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Bianchini E, Basile M, Bianchini F, Zito A, Romagnoli E, Aurigemma C, Paraggio L, Lunardi M, Laborante R, Fracassi F, Montone RA, Leone AM, Biondi-Zoccai G, Trani C, Burzotta F. Multivessel revascularization in non-ST segment elevation acute coronary syndromes: A systematic review and meta-analysis of 182,798 patients. Int J Cardiol 2024; 413:132392. [PMID: 39067526 DOI: 10.1016/j.ijcard.2024.132392] [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: 04/20/2024] [Revised: 06/12/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Patients experiencing non-ST segment elevation acute-coronary-syndromes (NSTE-ACS) often present with multivessel-coronary-artery-disease (MVD). An immediate complete multivessel revascularization (MVR) - within the index hospitalization - may be considered the default therapeutic strategy, although its risk-to-benefit profile has not been definitively established through dedicated clinical trials. METHODS A systematic review and meta-analysis, adhering to MOOSE and PRISMA guidelines, was conducted to assess studies comparing immediate MVR versus a conservative culprit-only revascularization (COR) in NSTE-ACS with MVD. The main endpoints were all-cause death, major adverse cardiovascular events (MACE) and non-fatal myocardial infarction (MI). The incidence of any revascularization or further percutaneous-coronary-interventions (PCIs) were also collected. The primary analyses for the main endpoints were conducted on propensity-matched groups only. RESULTS A total of 22 studies (182,798 patients) were identified. 7 studies, encompassing 11,372 patients, were included in the primary analysis of propensity score-matched groups. Immediate MVR significantly increased (28%) survival (OR 0.72, 95% CI 0.58-0.90, P < 0.01) along with a 35% reduction in MACE (OR 0.65, 95% CI 0.47-0.88, P = 0.01) and a 60% decrease in MI (OR 0.40, 95% CI 0.25-0.63, P < 0.01) during a mean 3-years follow-up compared to the propensity score-matched COR group. Results were consistent in the unmatched analyses. CONCLUSIONS This meta-analysis supports an immediate MVR for improving clinical outcomes in patients with NSTE-ACS and MVD as compared to a conservative immediate COR. These data prompt further evaluations regarding optimal strategies in the pursuit of MVR, including patient selection, revascularization modality, and assessment methods of revascularization completeness.
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Affiliation(s)
- Emiliano Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Basile
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Zito
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Mattia Lunardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Fracassi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy; Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy.
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Ozaki Y, Kitabata H, Takahata M, Katayama Y, Wada T, Hikida R, Taruya A, Shiono Y, Kuroi A, Yamano T, Tanimoto T, Tanaka A. Intracoronary Near-Infrared Spectroscopy to Predict No-Reflow Phenomenon During Percutaneous Coronary Intervention in Acute Coronary Syndrome. Am J Cardiol 2024; 219:17-24. [PMID: 38490338 DOI: 10.1016/j.amjcard.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) can identify the lipid-rich lesions, described as high lipid-core burden index (LCBI). The aim of this study was to investigate the relation between lipid-core plaque (LCP) in the infarct-related lesion detected using NIRS-IVUS and no-reflow phenomenon during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). We investigated 371 patients with ACS who underwent NIRS-IVUS in the infarct-related lesions before PCI. The extent of LCP in the infarct-related lesion was calculated as the maximum LCBI for each of the 4-mm longitudinal segments (maxLCBI4mm) measured by NIRS-IVUS. The patients were divided into 2 groups using a maxLCBI4mm cut-off value of 400. The overall incidence of no-reflow phenomenon was 53 of 371 (14.3%). No-reflow phenomenon more frequently occurred in patients with maxLCBI4mm ≥400 compared with those with maxLCBI4mm<400 (17.5% vs 2.5%, p <0.001). After propensity score matching, multivariable logistic regression analysis demonstrated that maxLCBI4mm (odds ratio: 1.008; 95% confidence interval: 1.005 to 1.012, p <0.001) was independently associated with the no-reflow phenomenon. The maxLCBI4mm of 719 in the infarct-related lesion had the highest combined sensitivity (69.8%) and specificity (72.1%) for the identification of no-reflow phenomenon. In conclusion, in patients with ACS, maxLCBI4mm in the infarct-related lesion assessed by NIRS-IVUS was independently associated with the no-reflow phenomenon during PCI.
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Affiliation(s)
- Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yosuke Katayama
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryo Hikida
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Yamashita A, Asada Y. Underlying mechanisms of thrombus formation/growth in atherothrombosis and deep vein thrombosis. Pathol Int 2023; 73:65-80. [PMID: 36598039 DOI: 10.1111/pin.13305] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/03/2022] [Accepted: 12/17/2022] [Indexed: 01/05/2023]
Abstract
Thrombosis remains a leading cause of death worldwide despite technological advances in prevention, diagnosis, and treatment. The traditional view of arterial thrombus formation is that it is a platelet-dependent process, whereas that of venous thrombus formation is a coagulation-dependent process. Current pathological and basic studies on atherothrombosis and venous thrombosis have revealed the diverse participation of platelet and coagulation activation mechanisms in both thrombus initiation and growth processes during clinical thrombotic events. Atherosclerotic plaque cell-derived tissue factor contributes to fibrin formation and platelet aggregation. The degree of plaque disruption and a blood flow alteration promote atherothrombotic occlusion. While blood stasis/turbulent flow due to luminal stenosis itself initiates venous thrombus formation. The coagulation factor XI-driven propagation phase of blood coagulation plays a major role in venous thrombus growth, but a minor role in hemostasis. These lines of evidence indicate that atherothrombosis onset is affected by the thrombogenic potential of atherosclerotic plaques, the plaque disruption size, and an alteration in blood flow. Upon onset of venous thrombosis, enhancement of the propagation phase of blood coagulation under blood stasis and a hypercoagulable state contribute to large thrombus formation.
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Affiliation(s)
- Atsushi Yamashita
- Pathophysiology Section, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yujiro Asada
- Pathophysiology Section, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Department of Pathology, Miyazaki Medical Association Hospital, Miyazaki, Japan
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4
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El-Azrak M, Boutaybi M, El Ouafi N, Bazid Z. Simultaneous total occlusion of the 3 major coronary arteries in a patient with inferior ST-segment elevation myocardial infarction complicated by cardiogenic shock and sinus bradycardia. Radiol Case Rep 2023; 18:1345-1348. [PMID: 36818999 PMCID: PMC9931509 DOI: 10.1016/j.radcr.2022.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
Simultaneous occlusion of more than one coronary artery is uncommon and associated with poor prognosis. We reported a particular case of a 62-year-old patient, who presented with an inferior ST-segment elevation myocardial infarction with right ventricular involvement complicated by cardiogenic shock, sinus bradycardia, and an extensive echocardiographic ischemia with severe left ventricular systolic dysfunction. Coronary angiography revealed occlusion of 3 major coronary arteries. Primary percutaneous coronary intervention of the right coronary artery was performed with hemodynamic recovery, chest pain, and ST-segment resolution. Treatment for heart failure with reduced ejection fraction was initiated, with a good outcome.
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Affiliation(s)
- Mohammed El-Azrak
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco,Corresponding author.
| | - Mohammed Boutaybi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco,Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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5
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Ding J, Li H, Liu W, Wang X, Feng Y, Guan H, Chen Z. miR-186-5p Dysregulation in Serum Exosomes from Patients with AMI Aggravates Atherosclerosis via Targeting LOX-1. Int J Nanomedicine 2022; 17:6301-6316. [PMID: 36536941 PMCID: PMC9758944 DOI: 10.2147/ijn.s383904] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose The formation of macrophage-derived foam cells via the uptake of modified lipoproteins is a pivotal development event in atherosclerosis. It has been reported that clinical and experimental myocardial infarction could accelerate atherosclerosis. Several studies have suggested the critical role of exosomes in cardiovascular diseases. However, the role of exosomes from patients with acute myocardial infarction (AMI) patients in atherogenesis remains unclear. Patients and Methods Serum exosomes from AMI patients (AMI-Exo) and control individuals (Con-Exo) were isolated and characterized. These exosomes were studied in vitro and in vivo to determine their impact on macrophage foaming and atherogenesis. Results Our results showed that AMI-Exo promoted foam cell formation in oxidized low-density lipoprotein (ox-LDL)-treated macrophages and progression of atherosclerosis in high-fat/cholesterol diet-fed ApoE-/- mice together with a significantly upregulated levels of lectin-like ox-LDL receptor-1 (LOX-1). The miR-186-5p was found to be downregulated in AMI-Exo and macrophages administered with AMI-Exo. Moreover, serum exosomal miR-186-5p achieved high diagnostic performance for AMI. Luciferase reporter assay indicated that miR-186-5p directly inhibited LOX-1. The endogenous or exogenous miR-186-5p deficiency enhanced lipid accumulation by upregulating LOX-1, whereas miR-186-5p mimics had a reverse effect. Conclusion In conclusion, the current findings suggest that dysregulated miR-186-5p in AMI-Exo may explain the contribution of acute ischemia events to the advancement of atherosclerosis by enhancing macrophage foaming via its target, LOX-1.
