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Abdelaziz A, Hafez A, Atta K, Elsayed H, Elaraby A, Ibrahim AA, Gadelmawla AF, Helmi A, Abdelazeem B, Lavie CJ, Tafur-Soto J. Antegrade Approach versus Retrograde Approach Percutaneous Coronary Intervention for Chronic Total Occlusion: An updated Meta-Analysis. Curr Probl Cardiol 2024:102832. [PMID: 39293774 DOI: 10.1016/j.cpcardiol.2024.102832] [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: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI. METHODS We searched PubMed, Scopus, WOS, and Cochrane Central until June, 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95% confidence intervals (CI). RESULTS A total of 18 studies comprising 18,830 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95% CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95% CI: 0.19 to 0.64), MI (OR= 0.36, 95% CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95% CI: 0.16 to 0.46), CIN (OR= 0.46, 95% CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95% CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95% CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95% CI: 1.1 to 1.22). CONCLUSION Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Karim Atta
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed A Ibrahim
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Farid Gadelmawla
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Helmi
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Basel Abdelazeem
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Jose Tafur-Soto
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
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Arase M, Nakanishi N, Tsutsumi R, Kawakami A, Arai Y, Sakaue H, Oto J. The Utility of Urinary Titin to Diagnose and Predict the Prognosis of Acute Myocardial Infarction. Int J Mol Sci 2024; 25:573. [PMID: 38203744 PMCID: PMC10778763 DOI: 10.3390/ijms25010573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Early detection and management are crucial for better prognosis in acute myocardial infarction (AMI). Serum titin, a component of the sarcomere in cardiac and skeletal muscle, was associated with AMI. Thus, we hypothesized that urinary N-fragment titin may be a biomarker for its diagnosis and prognosis. Between January 2021 and November 2021, we prospectively enrolled 83 patients with suspected AMI. Their urinary N-fragment titin, serum high-sensitivity troponin I (hsTnI), creatine kinase (CK), and creatine kinase-MB (CK-MB) were measured on admission. Then, urinary titin was assessed as diagnostic and prognostic biomarker in AMI. Among 83 enrolled patients, 51 patients were diagnosed as AMI. In AMI patients who were admitted as early as 3 h or longer after symptom onset, their urinary titin levels were significantly higher than non-AMI patients who are also admitted 3 h or longer after symptom onset (12.76 [IQR 5.87-16.68] pmol/mgCr (creatinine) and 5.13 [IQR 3.93-11.25] pmol/mgCr, p = 0.045, respectively). Moreover, the urinary titin levels in patients who died during hospitalization were incredibly higher than in those who were discharged (15.90 [IQR 13.46-22.61] pmol/mgCr and 4.90 [IQR 3.55-11.95] pmol/mgCr, p = 0.023). Urinary N-fragment titin can be used as non-invasive early diagnostic biomarker in AMI. Furthermore, it associates with hospital discharge disposition, providing prognostic utility.
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Affiliation(s)
- Miharu Arase
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan (Y.A.); (J.O.)
| | - Nobuto Nakanishi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan (Y.A.); (J.O.)
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan
| | - Rie Tsutsumi
- Department of Nutrition and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Ayuka Kawakami
- Department of Nutrition and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Yuta Arai
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan (Y.A.); (J.O.)
| | - Hiroshi Sakaue
- Department of Nutrition and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Jun Oto
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan (Y.A.); (J.O.)
