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Somkereki C, Palfi R, Scridon A. Prevention of contrast-associated acute kidney injury in an era of increasingly complex interventional procedures. Front Med (Lausanne) 2024; 10:1180861. [PMID: 38264052 PMCID: PMC10803418 DOI: 10.3389/fmed.2023.1180861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Radiological and interventional cardiology procedures are in continuous expansion, leading to an important increase in the incidence of contrast-associated acute kidney injury (CA-AKI). Although numerous methods of CA-AKI prevention have been studied, at present, there is no consensus on the definition of this entity or on its prevention. In this paper, we aim to provide a critical analysis of the existing data on the epidemiology, pathophysiology, and clinical significance of CA-AKI. Existing and emergent approaches for CA-AKI prevention are also discussed, with a focus on parenteral fluid administration and on the most recent clinical and experimental data. We also emphasize a number of questions that remain to be answered, and we identify hotspots for future research.
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Affiliation(s)
- Cristina Somkereki
- Cardiology Department, Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
- Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
| | - Renata Palfi
- Cardiology Department, Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
| | - Alina Scridon
- Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
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Zhu Y, Liu K, Kong X, Nan J, Gao A, Liu Y, Han H, Li H, Zhu H, Zhang J, Zhao Y. Comparison of Drug-Coated Balloon Angioplasty vs. Drug-Eluting Stent Implantation for Drug-Eluting Stent Restenosis in the Routine Clinical Practice: A Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2021; 8:766088. [PMID: 34926617 PMCID: PMC8671700 DOI: 10.3389/fcvm.2021.766088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In-stent restenosis (ISR) remains a challenging issue despite the great advance of drug-eluting stents (DES). In addition, the consensus was lacking regarding the optimal strategy for DES-ISR. Therefore, we aimed to evaluate angiographic and clinical outcomes of the two most effective treatments DES vs. drug-eluting balloon (DCB) for patients with DES-ISR. Methods: This meta-analysis used the data from the randomized controlled trials (RCTs), which were identified by a systematic search in the databases of PubMed, Embase, and Cochrane Library. Target lesion revascularization (TLR) was regarded as the primary endpoint. In addition, the late angiographic outcomes and other clinical outcomes, namely, cardiac death, myocardial infarction (MI), target vessel revascularization, stent thrombosis, and major adverse cardiac events, were also included for analysis. Results: Five RCTs with about 1,193 patients were included in this meta-analysis for the analysis. For the primary endpoint, the overall pooled outcomes suggested repeat DES implantation was associated with a significant reduction in the term of TLR compared with DCB angioplasty (risk ratio = 1.53, 95% CI 1.15-2.04, p = 0.003). But no significant difference in angiographic outcomes and other clinical endpoints were observed between DES and DCB. In the subgroup analysis, DCB was inferior to new-generation DES (NG-DES)/everolimus-eluting stent (EES) in the term of TLR. In addition, this non-significant trend was also noted in the subgroup of the paclitaxel-eluting stent (PES) vs. DCB. For the angiographic endpoints, EES, not PES, was associated with larger minimum lumen diameter [mean difference (MD) = -0.25, 95% CI -0.38 to -0.11, p = 0.0003], lower percent diameter stenosis (MD = 7.29%, 95% CI 2.86-11.71%, p = 0.001), and less binary restenosis (OR = 2.20, 95% CI 1.18-4.11, p = 0.01). But NG-DES/EES was comparable to DCB in cardiac death, MI, and stent thrombosis. Conclusions: For the patients with DES-ISR, treatment with DES, especially NG-DES/EES could reduce the risk of TLR significantly compared to DCB at long-term follow-up.
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Affiliation(s)
- Yong Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kesen Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangyun Kong
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Nan
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ang Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huagang Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianwei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Rivera-López R, García-López C, Sánchez-Moreno JM, Rivera-López RA, Almansa-López J, Rivera-Fernández R, Molina-Navarro E, Jiménez-Fernández M, Ortiz-Pérez S, Ramírez-Hernández JA. High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion. J Clin Med 2021; 10:jcm10215002. [PMID: 34768525 PMCID: PMC8584919 DOI: 10.3390/jcm10215002] [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: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0-68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3-64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19-6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03-6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57-12.40), diabetes (HR = 3.33 [1.22-9.24]), and older age, as in >57 (HR, 6.40 [1.81-22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
| | - Celia García-López
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-958020009
| | - José M. Sánchez-Moreno
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | | | - Julio Almansa-López
- Radiophysics Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | | | - Eduardo Molina-Navarro
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Miriam Jiménez-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Santiago Ortiz-Pérez
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- University of Granada (UGR), 18016 Granada, Spain;
| | - José A. Ramírez-Hernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Medicine Department, University of Granada (UGR), 18016 Granada, Spain
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Dworeck C, Redfors B, Völz S, Haraldsson I, Angerås O, Råmunddal T, Ioanes D, Myredal A, Odenstedt J, Hirlekar G, Koul S, Fröbert O, Linder R, Venetsanos D, Hofmann R, Ulvenstam A, Petursson P, Sarno G, James S, Erlinge D, Omerovic E. Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 9:323-332. [PMID: 33025815 PMCID: PMC7756052 DOI: 10.1177/2048872620908032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. RESULTS During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55-0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25-0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24-0.73, P = 0.002). CONCLUSIONS In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.