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Affiliation(s)
- Jiaxing Ding
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China,Department of Cardiology, Henan Provincial Key Lab for Control of Coronary Heart Disease, Henan Provincial People’s Hospital Heart Center, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Huili Li
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wei Liu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xuehua Wang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yu Feng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Hongquan Guan
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China,Correspondence: Zhijian Chen; Hongquan Guan, Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China, Tel + 86 27 85726011, Fax +86 27 85727340, Email
| | - Zhijian Chen
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Ebuchi Y, Kojima K, Murata N, Fukamachi D, Okumura Y. Serial Changes of Aortic Vulnerable Plaques Observed via Non-Obstructive General Angioscopy. Int Heart J 2022; 63:999-1003. [PMID: 36104238 DOI: 10.1536/ihj.22-248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stabilization of aortic vulnerable plaques has not been fully elucidated. Non-obstructive general angioscopy (NOGA) is a novel method for the detailed evaluation of atheromatous plaques in the aortic intimal wall. A 57-year-old man presenting with acute myocardial infarction underwent percutaneous coronary intervention (PCI). NOGA was performed for the evaluation of aortic atherosclerosis, and vulnerable puff-chandelier plaques in the aortic arch were identified. After a strictly controlled low-density lipoprotein cholesterol lowering therapy with a strong statin for 8 months after the primary PCI, NOGA revealed stabilized aortic plaques in the same lesions. Therefore, NOGA may be helpful in evaluating the effects of lipid-lowering therapy on aortic plaque stabilization.
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Affiliation(s)
| | - Keisuke Kojima
- Division of Cardiology, Nihon University Itabashi Hospital
| | | | | | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital
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Si N, Shi K, Li N, Dong X, Zhu C, Guo Y, Hu J, Cui J, Yang F, Zhang T. Identification of patients with acute myocardial infarction based on coronary CT angiography: the value of pericoronary adipose tissue radiomics. Eur Radiol 2022; 32:6868-6877. [PMID: 35505117 DOI: 10.1007/s00330-022-08812-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/12/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether radiomics analysis of pericoronary adipose tissue (PCAT) captured by coronary computed tomography angiography (CCTA) could discriminate acute myocardial infarction (MI) from unstable angina (UA). METHODS In a single-center retrospective case-control study, patients with acute MI (n = 105) were matched to patients with UA (n = 105) and all patients were randomly divided into training and validation cohorts with a ratio of 7:3. Fat attenuation index (FAI) and PCAT radiomics features selected by Max-Relevance and Min-Redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) around the proximal three major epicardial coronary vessels (LAD [left anterior descending artery], LCx [left circumflex artery], and RCA [right coronary artery]) were used to build logistic regression models. Finally, a FAI model, three radiomics models of PCAT (LAD, LCx, and RCA), and a combined model that used the scores of these independent models were constructed. The performance of the models was evaluated by identification, calibration, and clinical application. RESULTS In training and validation cohorts, compared with the FAI model (AUC = 0.53, 0.50), the combined model achieved superior performance (AUC = 0.97, 0.95) while there was a significant difference of AUC between two models (p < 0.05). The calibration curves of the combined model demonstrated the smallest Brier score loss. Decision curve analysis suggested that the combined model provided higher clinical benefit than the FAI model. CONCLUSIONS The CCTA-based radiomics phenotype of PCAT outperforms the FAI model in discriminating acute MI from UA. The combination of PCAT radiomics and FAI could further enhance the performance of acute MI identification. KEY POINTS • Fat attenuation index based on CCTA can detect inflammation-induced changes in the ratio of lipid to aqueous phase in pericoronary adipose tissue. • Fat attenuation index cannot distinguish acute MI patients from UA patients, suggesting that the two groups have the same degree of ratio of lipid to aqueous phase in pericoronary adipose tissue. • Radiomics features of PCAT have the potential to distinguish acute MI patients from UA patients.
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Affiliation(s)
- Nuo Si
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001, HeiLongJiang Province, China
| | - Ke Shi
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001, HeiLongJiang Province, China
| | - Na Li
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001, HeiLongJiang Province, China
| | - Xiaolin Dong
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001, HeiLongJiang Province, China
| | - Chentao Zhu
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001, HeiLongJiang Province, China
| | - Yan Guo
- GE Healthcare, No. 1, TongJi South Road, Daxing District, Beijing, China
| | - Jiesi Hu
- GE Healthcare, No. 1, TongJi South Road, Daxing District, Beijing, China
| | - Jingjing Cui
- Department of Research and Development, Shanghai United Imaging Intelligence, Co., Ltd., No. 2258, ChengBei Road, JiaDing District, Shanghai, 201807, China
| | - Fan Yang
- Department of Research and Development, Shanghai United Imaging Intelligence, Co., Ltd., No. 2258, ChengBei Road, JiaDing District, Shanghai, 201807, China
| | - Tong Zhang
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001, HeiLongJiang Province, China.
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8
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Homorodean C, Leucuta DC, Ober M, Homorodean R, Spinu M, Olinic M, Tataru D, Olinic DM. Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13671. [PMID: 34411283 DOI: 10.1111/eci.13671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients. METHODS A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models. RESULTS Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina. CONCLUSION Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non-culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.
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Affiliation(s)
- Calin Homorodean
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Ober
- Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | | | - Mihail Spinu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan Tataru
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
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9
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Sekimoto T, Koba S, Mori H, Sakai R, Arai T, Yokota Y, Sato S, Tanaka H, Masaki R, Oishi Y, Ogura K, Arai K, Nomura K, Kosaki R, Sakai K, Tsujita H, Kondo S, Tsukamoto S, Tsunoda F, Shoji M, Matsumoto H, Hamazaki Y, Shinke T. Small Dense Low-Density Lipoprotein Cholesterol: A Residual Risk for Rapid Progression of Non-Culprit Coronary Lesion in Patients with Acute Coronary Syndrome. J Atheroscler Thromb 2021; 28:1161-1174. [PMID: 33551393 PMCID: PMC8592706 DOI: 10.5551/jat.60152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 11/11/2022] Open
Abstract
AIM This study investigated whether the small dense low-density lipoprotein cholesterol (sd-LDL-c) level is associated with the rapid progression (RP) of non-culprit coronary artery lesions and cardiovascular events (CE) after acute coronary syndrome (ACS). METHODS In 142 consecutive patients with ACS who underwent primary percutaneous coronary intervention for the culprit lesion, the sd-LDL-c level was measured using a direct homogeneous assay on admission for ACS and at the 10-month follow-up coronary angiography. RP was defined as a progression of any pre-existing coronary stenosis and/or stenosis development in the initially normal coronary artery. CEs were defined as cardiac death, myocardial infarction, stroke, or coronary revascularization. RESULTS Patients were divided into two groups based on the presence (n=29) or absence (n=113) of RP after 10 months. The LDL-c and sd-LDL-c levels at baseline were equivalent in both the groups. However, the sd-LDL-c, triglyceride, remnant lipoprotein cholesterol (RL-c), and apoC3 levels at follow-up were significantly higher in the RP group than in the non-RP group. The optimal threshold values of sd-LDL-c, triglyceride, RL-c, and apoC3 for predicting RP according to receiver operating characteristics analysis were 20.9, 113, 5.5, and 9.7 mg/dL, respectively. Only the sd-LDL-c level (≥ 20.9 mg/dL) was significantly associated with incident CEs at 31±17 months (log-rank: 4.123, p=0.043). CONCLUSIONS The sd-LDL-c level on treatment was significantly associated with RP of non-culprit lesions, resulting in CEs in ACS patients. On-treatment sd-LDL-c is a residual risk and aggressive reduction of sd-LDL-c might be needed to prevent CEs.
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Affiliation(s)
- Teruo Sekimoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Rikuo Sakai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Taito Arai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuya Yokota
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shunya Sato
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hideaki Tanaka
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ryota Masaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kunihiro Ogura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ken Arai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kosuke Nomura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ryota Kosaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Koshiro Sakai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tsujita
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shigeto Tsukamoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Fumiyoshi Tsunoda
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Makoto Shoji
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuji Hamazaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Division of Cardiology, Otakanomori Hospital, Chiba, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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10
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Usui E, Matsumura M, Mintz GS, Zhou Z, Hada M, Yamaguchi M, Hoshino M, Kanaji Y, Sugiyama T, Murai T, Lee T, Yonetsu T, Kakuta T, Kunio M, Tearney GJ, Maehara A. Clinical outcomes of low-intensity area without attenuation and cholesterol crystals in non-culprit lesions assessed by optical coherence tomography. Atherosclerosis 2021; 332:41-47. [PMID: 34384955 DOI: 10.1016/j.atherosclerosis.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Pathologists have shown that intraplaque hemorrhage contributes to plaque destabilization and is frequently co-located with cholesterol crystals (CC). Optical coherence tomography (OCT)-detected low-intensity area without attenuation (LIA) may represent intraplaque hemorrhage. We aimed to examine the prevalence and impact of OCT-detected LIA + CC in untreated non-culprit lesions (NCLs) on subsequent major adverse cardiac events (MACE). METHODS OCT imaged NCLs in the culprit vessel in the patients who underwent OCT-guided percutaneous coronary intervention were included. An NCL was a lesion with >90° of diseased arc (≥0.5 mm intimal thickness), length ≥2 mm, and >5 mm away from stent edge. CC was defined as a thin linear region of high intensity. NCL-related MACE includes cardiac death, myocardial infarction, or ischemia-driven revascularization attributed to NCLs. RESULTS We included 735 NCLs in 566 patients with 2.5 ± 0.7 years follow-up. The prevalence of concomitant LIA with CC (LIA + CC) was 15.5% (114/735). Three-year NCL-related MACE rate was 2.9% (20 events) at a lesion level and 15.6% (78 events) at a patient level. Untreated NCLs with LIA + CC had an increased risk for NCL-MACE (adjusted hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.27-7.50, p = 0.01) along with thin-cap fibroatheroma (adjusted HR 4.38, 95% CI 1.44-13.30, p < 0.01) and minimum lumen area <3.5 mm2 (adjusted HR 5.33, 95% CI 1.94-14.62, p < 0.01). Patients having ≥1 untreated NCL with LIA + CC had an increased risk for NCL-MACE (adjusted HR 1.95, 95% CI 1.19-3.19, p < 0.01). CONCLUSIONS An OCT-detected LIA + CC in an NCL was associated with subsequent NCL-MACE.