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Li Y, Li D, Zhao L, Xu T, Lv Q, He J, Wang Y, Zhang W. Prognostic significance of troponin increment after percutaneous coronary intervention: A retrospective study. Front Cardiovasc Med 2022; 9:833522. [PMID: 36110418 PMCID: PMC9468763 DOI: 10.3389/fcvm.2022.833522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prognostic significance of troponin elevation following percutaneous coronary intervention (PCI) remains debated. This study aimed to evaluate the association between different thresholds of post-PCI cardiac troponin I (cTnI) and mortality. Methods From January 2012 to July 2017, 5,218 consecutive patients undergoing elective PCI with pre-PCI cTnI < 99th percentile of the upper reference limit (URL) were included. Levels of cTnI were measured before PCI and every 8 h for 24 h after procedural. The outcomes were 3-year cardiac mortality. Results Patients had a mean age of 66.2 years, 27.6% were women, 67.0% had hypertension, and 26.2% had diabetes mellitus. During the 3 years of follow-up, cardiac death occurred in 0.86%, 1.46%, 1.69%, 2.36%, and 2.86% of patients with cTnI < 1, ≥ 1 to < 5, ≥ 5 to < 35, ≥ 35 to < 70, and ≥ 70 times URL. The cardiac mortality rate was moderately increased with higher peak cTnI values, but the Kaplan-Meier curve demonstrated no significant association between any increment of cTnI and either cardiac or non-cardiac mortality. Isolated cTnI increment of ≥ 5 × URL, ≥ 35 × URL, and ≥ 70 × URL was occurred in 1,379 (26.4%), 197 (3.8%), and 70 (1.3%) patients, respectively. In multivariate Cox regression analysis and Fine-Gray model, none of the above cTnI thresholds was significantly associated with an increased risk of cardiac death. Conclusion In patients who underwent elective PCI, post-PCI cTnI elevation is not independently associated with cardiac mortality.
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Affiliation(s)
- Ya Li
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Duanbin Li
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Liding Zhao
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Tian Xu
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Qingbo Lv
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Jialin He
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Yao Wang
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Wenbin Zhang
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
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Liu J, Tang L, Lu Q, Yu Y, Xu QG, Zhang S, Chen YX, Dai WJ, Li JC. Plasma Quantitative Lipid Profiles: Identification of CarnitineC18:1-OH, CarnitineC18:2-OH and FFA (20:1) as Novel Biomarkers for Pre-warning and Prognosis in Acute Myocardial Infarction. Front Cardiovasc Med 2022; 9:848840. [PMID: 35479277 PMCID: PMC9037999 DOI: 10.3389/fcvm.2022.848840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
This study was aimed to determine the association between potential plasma lipid biomarkers and early screening and prognosis of Acute myocardial infarction (AMI). In the present study, a total of 795 differentially expressed lipid metabolites were detected based on ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). Out of these metabolites, 25 lipid metabolites were identified which showed specifical expression in the AMI group compared with the healthy control (HC) group and unstable angina (UA) group. Then, we applied the least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) methods to obtain three lipid molecules, including CarnitineC18:1-OH, CarnitineC18:2-OH and FFA (20:1). The three lipid metabolites and the diagnostic model exhibited well predictive ability in discriminating between AMI patients and UA patients in both the discovery and validation sets with an area under the curve (AUC) of 0.9. Univariate and multivariate logistic regression analyses indicated that the three lipid metabolites may serve as potential biomarkers for diagnosing AMI. A subsequent 1-year follow-up analysis indicated that the three lipid biomarkers also had prominent performance in predicting re-admission of patients with AMI due to cardiovascular events. In summary, we used quantitative lipid technology to delineate the characteristics of lipid metabolism in patients with AMI, and identified potential early diagnosis biomarkers of AMI via machine learning approach.
