (i) years of experience as interventional cardiologists (middle-level vs. junior-level) and (ii) volume of institutions where they belonged to (high-volume center vs. low-volume center). When judged against the expert-consensus, the agreement of non-expert observers in assessing physiological pattern of disease (focal or diffuse) ranged from 69.1 to 85.0% (p for heterogeneity < 0.0001). There was no evidence for a moderating effect of years of experience; the pooled accuracy of middle-level doctors was 78.8% (95% confidential interval [CI] 72.8-84.7%) vs. 79.1% for junior-level doctors (95% CI 75.9-82.2%, p = 0.95 for difference). On the other hand, we observed a significant moderating effect of center volume. Accuracy across non-experts in high-volume centers was 82.7% (95% CI 80.3-85.1%) vs. 75.1% for low-volume centers (95% CI 71.9-78.3%, p = 0.0002 for difference). Interpretation of PW-pullback by non-expert interventional cardiologists was considerably subjective.
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Affiliation(s)
- Takayuki Warisawa
- Hammersmith Hospital, Imperial College London, London, UK. .,Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashi-Cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - James P Howard
- Hammersmith Hospital, Imperial College London, London, UK
| | | | - Yousif Ahmad
- Hammersmith Hospital, Imperial College London, London, UK
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masafumi Nakayama
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan.,Tokyo Women's Medical University, Waseda University Joint Institution for Advanced Biomedical Sciences, Tokyo, Japan
| | - Sonoka Goto
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Yohei Yakuta
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Kenichi Karube
- Department of Cardiovascular Medicine, Okaya City Hospital, Okaya, Japan
| | - Fumiyasu Seike
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tadashi Murai
- AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Yuetsu Kikuta
- Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Toshiki Kaihara
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hisao Matsuda
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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18
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Abellán-Huerta J, Jurado-Román A, Lozano-Ruiz-Poveda F, López-Lluva MT, Negreira-Caamaño M, Pérez-Díaz P, Requena-Ibañez JA, Sánchez-Pérez I. Clinical Prognosis Associated With the Use of Overlapping Stents With Homogenous Versus Heterogeneous Pharmacological Characteristics for the Treatment of Diffuse Coronary Artery Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1355-1359. [PMID: 32354584 DOI: 10.1016/j.carrev.2020.04.025] [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: 03/14/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical impact of percutaneous coronary intervention (PCI) and implantation of overlapping stents (OS) using platforms with the same versus different pharmacological characteristics is unknown. Our objective was to compare the outcomes of PCI with OS according to their pharmacological characteristics. METHODS In this observational single-center registry, we included all PCI performed from April 2014 to December 2018 in which overlapping drug-eluting stents were implanted. Two groups were created according to whether the stents release the same drug [homogeneous: (HO)] or different [heterogeneous: (HE)]. The primary endpoint was the need for target lesion revascularization (TLR). Clinical assessment was performed after the procedure, bianually and at the end of follow-up (June 2019). RESULTS 381 lesions with OS (HO: 209; HE: 172) were included (75.1% male, 66.7 ± 11.6 years). Clinical presentation was stable coronary artery disease in 49.9%. Syntax score was 23.7 ± 13.3. The number of OS implanted was 2.2 ± 0.5 and the total stent length was 59.5 ± 20.1 mm (HE: 61.5 ± 21.6 vs. HO: 57.8 ± 18.8 mm; p < 0.01). After a median follow-up of 21 months, the HE group showed a lower TLR rate than the HO group (HE:2.3% vs HO:7.2%; p = 0.03). The rates of cardiac death (p = 0.44), myocardial infarction (p = 0.36) and stent thrombosis (p = 0.85) were similar between groups. In the multivariate analysis, the OS with homogeneous-drug devices was an independent predictor of a higher rate of TLR. CONCLUSIONS PCI using OS with homogeneous pharmacological characteristics was associated with a higher rate of TLR in comparison with the implantation of OS with heterogeneous pharmacological characteristics.
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Affiliation(s)
- José Abellán-Huerta
- Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain.