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Affiliation(s)
- Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Masahiro Hada
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masao Yamaguchi
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tetsumin Lee
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Mie Kunio
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Canon U.S.A., Inc., Cambridge, MA, USA
| | - Guillermo J Tearney
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, USA.
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11
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Schaaf M, Croisille P, Py A, Roubille F, Biere L, Bochaton T, Perret T, Belle L, De Poli F, Hovasse T, Lairez O, Boussaha I, Rioufol G, Prunier F, Ovize M, Mewton N. Non-culprit artery myocardial infarction and complex coronary lesions in anterior ST-elevated myocardial infarction patients. Cardiology 2021; 146:728-736. [PMID: 34348264 DOI: 10.1159/000518137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mathieu Schaaf
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Pierre Croisille
- Radiology Department, Hôpital Nord, CHU Saint-Etienne, Saint Etienne, France
| | - Agathe Py
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Fédération de Cardiologie, Hospices Civils de Lyon, Lyon, France
| | - François Roubille
- Cardiology Department, Hôpital Arnaud de Villeuneuve, CHU de Montpellier, Montpellier, France
| | - Loic Biere
- Cardiology Department, CHU d'Angers, Angers, France
| | - Thomas Bochaton
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Thibault Perret
- Cardiology Department, Centre Hospitalier, St Joseph Saint Luc, Lyon, France
| | - Loic Belle
- Cardiology Department, Centre Hospitalier d'Annecy, Annecy, France
| | | | - Thomas Hovasse
- Cardiology Department, Jacques Cartier Institute, Massy, France
| | - Olivier Lairez
- Cardiology Department, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Inesse Boussaha
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Gilles Rioufol
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | | | - Michel Ovize
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
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12
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Lin A, Nerlekar N, Yuvaraj J, Fernandes K, Jiang C, Nicholls SJ, Dey D, Wong DTL. Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study. Eur Heart J Cardiovasc Imaging 2021; 22:298-306. [PMID: 33106867 PMCID: PMC7899274 DOI: 10.1093/ehjci/jeaa224] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD). METHODS AND RESULTS Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (-82.3 ± 5.5 HU) compared with patients with stable CAD (-90.6 ± 5.7 HU, P < 0.001) and controls (-95.8 ± 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation. CONCLUSION PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.
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Affiliation(s)
- Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Katrina Fernandes
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Cathy Jiang
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
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13
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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14
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Merkulova IN, Shariya MA, Mironov VM, Shabanova MS, Veselova TN, Gaman SA, Barysheva NA, Shakhnovich RM, Zhukova NI, Sukhinina TS, Staroverov II, Ternovoy SK. [Computed Tomography Coronary Angiography Possibilities in "High Risk" Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound]. ACTA ACUST UNITED AC 2021; 60:64-75. [PMID: 33522469 DOI: 10.18087/cardio.2020.12.n1304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.
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Affiliation(s)
- I N Merkulova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M A Shariya
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - V M Mironov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M S Shabanova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T N Veselova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S A Gaman
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N A Barysheva
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - R M Shakhnovich
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N I Zhukova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T S Sukhinina
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - I I Staroverov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S K Ternovoy
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
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15
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Preemptive percutaneous coronary intervention for coronary artery disease: identification of the appropriate high-risk lesion. Curr Opin Cardiol 2021; 35:712-719. [PMID: 32852346 DOI: 10.1097/hco.0000000000000789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Management of patients with coronary artery disease (CAD) has been based on identification of a coronary obstruction causing ischemia and performing a revascularization procedure to reduce that ischemia, with the goal of thereby preventing subsequent major adverse cardiac events (MACEs) in that vascular territory. Recent investigations demonstrate that preemptive percutaneous coronary intervention (PCI) of nonculprit coronary lesions (NCLs) that may not cause ischemia in patients with ST-segment elevation myocardial infarction (STEMI) reduces MACE. In this review, we focus on preemptive PCI, discuss its mechanistic benefits and speculate on its potential value for other coronary syndromes. RECENT FINDINGS The COMPLETE trial in STEMI patients treated with primary PCI demonstrated that preemptive PCI of NCL obstructions, which may not cause ischemia, but often exhibit high-risk OCT plaque characteristics, reduced cardiovascular death or nonfatal myocardial infarction. Reduction in MACE from preemptive PCI of NCL was similar for lesions confirmed to cause ischemia (fractional flow reserve <0.80) and for lesions that were only visually assessed to have luminal obstruction at least 70%.The ISCHEMIA trial in patients with stable CAD and moderate/severe ischemia demonstrated that MACE risk increased progressively with more extensive atherosclerosis, but that performing PCI of ischemia-producing lesions did not reduce MACE. Adverse cardiac events likely originated in high-risk plaque areas not treated with PCI. SUMMARY In STEMI patients, preemptive PCI of high-risk NCL that may not cause ischemia improves long-term MACE. In stable CAD patients, MACE increases as the atherosclerotic burden increases, but PCI of the ischemia-producing lesion itself does not improve outcomes compared with optimal medical therapy. Adverse events likely originate in high-risk plaque areas that are distinct from ischemia-producing obstructions. Identification of highest-risk atherosclerotic lesions responsible for future MACE may provide an opportunity for preemptive PCI in patients with a variety of coronary syndromes.
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16
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Late peri-stent contrast staining appearance due to rupture of atherogenic neointima following drug-eluting stent. J Cardiol Cases 2020; 23:210-213. [PMID: 33995698 DOI: 10.1016/j.jccase.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/01/2020] [Accepted: 10/17/2020] [Indexed: 11/20/2022] Open
Abstract
The development of peri-stent contrast staining (PSS) after coronary intervention with implantation of a stent is observed in approximately 1-3% of patients treated with drug-eluting stent. Although the cumulative incidences of late in-stent restenosis and stent thrombosis are significantly higher in lesions with PSS than in those without the finding, the mechanisms for the development of PSS have not yet been fully elucidated. In this report, we describe a case of rapid development of PSS with ulcer formation caused by rupture of atherogenic neointima, which was observed by serial optical coherence tomography examinations over 6 months. Protrusion of the stent-jailed underlying necrotic core toward the lumen by the contracting force might have resulted in formation of atherogenic neointima within the stent. Subsequently, rupture of this necrotic core induced by iatrogenic neointimal injury due to balloon dilation and dissolution of the accumulated necrotic core may have resulted in PSS formation 6 months after the procedure. These findings may be helpful for consideration of etiology and therapeutic strategy for lesions with PSS. <Learning objective: The mechanisms of peri-stent contrast staining (PSS) formation late after drug-eluting stent (DES) implantation are diverse. Rupture of atherogenic neointima with subsequent dissolution of the stent-jailed underlying plaque debris could be one of the mechanisms of rapid PSS formation after implantation of DES. An accurate assessment of lesion morphology within the stent and patient-tailored management can reduce morbidity and mortality in patients who have undergone DES implantation.>.
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17
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Ilardi F, Ferrone M, Avvedimento M, Servillo G, Gargiulo G. Complete Revascularization in Acute and Chronic Coronary Syndrome. Cardiol Clin 2020; 38:491-505. [PMID: 33036712 DOI: 10.1016/j.ccl.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In patients with multivessel disease, complete revascularization (CR) is the most biologically plausible approach irrespective of definition or type or clinical setting (acute or chronic coronary syndrome [ACS or CCS]). It aims at minimizing residual ischemia, relieving symptoms and reducing the risk of future cardiovascular events. Large evidence supports CR benefits in ACS, predominantly ST-segment elevation myocardial infarction, except cardiogenic shock, although optimal assessment and timing remain debated. In patients with CCS, when revascularization is indicated, a functional CR should be attempted. Therefore, heart-team is crucial in selecting the ideal strategy for each patient to optimize decision-making.