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Affiliation(s)
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | | | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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Lizano-Díez I, Paz Ruiz S. Analysis of the Financial Impact of Using Cangrelor on the Safety and Efficacy Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Whom Oral Therapy with P2Y 12 Inhibitors is Not Feasible or Desirable, in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:77-87. [PMID: 33536769 PMCID: PMC7850430 DOI: 10.2147/ceor.s290377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor indicated for the reduction of thrombotic cardiovascular events in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) in whom oral P2Y12 inhibitors are not feasible or desirable. The objective was to assess the financial impact of introducing cangrelor into the hospital formulary in Spain. PATIENTS AND METHODS A budget impact model was developed to calculate the cost difference between two scenarios (without and with cangrelor) to treat CAD patients undergoing PCI in whom oral P2Y12 inhibitors are not feasible or desirable, over 3 years. Intravenous P2Y12 inhibitor (cangrelor), oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor), and glycoprotein IIb-IIIa inhibitors (GPIs) for bail-out use were considered. Epidemiological, efficacy (thrombotic events including cardiac death), safety (bleeding events), and costs (€, 2019) data were based on Spanish registries, clinical trials, and meta-analyses. One-way sensitivity analysis established the effect of uncertainty on results. RESULTS For years 1, 2, and 3, the target population to receive cangrelor was 607, 1,822, and 3,340 patients, and cangrelor uptake was 23.70%, 58.30%, and 51.30%, respectively. The 3-year budget impact was 1,021,717€ varying from 50,245€ in year 1 to 599,272€ in year 3. The results were sensitive to the number of patients treated with GPIs in Spanish hospitals. CONCLUSION Based on our results, the financial effort needed to introduce the use of cangrelor in patients undergoing PCI in whom antiplatelet therapy with oral P2Y12 inhibitors is not feasible or desirable barely exceeds one million € over three years, in Spain.
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Ojeda S, Romaguera R, Cruz-González I, Moreno R. [Spanish Cardiac Catheterization and Coronary Intervention Registry. 29th Official Report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2019)]. Rev Esp Cardiol 2020; 73:927-936. [PMID: 33012949 PMCID: PMC7521891 DOI: 10.1016/j.recesp.2020.07.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual report on the activity for 2019. METHODS All Spanish centers with a catheterization laboratory were invited to participate. Data were introduced online and analyzed by an external company together with the Steering Committee of the ACI-SEC. RESULTS A total of 119 centers participated (83 public, 36 private). In all, there were 165 124 diagnostic studies (4.7% more than in 2018). The use of pressure wire and intravascular ultrasound increased by 20% and that of optical coherence tomography by 8.4%. The number of percutaneous coronary interventions (PCI) rose by 4.5% (75 819 procedures). Of these, 22 529 were performed in the acute myocardial infarction setting, with 91.8% being primary PCI (6.3% increase). The mean number of primary PCIs per million inhabitants increased to 439. Among PCIs, access was radial in 88.3%. There were 4281 transcatheter aortic valve implantations (21.0% increase), with an average of 90.9 per million inhabitants. Mitral valve repair also rose by 17.4% (n = 385), left atrial appendage closure by 43.0% (n = 921) and patent foramen ovale closure by 38.1% (n = 710). CONCLUSIONS In 2019, the use of intracoronary diagnostic techniques increased, as did that of diagnostic and therapeutic coronary procedures, mainly in primary PCI. Of particular note was the marked increase in the number of transcatheter aortic valve implantations, as well as in the number of mitral valve repairs and left atrial appendage and patent foramen ovale closure procedures.
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Affiliation(s)
- Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica (IMIBIC), Universidad de Córdoba, Córdoba, España
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Raúl Moreno
- Servicio de Cardiología, Hospital La Paz, IDIPAZ, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
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