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Affiliation(s)
- Jun Liu
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Liangqiu Tang
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Qiqi Lu
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Yi Yu
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
- The Central Laboratory, Yangjiang People's Hospital, Yangjiang, China
| | - Qiu-Gui Xu
- The Central Laboratory, Yangjiang People's Hospital, Yangjiang, China
| | - Shanqiang Zhang
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Yun-Xian Chen
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Wen-Jie Dai
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Ji-Cheng Li
- Medical Research Center and Department of Cardiology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
- The Central Laboratory, Yangjiang People's Hospital, Yangjiang, China
- Department of Histology and Embryology, Shaoguan University School of Medicine, Shaoguan, China
- Institute of Cell Biology, Zhejiang University, Hangzhou, China
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Zhang D, Zhao Z, Gao G, Xu H, Wang H, Liu S, Yin D, Feng L, Zhu C, Wang Y, Zhao Y, Yang Y, Gao R, Xu B, Dou K. Jailed Balloon Technique Is Superior to Jailed Wire Technique in Reducing the Rate of Side Branch Occlusion: Subgroup Analysis of the Conventional Versus Intentional StraTegy in Patients With High Risk PrEdiction of Side Branch OccLusion in Coronary Bifurcation InterVEntion Trial. Front Cardiovasc Med 2022; 9:814873. [PMID: 35433861 PMCID: PMC9008226 DOI: 10.3389/fcvm.2022.814873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveJailed balloon technique (JBT) is an active side branch (SB) protection strategy and is considered to be superior to the jailed wire technique (JWT) in reducing SB occlusion. However, no randomized trials have proved that. We aim to investigate whether JBT could decrease the SB occlusion rate.MethodsConventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (CIT-RESOLVE) (NCT02644434, registered on December 31, 2015) (https://clinicaltrials.gov) is a randomized trial that assessed the effects of different strategies on SB occlusion rate in patients with a high risk of SB occlusion. The present subgroup analysis enrolled bifurcation lesions (2 mm ≤ reference vessel diameter of SB < 2.5 mm) with Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation intervention (V-RESOLVE) score ≥ 12 points. The primary endpoint is SB occlusion. One-year clinical events were compared.ResultsA total of 284 subjects at 16 sites were randomly assigned to the JBT group (n = 143) or the JWT group (n = 141). The rate of SB occlusion (9.1 vs. 19.9%, p = 0.02) and periprocedural myocardial infarction (defined by WHO, 7 vs. 14.9%, p = 0.03) is significantly lower in the JBT group than in the JWT group. The JBT and JWT groups showed no significant differences in cardiac death (0.7 vs. 0.7%, p = 1), myocardial infarction (MI, 6.3 vs. 7.1%, p = 0.79), target lesion revascularization (TLR, 1.4 vs. 2.1%, p = 0.68), and major cardiac adverse events (MACE, a composite of all-cause death, MI, or TLR, 8.4 vs. 10.6%, p = 0.52) during a 1-year follow-up.ConclusionIn patients with a high risk of SB occlusion (V-RESOLVE score ≥ 12 points), JBT is superior to JWT in reducing SB occlusion. However, no significant differences were detected in 1-year MACE.
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Affiliation(s)
- Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyong Zhao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guofeng Gao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Xu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuai Liu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Feng
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenggang Zhu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Catheterization Laboratories, Fu Wai Hospital, Beijing, China
- *Correspondence: Bo Xu,
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Kefei Dou,
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Qin Q, Zheng B, Liu J, Zhang B, Chen M, Li J, Huo Y. Active Versus Conventional Side Branch Protection Strategy for Coronary Bifurcation Lesions. Int Heart J 2021; 62:1241-1248. [PMID: 34789648 DOI: 10.1536/ihj.21-467] [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
The side branch (SB) provisional stenting strategy is currently the recommended approach for most coronary bifurcation lesions. However, this strategy may result in SB deterioration, which is associated with an increased incidence of periprocedural myocardial infarction (PMI) and may adversely affect the long-term prognosis. Various techniques for SB protection (SB-P) have been developed to reduce SB occlusion and improve the clinical prognosis. This meta-analysis was performed to compare the outcomes of an active SB-P strategy of jailed balloon technique, balloon-stent kissing technique, and jailed Corsair technique versus the conventional SB-P strategy based on jailed wire technique.This meta-analysis included 5 studies (4 randomized and 1 observational) involving a total of 1,174 patients in whom the active and conventional SB-P strategies were compared. Fixed- and random-effects models were used to calculate summary risk ratios (RRs).The risk of SB occlusion was significantly lower in active SB-P strategy [RR 0.47, 95% confidence interval (CI) 0.30-0.73 in fixed-effect model; RR 0.52, 95% CI 0.31-0.87 in random-effect model]. The risk of PMI was similar between the two strategies (RR 0.63, 95% CI 0.30-1.33 in fixed-effect model; RR 0.71, 95%CI 0.20-2.48 in random-effect model). The rate of long-term major adverse cardiovascular events was similar between the groups (RR 0.48, 95% CI 0.15-1.48 in fixed-effect model; RR 0.49, 95% CI 0.16-1.52 in random-effect model).The active SB-P strategy in coronary bifurcation lesions is associated with reduced SB deterioration, but it does not decrease PMI or improve the long-term prognosis.