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Affiliation(s)
- Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy; Mediterranea Cardiocentro, Via Orazio 2, Naples 80122, Italy
| | - Marco Ferrone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy; Division of Invasive Cardiology, Clinica Montevergine, Via Mario Malzoni, 5, Mercogliano (Avellino) 83013, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy.
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18
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Hashmi KA, Saeed HY, Farid MS, Najam J, Irfan M, Hashmi AA. Frequency of Multivessel Severe Coronary Artery Disease in Patients With Non-ST Segment Elevation Myocardial Infarction Having Markedly Raised Cardiac Troponin T. Cureus 2020; 12:e9571. [PMID: 32913688 PMCID: PMC7474558 DOI: 10.7759/cureus.9571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Non-ST segment elevation myocardial infarction (NSTEMI) is becoming more common than ST segment elevation myocardial infarction (STEMI) and data regarding presence of underlying multivessel coronary artery disease (MVCAD) in these patients is consistent in locoregional population that leads to lethal delays in proper management. Therefore, in the current study, we aimed to evaluate the frequency of MVCAD in NSTEMI with markedly raised troponin T levels. This will help to identify patients that should be labeled as high risk and must be referred for coronary revascularization on priority basis, so that clinical outcomes can be improved in these patients. Methods This cross-sectional research study was carried out at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan over a period of one year. A total of 326 patients with history of chest discomfort within past 48 hours of presentation or angina equivalent symptoms and cardiac troponin T more than 500 ng/l were included in the study. Coronary angiography was done within 72 hours of same hospital admission. The outcome variable i.e. MVCAD was determined. Results Mean age of patients was 50.74 ± 7.75 years with range of 30 to 60 years. MVCAD was found in 107 (32.82%) patients, whilst there was no MVCAD in 219 (67.18%) patients. Moreover, no significant association of MVCAD was noted with age or smoking. Conclusion We found presence of MVCAD in a considerable number of patients presenting with NSTEMI. The key to detect the underlying presence of MVCAD in these patients is lifted troponin T levels. Therefore, we conclude that any patient with elevated troponin T levels, even in the absence of ST segment elevation, should undergo cardiac catheterization to detect presence of MVCAD as this subset of patients can benefit from early revascularization including coronary artery bypass graft (CABG) surgery.
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Affiliation(s)
- Kashif A Hashmi
- Cardiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Hadi Y Saeed
- Cardiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | | | - Javeria Najam
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Atif Ali Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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19
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Matsushita K, Hibi K, Komura N, Kimura Y, Matsuzawa Y, Konishi M, Maejima N, Iwahashi N, Kosuge M, Ebina T, Tamura K, Kimura K. Impact of serum lipoprotein (a) level on coronary plaque progression and cardiovascular events in statin-treated patients with acute coronary syndrome: a yokohama-acs substudy. J Cardiol 2020; 76:66-72. [DOI: 10.1016/j.jjcc.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
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20
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Tovar Forero MN, Scarparo P, den Dekker W, Balbi M, Masdjedi K, van Zandvoort L, Kardys I, Ameloot K, Daemen J, Lemmert M, Wilschut J, de Jaegere P, Zijlstra F, Van Mieghem N, Diletti R. Revascularization Strategies in Patients Presenting With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease. Am J Cardiol 2020; 125:1486-1491. [PMID: 32200948 DOI: 10.1016/j.amjcard.2020.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
The optimal revascularization strategy for residual coronary stenosis following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains controversial. This is a retrospective single-centre study including patients with STEMI and MVD. Based on the revascularization strategy, 3 groups were identified: (1) culprit only (CO), (2) ad hoc multivessel revascularization (MVR), and (3) staged MVR. Clinical outcomes were compared in terms of major adverse cardiac events (MACE), a composite of cardiac death, any myocardial infarction, and any unplanned revascularization at a long-term follow-up. A total of 958 patients were evaluated, 489 in the CO, 254 in the ad hoc, and 215 in the staged group. In the staged group, 65.6% of the patients received planned percutaneous coronary intervention, 9.7% coronary artery bypass grafting, 8.4% no further intervention after lesion reassessment, and in 16.3% an event occurred before the planned procedure. At 1,095 days, MACE was 36.1%, 16.7%, and 31% for CO, ad hoc, and staged groups, respectively. A MVR strategy was associated with lower rate of all-cause death compared with CO (HR 0.50; 95%CI [0.31 to 0.80]; p = 0.004). Complete revascularization reduced the rate of MACE (HR 0.30 [0.21 to 0.43] p < 0.001) compared with incomplete revascularization. Ad hoc MVR had lower rate of MACE compared with staged MVR (HR 0.61 [0.39 to 0.96] p = 0.032) mainly driven by less unplanned revascularizations. In conclusion, in patients with STEMI and MVD, complete revascularization reduced the risk of MACE. Ad hoc MVR appeared a reasonable strategy with lower contrast and stent usage and costs.
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Affiliation(s)
| | - Paola Scarparo
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand den Dekker
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Matthew Balbi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laurens van Zandvoort
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Koen Ameloot
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Miguel Lemmert
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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21
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Tashiro H, Tanaka A, Ishii H, Sakakibara K, Tobe A, Kataoka T, Miki Y, Hitora Y, Niwa K, Furusawa K, Murohara T. Lipid-rich large plaques in a non-culprit left main coronary artery and long-term clinical outcomes. Int J Cardiol 2020; 305:5-10. [PMID: 32029305 DOI: 10.1016/j.ijcard.2020.01.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND An integrated backscatter (IB) intravascular ultrasound (IVUS) provides an information about tissue components and vulnerability of coronary plaques. The presence of vulnerable plaque in non-culprit lesion is associated with future clinical events. The purpose of this study was to assess the association between the characteristics of non-culprit left main coronary artery (LMCA) plaques evaluated by IB-IVUS and long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). METHODS Among the patients who underwent non-LMCA PCI, we studied 366 patients with adequate LMCA IVUS images. Conventional and IB-IVUS analyses of the LMCA segment were performed. Lipid-rich large plaque was defined as the presence of both a lager plaque volume and a higher percentage of the lipid component than the obtained median values. Major adverse cardiovascular events (MACE) included cardiac death, myocardial infarction, and unplanned revascularization. RESULTS The mean age of the patients was 68.5 ± 10.2 years, 79.8% were men. Median follow-up period was 6.0 years (IQR: 4.2-8.1 years). The incidence of MACE was significantly higher in patients with lipid-rich large plaques (P = .006). The incidence rates of cardiac death, myocardial infarction, and unplanned revascularization were significantly higher in patients with lipid-rich large plaques (P = .02, 0.004, and 0.02, respectively). Multivariate Cox regression analysis showed that the presence of a lipid-rich large plaque was significantly associated with MACE (HR: 1.74; 95%CI: 1.17-2.58; P = .006). CONCLUSION The presence of lipid-rich large plaques in a non-culprit LMCA can be associated with the long-term MACE in patients who have undergone PCI.
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Affiliation(s)
- Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Sakakibara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Miki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Hitora
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyoshi Niwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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22
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Abstract
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed toward more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high-quality imaging studies, both invasive and noninvasive, which promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events. We discuss the role of VP imaging in managing atherosclerotic vascular disease.
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23
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Al-Abdouh A, Barbarawi M, Bizanti A, Abudaya I, Upadhrasta S, Elias H, Zhao D, Savji N, Lakshman H, Hasan R, Michos ED. Complete Revascularization in Patients With STEMI and Multi-Vessel Disease: A Meta-Analysis of Randomized Controlled Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:684-691. [PMID: 32241726 DOI: 10.1016/j.carrev.2020.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is the treatment of choice for ST-elevation myocardial infarction (STEMI). However, efficacy of complete vs culprit only revascularization in patients with STEMI and multivessel disease remains unclear. METHODS We searched PubMed/MEDLINE, and Cochrane library. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), repeat revascularization, stroke, major bleeding, and contrast induced nephropathy. Estimates were calculated as random effects hazard ratios (HRs) with 95% confidence intervals (CI). RESULTS Twelve trials with 7592 patients were included. There was a significantly lower risk of MACE [HR 0.61; 95% CI (0.43-0.60); p = 0.0009; I2 = 72%], cardiovascular mortality [HR 0.74; 95% CI (0.56-0.99); p = 0.04; I2 = 2%], and repeat revascularization [HR 0.43; 95% CI (0.31-0.59); p < 0.00001; I2 = 67%] in patients treated with complete compared with culprit-only revascularization. There was no statistically significant difference in MI [HR 0.77; 95% CI (0.52-1.12); p = 0.17; I2 = 49%], all-cause mortality [HR 0.86; 95% CI (0.65-1.13); p = 0.28; I2 = 14%], heart failure [HR 0.82 95% CI (0.51-1.32); p = 0.42; I2 = 26%], major bleeding [HR 1.07; 95% CI (0.66-1.75); p = 0.78; I2 = 25%], stroke [HR 0.67; 95% CI (0.24-1.89); p = 0.45; I2 = 54%], or contrast induced nephropathy, although higher contrast volumes were used in the complete revascularization group [HR 1.22; 95% CI (0.78-1.92); p = 0.39; I2 = 0%]. CONCLUSION Complete revascularization was associated with a significantly lower risk of MACE, cardiovascular mortality, and repeat revascularization compared with culprit-only revascularization. These results suggest complete revascularization with PCI following STEMI and multivessel disease should be considered.