| | - Alfonso Jurado-Román
- Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain
| | | | - María T López-Lluva
- Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain
| | | | - Pedro Pérez-Díaz
- Clinical Cardiology Department, University General Hospital of Ciudad Real, Spain
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Chiarito M, Stefanini GG, Godino C, Sardella G. Impact of Diabetes on Clinical Outcomes After Polymer-Free Amphilimus- and Biolimus-Eluting Stent Implantation. JACC Cardiovasc Interv 2019; 12:1745-1747. [PMID: 31126886 DOI: 10.1016/j.jcin.2019.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
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Fukutomi M, Takahashi M, Toriumi S, Ogoyama Y, Oba Y, Funayama H, Kario K. Evaluation of stent length on the outcome of ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Coron Artery Dis 2019; 30:196-203. [PMID: 30973831 DOI: 10.1097/mca.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A longer stent length is known to be a predictor of adverse events after a percutaneous coronary intervention (PCI). However, the evaluation of the stent length on the outcome of ST-segment elevation myocardial infarction (STEMI) patients is not enough. PATIENTS AND METHODS A total of 686 STEMI patients who underwent primary PCI were divided into four groups according to the total stent length as follows: short (<18 mm, n=183), lower-medium (18-23 mm, n=256), upper-medium (24-31 mm, n=155), and long (≥32 mm, n=92). We compared the all-cause mortality, major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, and stroke after discharge), target lesion revascularization, and target vessel revascularization with a median follow-up of 1213 days among these four groups. RESULTS There were no significant differences in MACEs (10.4% in the short, 7.0% in the lower-medium, 6.5% in the upper-medium, 7.6% in the long, P=0.633) among the different stent length groups. The all-cause mortality, target lesion revascularization, and target vessel revascularization also did not differ among the four groups. In the drug-eluting stent (n=237) and bare-metal stent subgroups (n=449), all outcomes were comparable among the groups. However, in the diabetes subgroup (n=265), the rate of MACEs was higher in the long group than in the other groups, although the difference was not significant (6.6% in the short, 9.6% in the lower-medium, 3.4% in upper-medium, 16.7% in long group, P=0.095). CONCLUSION A long stent length was not associated with adverse clinical outcomes in STEMI patients who underwent primary PCI.
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Affiliation(s)
- Motoki Fukutomi
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Abstract
PURPOSE OF REVIEW This review discusses the outcomes of percutaneous coronary intervention (PCI) in women who experience acute myocardial infarction (AMI) and are treated with drug-eluting stents (DES). The review also describes the role of the new-generation DES compared with the early generation. RECENT FINDINGS Recent literature shows that the new-generation DES can be effective in women who present with AMI. Women with AMI may be undertreated and are underrepresented in studies of AMI. Recently, it has been shown that the newer generation DES are effective and beneficial in women with AMI, similar to men. As further generations of DES are created, the future appears promising for continued advancements in women's cardiovascular health.
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Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA.
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Guedeney P, Baber U, Claessen B, Aquino M, Camaj A, Sorrentino S, Vogel B, Farhan S, Faggioni M, Chandrasekhar J, Kalkman DN, Kovacic JC, Sweeny J, Barman N, Moreno P, Vijay P, Shah S, Dangas G, Kini A, Sharma S, Mehran R. Temporal trends, determinants, and impact of high-intensity statin prescriptions after percutaneous coronary intervention: Results from a large single-center prospective registry. Am Heart J 2019; 207:10-18. [PMID: 30404046 DOI: 10.1016/j.ahj.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting. METHODS All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg. RESULTS A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P < .001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non-ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P < .001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P < .001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P < .001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P < .001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P = .006), Asian races (OR 0.73, 95% CI 0.65-0.83, P < .001), and older age (OR 0.90, 95% CI 0.88-0.92, P < .001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P = .84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P = .05). CONCLUSION Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.
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Affiliation(s)
- Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY; ACTION study group, Sorbonne université, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Hospital Pitié Salpêtrière, Paris, France
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bimmer Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michela Faggioni
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deborah N Kalkman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | | | | | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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Differences in coronary plaque morphology between East Asian and Western White patients: an optical coherence tomography study. Coron Artery Dis 2018; 29:597-602. [PMID: 30020113 DOI: 10.1097/mca.0000000000000653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Prevalence of coronary artery disease as well as cardiac mortality varies between Asian and White patients. However, the link between race and plaque characteristics in patients with coronary artery disease remains largely unexplored. Thus, we aimed to investigate the detailed culprit plaque characteristics between East Asian and White patients using optical coherence tomography. PATIENTS AND METHODS A total of 101 East Asians were matched to 101 White patients. Matching parameters included age, sex, clinical presentation, hyperlipidemia, diabetes mellitus, and lesion location. RESULTS There were no differences in underlying pathology (rupture vs. erosion) of acute coronary syndrome (P=0.935). Lesion length was longer (18.0±6.0 vs. 14.6±5.4 mm; P<0.002), lipid length was greater (9.4±4.6 vs. 7.2±3.8 mm; P<0.023), lipid index was higher (1635±987 vs. 1104±730; P=0.002), and mean reference area was larger (8.1±3.0 vs. 6.5±2.4 mm; P<0.021) in White patients compared with East Asian patients. CONCLUSION There are significant differences in plaque morphology between East Asian and White patients even after controlling for confounders. Our findings underscore key differences in atherosclerosis between East Asian and White populations, and may have to be taken into consideration when interpreting the results of future research.
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Ziada KM, George B. Impact of Stent Length on Outcomes in Women: Newer Generation Stents Are Better, But Far From Perfect. JACC Cardiovasc Interv 2018; 11:66-67. [PMID: 29301649 DOI: 10.1016/j.jcin.2017.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky.
| | - Bennet George
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
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