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Affiliation(s)
- Ahmad Al-Abdouh
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America.
| | - Mahmoud Barbarawi
- Department of Medicine, Hurley Medical Center, Michigan State University, Flint, MI, United States of America
| | - Anas Bizanti
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America
| | - Ibrahim Abudaya
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America
| | - Sireesha Upadhrasta
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America
| | - Hadi Elias
- Department of Cardiology, Geisenger Medical Center, PA, United States of America
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Nazir Savji
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Harini Lakshman
- Department of Medicine, Hurley Medical Center, Michigan State University, Flint, MI, United States of America
| | - Rani Hasan
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
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24
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Nordkin I, Goldberg A, Israeli Z, Halabi M. Complicated acute myocardial infarction with simultaneous occlusion of two coronary arteries. Clin Case Rep 2020; 8:449-452. [PMID: 32185034 PMCID: PMC7069877 DOI: 10.1002/ccr3.2685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 11/09/2022] Open
Abstract
Simultaneous occlusion of two coronary arteries in acute MI is infrequent and may be accompanied by cardiogenic shock. Prompt restoration of normal coronary flow can salvage the myocardium and decrease a possible risk of death from complications.
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Affiliation(s)
- Irina Nordkin
- Cardiology DepartmentZiv Medical CenterTzfatIsrael
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
| | - Alexander Goldberg
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
- Interventional Cardiology UnitZiv Medical CenterTzfatIsrael
| | - Zeev Israeli
- Cardiology DepartmentZiv Medical CenterTzfatIsrael
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
| | - Majdi Halabi
- Cardiology DepartmentZiv Medical CenterTzfatIsrael
- The Azrieli Faculty of MedicineBar‐Ilan UniversityIsrael
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25
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Kang M, Hurwitz C, Exner T, Yang A, Connor D, Parsi K. Angioscopy: Direct visualization of chronic venous occlusion, May-Thurner syndrome, and other applications in phlebology. J Vasc Surg Venous Lymphat Disord 2019; 7:870-881. [DOI: 10.1016/j.jvsv.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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26
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Kawai K, Fujii K, Shirakawa M, Uchida K, Yamada K, Kawakami R, Imanaka T, Hao H, Hirota S, Ishihara M, Yoshimura S. Comparison of angioscopy and histopathology for the evaluation of carotid plaque characteristics: an ex vivo validation study. Int J Cardiovasc Imaging 2019; 36:231-239. [PMID: 31664681 DOI: 10.1007/s10554-019-01720-8] [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: 05/04/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
Abstract
Intravascular angioscopy is widely used for evaluating plaque characteristics through the plaque color in the coronary artery. This study evaluated whether angioscopy is capable of identifying various plaque morphologies, including necrotic core and intraplaque hemorrhage (IPH) in the carotid artery. Nine patients underwent carotid endarterectomy for carotid artery stenosis, and these specimens were imaged ex vivo by angioscopy within 6 h. An angioscopic examination of carotid plaque evaluated its color intensity as follows: white, yellow, or red. The IPH area, necrotic core area, and fibrous cap thickness was measured on histological sections at each site. A total of 7 plaques were graded as white plaques, 10 as yellow, and 8 as red by angioscopy. The IPH area and the percent area occupied by IPH were larger in red and yellow plaques than in white plaques (10.7 ± 9.3 mm2, 9.4 ± 7.8 mm2, and 2.2 ± 1.7 mm2, respectively, P = 0.074; and 25 ± 10%, 19 ± 13%, and 7 ± 5%, respectively, P = 0.008). Furthermore, the thickness of the fibrous cap was significantly thinner in red plaques than in yellow and white plaques (128 ± 34 µm, 328 ± 136 µm, and 285 ± 102 µm, respectively, P = 0.002). The ROC analysis for predicting a presence of red plaques identified that the optimal cutoff value of fibrous cap thickness was 181 µm (area under the curve = 0.987, 100% sensitivity, 90% specificity). The prevalence of red plaques on intravascular angioscopy may represent the existence of plaques containing relatively larger necrotic core and IPH with a thin fibrous cap.
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Affiliation(s)
- Kenji Kawai
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenichi Fujii
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho Nishinomiya, Nishinomiya, Hyogo, 6638501, Japan.
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Rika Kawakami
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho Nishinomiya, Nishinomiya, Hyogo, 6638501, Japan
| | - Takahiro Imanaka
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyuki Hao
- Department of Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho Nishinomiya, Nishinomiya, Hyogo, 6638501, Japan
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
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27
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Monzo L, Cocco N, Sergi SC, Donahue M, Calò L. A case of recurrent acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2019; 21:259-263. [PMID: 31592854 DOI: 10.2459/jcm.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Luca Monzo
- Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, 'Sapienza' University.,Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Nino Cocco
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | | | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
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28
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Sato T, Horikawa M, Takei S, Yamazaki F, Ito TK, Kondo T, Sakurai T, Kahyo T, Ikegami K, Sato S, Sato R, Jinno Y, Kawano H, Naoe S, Arita M, Kashiwagi Y, Setou M. Preferential Incorporation of Administered Eicosapentaenoic Acid Into Thin-Cap Atherosclerotic Plaques. Arterioscler Thromb Vasc Biol 2019; 39:1802-1816. [PMID: 31366219 DOI: 10.1161/atvbaha.119.313093] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE n-3 polyunsaturated fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have beneficial effects on atherosclerosis. Although specific salutary actions have been reported, the detailed distribution of n-3 polyunsaturated fatty acids in plaque and their relevance in disease progression are unclear. Our aim was to assess the pharmacodynamics of EPA and DHA and their metabolites in atherosclerotic plaques. Approach and Results: Apolipoprotein E-deficient (Apoe-/-) mice were fed a Western diet supplemented with EPA (1%, w/w) or DHA (1%, w/w) for 3 weeks. Imaging mass spectrometry analyses were performed in the aortic root and arch of the Apoe-/- mice to evaluate the distribution of EPA, DHA, their metabolites and the lipids containing EPA or DHA in the plaques. Liquid chromatography-mass spectrometry and histological analysis were also performed. The intima-media thickness of atherosclerotic plaque decreased in plaques containing free EPA and EPAs attached with several lipids. EPA was distributed more densely in the thin-cap plaques than in the thick-cap plaques, while DHA was more evenly distributed. In the aortic root, the distribution of total EPA level and cholesteryl esters containing EPA followed a concentration gradient from the vascular endothelium to the media. In the aortic arch, free EPA and 12-hydroxy-EPA colocalized with M2 macrophage. CONCLUSIONS Administered EPA tends to be incorporated from the vascular lumen side and preferentially taken into the thin-cap plaque.
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Affiliation(s)
- Tomohito Sato
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,First Department of Surgery (T. Sato), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Makoto Horikawa
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shiro Takei
- Department of Environmental Biology, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan (S.T.)
| | - Fumiyoshi Yamazaki
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takashi K Ito
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takeshi Kondo
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takanobu Sakurai
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoaki Kahyo
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Koji Ikegami
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shumpei Sato
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ryota Sato
- Division of Cardiology, Internal Medicine 3 (R.S.), Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yasutaka Jinno
- Development Research, Pharmaceutical Research Center, Mochida Pharmaceutical Co, Ltd, Shizuoka, Japan (Y.J., H.K., S.N.)
| | - Hiroyuki Kawano
- Development Research, Pharmaceutical Research Center, Mochida Pharmaceutical Co, Ltd, Shizuoka, Japan (Y.J., H.K., S.N.)
| | - Satoko Naoe
- Development Research, Pharmaceutical Research Center, Mochida Pharmaceutical Co, Ltd, Shizuoka, Japan (Y.J., H.K., S.N.).,Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences (IMS), Kanagawa, Japan (S.N., M.A.)
| | - Makoto Arita
- Preeminent Medical Photonics Education and Research Center, Shizuoka, Japan (M.S.)
| | - Yukiyasu Kashiwagi
- Osaka Research Institute of Industrial Science and Technology, Japan (Y.K., )
| | - Mitsutoshi Setou
- From the Department of Cellular and Molecular Anatomy (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,International Mass Imaging Center (T. Sato, M.H., F.Y., T.K.I., T. Kondo, T. Sakurai, T. Kahyo, K.I., S.S., M.S.), Hamamatsu University School of Medicine, Shizuoka, Japan.,Department of Anatomy, The University of Hong Kong, China (M.S.)
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Fox KAA, Metra M, Morais J, Atar D. The myth of ‘stable’ coronary artery disease. Nat Rev Cardiol 2019; 17:9-21. [DOI: 10.1038/s41569-019-0233-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
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Kojima K, Kimura S, Hayasaka K, Mizusawa M, Misawa T, Yamakami Y, Sagawa Y, Ohtani H, Hishikari K, Sugiyama T, Hikita H, Takahashi A. Aortic Plaque Distribution, and Association between Aortic Plaque and Atherosclerotic Risk Factors: An Aortic Angioscopy Study. J Atheroscler Thromb 2019; 26:997-1006. [PMID: 30918164 PMCID: PMC6845689 DOI: 10.5551/jat.48181] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Knowledge of subclinical plaque morphology and plaque distribution in the aorta in vivo remains unclear. This study aimed to increase the body of knowledge in this area. Methods: We enrolled 37 consecutive patients with stable angina pectoris patients who underwent non-obstructive angioscopy for both the coronary artery and aorta immediately after percutaneous coronary intervention. We evaluated the presence of aortic plaques and the distribution of plaque instability. Patients were allocated into two groups according to the number of vulnerable plaques in whole aorta (a low [0–11] and high [≥ 12] group). We evaluated the relationships between the two groups in terms of cardiovascular risk factors. Results: Aortic plaques were identified using non-obstructive angioscopy in all patients, and the greatest number of plaques was found at the infrarenal abdominal aorta (IAA) (the aortic arch, the descending thoracic aorta, the suprarenal abdominal aorta, the IAA, and common iliac artery; 65%, 76%, 65%, 95%, and 49%, respectively; p < 0.001). The maximum yellow grade, and the number of intense yellow plaques, ruptured plaques, and thrombi were highest at the IAA (p < 0.001). The prevalence of diabetes mellitus and peripheral arterial disease was higher in the high vulnerable plaque group (83.3% vs. 40.0%, p = 0.010, 50.0% vs. 8.0%, p = 0.005, respectively). Conclusions: Aortic atherosclerosis was the most severe at the IAA, and aortic plaque vulnerability and distribution were associated with the prevalence of diabetes mellitus and peripheral artery disease in patients with stable angina pectoris. Non-obstructive angioscopy may identify patients at high risk of future aortic events.
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Affiliation(s)
| | | | | | | | - Toru Misawa
- Cardiovascular Center, Yokosuka Kyosai Hospital
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31
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Tian J, Wang X, Tian J, Yu B. Gender differences in plaque characteristics of nonculprit lesions in patients with coronary artery disease. BMC Cardiovasc Disord 2019; 19:45. [PMID: 30808307 PMCID: PMC6390304 DOI: 10.1186/s12872-019-1023-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/15/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although numerous reports suggest sex-related differences in atherosclerosis, limited data describing gender-associated differences in plaque morphology and composition are currently available. The aim of the present study was to compare coronary nonculprit plaque characteristics in women and men with coronary artery disease (CAD) by optical coherence tomography (OCT). METHODS This was a retrospective study. A total of 187 nonculprit plaques were identified in 103 patients with CAD who underwent OCT imaging of all 3 coronary arteries. These patients included 77 (74.8%) men and 26 (25.2%) women. RESULTS Female patients were significantly older than males (mean age, 70.8 ± 7.3 vs 60.8 ± 9.8 years; P < 0.001) and less likely to be current smokers (P = 0.007). OCT analysis included the presence of lipid-rich plaque, maximum lipid arc, lipid-core length, lipid index (LI), fibrous cap thickness, and the incidence of thin-cap fibroatheroma (TCFA). Nonculprit plaques in men exhibited greater lipid-core length and LI compared with those of women (9.4 ± 4.5 vs. 7.3 ± 4.3 mm, P = 0.024; 1615.1 ± 893.8 vs. 1237.8 ± 859.8, P = 0.035, respectively). In the univariate linear regression model, sex and current smoker were all associated with a larger LI, whereas only use of statin was independent risk factor for a larger LI in multivariate analysis. CONCLUSIONS Coronary nonculprit plaques in male patients with CAD contain larger lipid cores than those of female patients.
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Affiliation(s)
- Jiangtian Tian
- Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.,Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Xuedong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Bo Yu
- Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. .,Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
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Noguchi T. High-intensity plaques as a novel surrogate marker of vulnerable coronary lesions? J Cardiol 2019; 70:518-519. [PMID: 29110765 DOI: 10.1016/j.jjcc.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/13/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
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Kojima K, Kimura S, Hayasaka K, Mizusawa M, Misawa T, Yamakami Y, Sagawa Y, Ohtani H, Hishikari K, Sugiyama T, Hikita H, Takahashi A. Observation of an Asymptomatic Dissecting Aortic Aneurysm Using Non-Obstructive Angioscopy. Int Heart J 2018; 59:1462-1465. [DOI: 10.1536/ihj.18-018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | - Toru Misawa
- Cardiovascular Center, Yokosuka Kyosai Hospital
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Ermis E, Kahraman S, Ucar H, Ozyılmaz SO, Allahverdiyev S. Triple Coronary Artery Thrombosis Presenting as Acute Anterior ST-Segment Elevation Myocardial Infarction. Int J Angiol 2018; 27:223-226. [PMID: 30410294 DOI: 10.1055/s-0037-1608959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Simultaneous multivessel epicardial coronary artery thrombosis is an uncommon finding in acute ST-segment elevation myocardial infarction (STEMI). It generally leads to cardiogenic shock and sudden cardiac death in the hospital. We report a 42-year-old male patient presenting with acute anterior STEMI with triple coronary artery thrombosis. An emergency coronary angiogram showed total occlusion of the left anterior descending artery (LAD) with thrombus formation. At the same time, thrombus formations were also seen in the circumflex artery (CXA), the second obtuse marginal (OM2) branch, and the distal right coronary artery (RCA). We unsuccessfully attempted thrombus aspiration of the LAD. Subsequently, we decided to stent the LAD, and a successful percutaneous coronary intervention (PCI) was performed for the LAD. In a second procedure, RCA thrombosis regressed with 24-hour tirofiban (glycoprotein IIb/IIIa receptor inhibitor) perfusion, although CXA thrombosis and OM thrombosis did not regress. Therefore, we performed stenting of the CXA and OM with a newer provisional technique called the flower petal technique. Thrombolysis in myocardial infarction (TIMI) flow grade III was seen after stenting. The patient was discharged from the hospital 5 days after PCI without any symptoms.
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Affiliation(s)
- Emrah Ermis
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Silivri State Hospital, Istanbul, Turkey
| | - Hakan Ucar
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Sinem Ozbay Ozyılmaz
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Samir Allahverdiyev
- Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
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35
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Kimura S, Sugiyama T, Hishikari K, Nakagama S, Nakamura S, Misawa T, Mizusawa M, Hayasaka K, Yamakami Y, Sagawa Y, Kojima K, Ohtani H, Hikita H, Takahashi A. The clinical significance of echo-attenuated plaque in stable angina pectoris compared with acute coronary syndromes: A combined intravascular ultrasound and optical coherence tomography study. Int J Cardiol 2018; 270:1-6. [PMID: 29908828 DOI: 10.1016/j.ijcard.2018.05.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Echo-attenuated plaque (EA) on intravascular ultrasound (IVUS) is related to poor outcomes after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients. However, the clinical significance of EA in stable angina pectoris (SAP) patients compared with that in ACS patients remains unclear. We assessed the relationships between EA and unstable plaque characteristics in patients with ACS and SAP. METHODS We investigated 609 coronary lesions in 609 patients (234 with ACS; 375 with SAP) undergoing pre-intervention IVUS and optical coherence tomography (OCT). The differences in plaque morphology and post-PCI outcomes were assessed according to the clinical status of ACS or SAP and the presence or absence of EA. RESULTS EA was more frequent in patients with ACS than in those with SAP (44.0% vs. 25.1%, p < 0.001). SAP-EA lesions showed thicker fibrous cap (157 ± 97 μm vs. 100 ± 58 μm, p < 0.001), smaller lipid arc (208 ± 76° vs. 266 ± 99°, p < 0.001), smaller plaque burden (83.0 ± 6.1% vs. 86.5 ± 4.1%, p < 0.001), and lower frequency of transient slow-reflow phenomenon during PCI (21.3% vs. 51.5%, p < 0.001) than ACS-EA lesions, but similar plaque vulnerability compared with ACS-non-EA lesions. SAP-EA lesions had less frequent OCT-thrombus than ACS-non-EA lesions (20.2% vs. 71.2%, p < 0.001). CONCLUSIONS SAP-EA lesions had less plaque vulnerability than ACS-EA lesions, but were comparable to ACS-non-EA lesions. Less frequent thrombus formation might differentiate SAP-EA lesions from ACS-non-EA lesions. A combined IVUS and OCT approach might be useful to assess plaque vulnerability in SAP-EA lesions compared with ACS lesions.
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Affiliation(s)
- Shigeki Kimura
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
| | - Tomoyo Sugiyama
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Shun Nakagama
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shun Nakamura
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Toru Misawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Kazuto Hayasaka
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yosuke Yamakami
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yuichiro Sagawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Keisuke Kojima
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hirofumi Ohtani
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroyuki Hikita
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
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Early and long-term outcomes of complete revascularization with percutaneous coronary intervention in patients with multivessel coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:32-41. [PMID: 29743902 PMCID: PMC5939543 DOI: 10.5114/aic.2018.74353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The clinical significance of complete revascularization with percutaneous coronary intervention (CR-PCI) in patients with non-ST-segment acute coronary syndrome (NSTE-ACS) remains uncertain. Aim To evaluate the impact of CR-PCI during index hospitalization on short and long-term incidence of death and composite endpoint among patients with multivessel coronary artery disease (CAD) presenting with NSTE-ACS. Material and methods We analyzed consecutive data of 1,592 patients with multivessel CAD from 2006 to 2014. Patients with prior coronary artery bypass grafting (CABG), cardiogenic shock, treated conservatively or with CABG and scheduled for planned CABG or PCI after discharge were excluded. The 30-day and 12-month composite endpoint was defined as all-cause death, nonfatal myocardial infarction (MI) or ACS-driven unplanned revascularization. Six hundred and ninety-five patients were divided into 2 groups: CR-PCI (n = 137) (CR-PCI during index hospitalization) and IR-PCI (n = 558) (incomplete revascularization). Results Incidence of composite endpoint (3.6% vs. 10.2%; HR = 0.31; 95% CI: 0.12–0.87; p = 0.025) and death (0.7% vs. 5.7%, HR = 0.11; 95% CI: 0.02–0.93; p = 0.043) at 30 days was lower in CR-PCI than in IR-PCI. At 12-month follow-up occurrence of composite endpoint was lower in CR-PCI (14.7%) than in IR-PCI (27.4%, p = 0.0037). Multivariate analysis confirmed that CR PCI was associated with a reduction in 12-month composite endpoint (HR = 0.56; 95% CI: 0.31–0.99; p = 0.046). The 12-month mortality was lower in CR-PCI (7.4% vs. 14.8%; p = 0.031), but it was not confirmed in the multivariate analysis. Conclusions In patients with multivessel CAD and NSTE-ACS, CR-PCI during index hospitalization was independently associated with improved early and long-term prognosis without significant differences in periprocedural outcomes in comparison to IR-PCI.
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Motovska Z, Hlinomaz O, Kala P, Hromadka M, Knot J, Varvarovsky I, Dusek J, Jarkovsky J, Miklik R, Rokyta R, Tousek F, Kramarikova P, Svoboda M, Majtan B, Simek S, Branny M, Mrozek J, Cervinka P, Ostransky J, Widimsky P. 1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor. J Am Coll Cardiol 2018; 71:371-381. [DOI: 10.1016/j.jacc.2017.11.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Vogel B, Mehta SR, Mehran R. Reperfusion strategies in acute myocardial infarction and multivessel disease. Nat Rev Cardiol 2017; 14:665-678. [DOI: 10.1038/nrcardio.2017.88] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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39
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Kitagawa T, Yamamoto H, Toshimitsu S, Sasaki K, Senoo A, Kubo Y, Tatsugami F, Awai K, Hirokawa Y, Kihara Y. 18F-sodium fluoride positron emission tomography for molecular imaging of coronary atherosclerosis based on computed tomography analysis. Atherosclerosis 2017; 263:385-392. [PMID: 28528743 DOI: 10.1016/j.atherosclerosis.2017.04.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS We aimed at evaluating the relation of 18F-sodium fluoride (18F-NaF) uptake on positron emission tomography (PET) to coronary atherosclerosis detected and assessed by computed tomography (CT). METHODS Thirty-two patients with one or more coronary atherosclerotic lesions detected on cardiac CT underwent 18F-NaF PET/CT. Each coronary atherosclerotic lesion was evaluated on CT angiography for plaque types (calcified plaque [CP], non-calcified plaque [NCP], partially calcified plaque [PCP]), and the presence of CT-based high-risk features (minimum CT density <30 Hounsfield units and vascular remodeling index >1.1). Focal 18F-NaF uptake of each lesion was quantified using maximum tissue-to-background ratio (TBRmax). RESULTS A total of 111 lesions were studied. In a patient-based analysis, logarithmically transformed coronary calcium score correlated positively with maximum TBRmax per patient, and 15 patients with myocardial infarction or unstable angina history showed a higher maximum TBRmax per patient than those without (1.36 ± 0.15 versus 1.15 ± 0.15, p = 0.0006). In a lesion-based analysis, PCP showed a higher TBRmax than CP and NCP (1.17 ± 0.19 versus 1.00 ± 0.24 and 0.92 ± 0.18, respectively, p < 0.0001), and the lesions with high-risk features had a higher TBRmax than those without (1.20 ± 0.21 versus 1.02 ± 0.20, p = 0.0011). CONCLUSIONS Coronary arterial 18F-NaF uptake is related to total plaque burden, coronary event history, and specific features of coronary atherosclerosis based on CT analysis. 18F-NaF PET/CT, in combination with cardiac CT, may provide a new molecular imaging approach to identify high-risk patients and coronary atherosclerotic lesions.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Hideya Yamamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Ko Sasaki
- Hiroshima Heiwa Clinic, Hiroshima, Japan
| | - Atsuhiro Senoo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yumiko Kubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Ananthakrishna R, Wang LJ, Zhao LP, Tan HC. Double jeopardy in acute ST-segment elevation myocardial infarction. Singapore Med J 2017; 58:225-227. [PMID: 28429037 DOI: 10.11622/smedj.2017030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Li-Jun Wang
- Department of Cardiology, National University Heart Centre, Singapore
| | - Liang Ping Zhao
- Department of Cardiology, National University Heart Centre, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
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Tan Y, Zhou J, Zhou Y, Yang X, Yang J, Chen Y. Characteristics Detected on Computed Tomography Angiography Predict Coronary Artery Plaque Progression in Non-Culprit Lesions. Korean J Radiol 2017; 18:487-497. [PMID: 28458601 PMCID: PMC5390618 DOI: 10.3348/kjr.2017.18.3.487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 10/03/2016] [Indexed: 11/15/2022] Open
Abstract
Objective This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL). Materials and Methods In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic. Results Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391–24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103–22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242–43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000–1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006). Conclusion Noninvasive assessment of NCLs by CCTA has potential prognostic value.
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Affiliation(s)
- Yahang Tan
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.,The School of Medicine, Nankai University, Tianjin 300071, China
| | - Jia Zhou
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.,Department of Cardiology, Tianjin Chest Hospital, Tianjin 300000, China
| | - Ying Zhou
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.,Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Xiaobo Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.,The School of Medicine, Nankai University, Tianjin 300071, China
| | - Junjie Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
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Ishihara M, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Fujino M, Yasuda S, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Uematsu M, Hirata K, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Tobaru T, Oshima S, Nakai M, Nishimura K, Miyamoto Y, Ogawa H. Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation - The J-MINUET Study. Circ J 2017; 81:958-965. [PMID: 28320999 DOI: 10.1253/circj.cj-17-0033] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND According to troponin-based criteria of myocardial infarction (MI), patients without elevation of creatine kinase (CK), formerly classified as unstable angina (UA), are now diagnosed as non-ST-elevation MI (NSTEMI), but little is known about their outcomes.Methods and Results:Between July 2012 and March 2014, 3,283 consecutive patients with MI were enrolled. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure and urgent revascularization for UA. There were 2,262 patients with ST-elevation MI (STEMI), 563 NSTEMI with CK elevation (NSTEMI+CK) and 458 NSTEMI without CK elevation (NSTEMI-CK). From day 0, Kaplan-Meier curves for the primary endpoint began to diverge in favor of NSTEMI-CK for up to 30 days. The 30-day event rate was significantly lower in patients with NSTEMI-CK (3.3%) than in STEMI (8.6%, P<0.001) and NSTEMI+CK (9.9%, P<0.001). Later, the event curves diverged in favor of STEMI. The event rate from 31 days to 3 years was significantly lower in patients with STEMI (19.8%) than in NSTEMI+CK (33.6%, P<0.001) and NSTEMI-CK (34.2%, P<0.001). Kaplan-Meier curves from 31 days to 3 years were almost identical between NSTEMI+CK and NSTEMI-CK (P=0.91). CONCLUSIONS Despite smaller infarct size and better short-term outcomes, long-term outcomes of NSTEMI-CK after convalescence were as poor as those for NSTEMI+CK and worse than for STEMI.
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Affiliation(s)
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Atsushi Hirohata
- Department of Cardiology, The Sakakibara Heart Institute of Okayama
| | | | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | | | | | | | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Hiroshi Funayama
- Department of Integrated Medicine, Saitama Medical Center Jichi Medical University
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Ken Kozuma
- Department of Cardiology, Teikyo University
| | | | - Shigeru Oshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
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Improving the visual field in coronary artery by with non-obstructive angioscopy: dual infusion method. Int J Cardiovasc Imaging 2017; 33:789-796. [DOI: 10.1007/s10554-017-1079-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
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Hamo CE, Klem I, Rao SV, Songco V, Najjar S, Lakatta EG, Raman SV, Harrington RA, Heitner JF. The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting with ST-Elevation Myocardial Infarction. PLoS One 2017; 12:e0169108. [PMID: 28060863 PMCID: PMC5218460 DOI: 10.1371/journal.pone.0169108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Identification of the infarct-related artery (IRA) in patients with STEMI using coronary angiography (CA) is often based on the ECG and can be challenging in patients with severe multi-vessel disease. The current study aimed to determine how often percutaneous intervention (PCI) is performed in a coronary artery different from the artery supplying the territory of acute infarction on cardiac magnetic resonance imaging (CMR). METHODS We evaluated 113 patients from the Reduction of infarct Expansion and Ventricular remodeling with Erythropoetin After Large myocardial infarction (REVEAL) trial, who underwent CMR within 4±2 days of revascularization. Blinded reviewers interpreted CA to determine the IRA and CMR to determine the location of infarction on a 17-segment model. In patients with multiple infarcts on CMR, acuity was determined with T2-weighted imaging and/or evidence of microvascular obstruction. RESULTS A total of 5 (4%) patients were found to have a mismatch between the IRA identified on CMR and CA. In 4/5 cases, there were multiple infarcts noted on CMR. Thirteen patients (11.5%) had multiple infarcts in separate territories on CMR with 4 patients (3.5%) having multiple acute infarcts and 9 patients (8%) having both acute and chronic infarcts. CONCLUSIONS In this select population of patients, the identification of the IRA by CA was incorrect in 4% of patients presenting with STEMI. Four patients with a mismatch had an acute infarction in more than one coronary artery territory on CMR. The role of CMR in patients presenting with STEMI with multi-vessel disease on CA deserves further investigation.
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Affiliation(s)
- Carine E. Hamo
- Department of Medicine, Stony Brook University Hospital, Stony Brook New York, United States of America
| | - Igor Klem
- The Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Sunil V. Rao
- The Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Vincent Songco
- Division of Cardiology, New York Methodist Hospital, Brooklyn, New York, United States of America
| | - Samer Najjar
- MedStar Health Research Institute, Washington, DC, United States of America
- Intramural Research Program, National Institute of Aging, the National Institute of Health, Baltimore, Maryland, United States of America
| | - Edward G. Lakatta
- Intramural Research Program, National Institute of Aging, the National Institute of Health, Baltimore, Maryland, United States of America
| | - Subha V. Raman
- Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio, United States of America
| | - Robert A. Harrington
- Department of Medicine, Stanford University, Palo Alto, California, United States of America
| | - John F. Heitner
- Division of Cardiology, New York Methodist Hospital, Brooklyn, New York, United States of America
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Vergallo R, Uemura S, Soeda T, Minami Y, Cho JM, Ong DS, Aguirre AD, Gao L, Biasucci LM, Crea F, Yu B, Lee H, Kim CJ, Jang IK. Prevalence and Predictors of Multiple Coronary Plaque Ruptures: In Vivo 3-Vessel Optical Coherence Tomography Imaging Study. Arterioscler Thromb Vasc Biol 2016; 36:2229-2238. [PMID: 27634834 DOI: 10.1161/atvbaha.116.307891] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/30/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures. APPROACH AND RESULTS Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039). CONCLUSIONS Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate.
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Affiliation(s)
- Rocco Vergallo
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Shiro Uemura
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Tsunenari Soeda
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Yoshiyasu Minami
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Jin-Man Cho
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Daniel S Ong
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Aaron D Aguirre
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Lei Gao
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Luigi M Biasucci
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Filippo Crea
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Bo Yu
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
| | - Hang Lee
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Chong-Jin Kim
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.)
| | - Ik-Kyung Jang
- From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
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Sakakura K, Yasu T, Kobayashi Y, Katayama T, Sugawara Y, Funayama H, Takagi Y, Ikeda N, Ishida T, Tsuruya Y, Kubo N, Saito M. Noninvasive Tissue Characterization of Coronary Arterial Plaque by 16-Slice Computed Tomography in Acute Coronary Syndrome. Angiology 2016; 57:155-60. [PMID: 16518522 DOI: 10.1177/000331970605700204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Noninvasive characterization of coronary plaques is challenging for cardiologists. The authors’ goal was to explore the clinical feasibility of newly developed 16-slice computed tomography (CT) in tissue characterization of coronary arterial plaques in patients with acute coronary syndrome. Sixteen patients with acute coronary syndrome underwent 16-slice CT (Aquillion, Toshiba) and coronary arteriography with intravascular ultrasound (IVUS) within 7 days. Twenty-three plaques were classified by IVUS according to plaque echogenicity: 6 soft plaques, 11 intermediate plaques, and 6 calcified plaques. Mean (±SD) CT numbers (Hounsfield units [HU]) of these 3 types of plaques were 50.6 ±14.8 HU, 131 ±21.0 HU, and 721 ±231 HU, respectively. Sixteen-slice CT facilitates noninvasive tissue characterization of coronary arterial plaques.
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Affiliation(s)
- Kenichi Sakakura
- First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan
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Bates ER, Tamis-Holland JE, Bittl JA, O’Gara PT, Levine GN. PCI Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. J Am Coll Cardiol 2016; 68:1066-81. [DOI: 10.1016/j.jacc.2016.05.086] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/19/2016] [Accepted: 05/10/2016] [Indexed: 12/19/2022]
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48
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Enhanced IVUS: Advances Allowing Higher Resolution and Integrated Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9384-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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49
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Saybolt MD, Lilly SM, Patel D, Hamamdzic D, Llano R, Fenning RS, Madden S, Wilensky RL. The vulnerable artery: early and rapid deposition of lipid in coronary arteries is associated with subsequent development of thin-cap fibroatheromas. EUROINTERVENTION 2016; 11:e1612-8. [PMID: 27056122 DOI: 10.4244/eijv11i14a312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to determine whether intravascular ultrasound (IVUS) and near infrared spectroscopy (NIRS) could identify arteries which would subsequently develop a thin-cap fibroatheroma (TCFA). METHODS AND RESULTS Three-vessel angiography, IVUS and NIRS evaluations were performed at three, six and nine months after induction of diabetes mellitus and hypercholesterolaemia in 13 Yorkshire pigs (n=37 arteries). In vivo total arterial plaque plus media (P+M) area, echo-attenuated plaque (AP) area by IVUS, and lipid core burden index (LCBI) by NIRS were compared to histology at nine months. P+M mean area increased over time (3 vs. 6 months p<0.01; 6 vs. 9 months p<0.01), as did the AP area and mean LCBI between three and six months (p<0.01). There were 69 TCFAs within 18 arteries. The mean LCBI at six months was greater in arteries containing a TCFA (77.8±17.4 vs. 34.3±11.4; p=0.04) as was the ∆LCBI from three to six months (55.3±16.9 vs. 3.3±16.0; p=0.03). Arteries which contained TCFA at nine months had greater AP area by IVUS at six months (p=0.007). CONCLUSIONS The early and persistent accumulation of total arterial lipid detected by NIRS was associated with the future development of TCFAs.
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Affiliation(s)
- Matthew D Saybolt
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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50
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Koskinas KC, Zaugg S, Yamaji K, García-García HM, Taniwaki M, Klingenberg R, Moschovitis A, Lüscher TF, van Tits LJ, Matter CM, Windecker S, Räber L. Changes of coronary plaque composition correlate with C-reactive protein levels in patients with ST-elevation myocardial infarction following high-intensity statin therapy. Atherosclerosis 2016; 247:154-60. [PMID: 26921743 DOI: 10.1016/j.atherosclerosis.2016.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Levels of inflammatory biomarkers associate with changes of coronary atheroma burden in statin-treated patients with stable coronary artery disease. This study sought to determine changes of plaque composition in vivo in relation to high-sensitivity C-reactive protein (hs-CRP) levels in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin therapy. METHODS The IBIS-4 study performed serial (baseline and 13-month), 2-vessel intravascular ultrasound (IVUS) and radiofrequency-IVUS of the non-infarct-related arteries in patients with STEMI treated with high-intensity statin therapy. The present analysis included 44 patients (80 arteries) with serial measurements of hs-CRP. RESULTS At follow-up, median low-density lipoprotein cholesterol (LDL-C) levels decreased from 126 to 77 mg/dl, HDL-C increased from 44 to 47 mg/dl, and hs-CRP decreased from 1.6 to 0.7 mg/L. Regression of percent atheroma volume (-0.99%, 95% CI -1.84 to -0.14, p = 0.024) was accompanied by reduction of percent fibro-fatty (p = 0.04) and fibrous tissue (p < 0.001), and increase in percent necrotic core (p = 0.006) and dense calcium (p < 0.001). Follow-up levels of hs-CRP, but not LDL-C, correlated with changes in percent necrotic core (p = 0.001) and inversely with percent fibrous tissue volume (p = 0.008). Similarly, baseline-to-follow-up change of hs-CRP correlated with the change in percent necrotic core volume (p = 0.02). CONCLUSIONS In STEMI patients receiving high-intensity statin therapy, stabilization of VH-IVUS-defined necrotic core was confined to patients with lowest on-treatment levels and greatest reduction of hs-CRP. Elevated CRP levels at follow-up may identify progression of high-risk coronary plaque composition despite intensive statin therapy and overall regression of atheroma volume.
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Affiliation(s)
| | - Serge Zaugg
- Clinical Trials Unit, Bern University, Bern, Switzerland
| | - Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Masanori Taniwaki
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Aris Moschovitis
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas F Lüscher
- Cardiology Department, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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