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Affiliation(s)
- Qiao Qin
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Bo Zheng
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Jiahui Liu
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Bin Zhang
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Ming Chen
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Jianping Li
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Yong Huo
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
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Liu MJ, Chen CF, Gao XF, Liu XH, Xu YZ. Impact of periprocedural myocardial injury on long-term clinical outcomes of chronic total occlusion patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Coron Artery Dis 2021; 31:208-214. [PMID: 31703014 PMCID: PMC7147396 DOI: 10.1097/mca.0000000000000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Several studies have evaluated the long-term clinical outcomes of periprocedural myocardial injury for chronic total occlusions patients. However, the results of these studies were inconsistent. To determine whether the periprocedural myocardial injury has adverse effects on long-term clinical outcomes in chronic total occlusion patients undergoing percutaneous coronary intervention. Methods: We searched Cochrane Library, PubMed, and Embase for eligible articles from their date of inception up to March 2019. Long-term clinical outcomes included major adverse cardiac events, all-cause death, cardiac death, myocardial infarction, and target vessel revascularization. Odds ratios with 95% confidence intervals were calculated as summary statistics by using Review Manager software. Results: A total of 8 observational studies involving 5879 chronic total occlusions patients were included in this meta-analysis. These results of this meta-analysis indicated that periprocedural myocardial injury was associated with a higher risk of major adverse cardiac events (odds ratio, 1.94; 95% confidence interval, 1.22–3.08; P = 0.005), a higher risk of all-cause death (odds ratio, 1.30; 95% confidence interval, 1.02–1.64; P = 0.03), a higher risk of cardiac death (odds ratio, 2.59; 95% confidence interval, 1.41–4.78; P = 0.002), a higher risk of myocardial infarction (odds ratio, 3.07; 95% confidence interval, 1.90–4.98; P < 0.00001), and a higher risk of target vessel revascularization (odds ratio, 2.07; 95% confidence interval, 1.35–3.16; P=0.0008) than non-periprocedural myocardial injury. Conclusion: Periprocedural myocardial injury was associated with significantly increased risk of major adverse cardiac events, all-cause death, cardiac death, myocardial infarction, and target vessel revascularization in chronic total occlusion patients undergoing percutaneous coronary intervention at long-term follow-up.
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Affiliation(s)
- Mei-Jun Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Liu J, Zhang B, Chen M, Zheng B. High-dose statin pretreatment decreases periprocedural myocardial infarction and cardiovascular events in East Asian patients undergoing percutaneous coronary intervention: A meta-analysis of fifteen randomized controlled trials. Medicine (Baltimore) 2021; 100:e26278. [PMID: 34160392 PMCID: PMC8238325 DOI: 10.1097/md.0000000000026278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/18/2020] [Accepted: 05/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Numerous studies have shown that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and short-term major adverse cardiac events (MACE) in western people undergoing percutaneous coronary intervention (PCI). However, the effects in East Asian patients are still controversial. The objective was to evaluate the effects of short-term high-dose statin (all types) pretreatment compared with the control (low-dose or no statin) on the reduction of the rate of MACE and PMI in East Asian patients. METHODS PubMed/Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) in East Asian patients up to December 2019, in which short-term high-dose statin pretreatment was compared with control for patients undergoing PCI. The primary outcome measure was the incidence of MACE at 30 days. The secondary outcome measure was the incidence of PMI. The meta-analysis was performed with the fixed-effect model or random-effects model according to the heterogeneity. The meta-analysis was performed using RevMan 5.3 software (Cochrane Collaboration). RESULTS Fifteen RCTs that enrolled 4313 East Asian patients were identified. High-dose statin pretreatment was associated with a 54% relative reduction in 30-day MACE (OR, 0.46; 95% CI, 0.31-0.67; P < .001) and a 50% relative reduction in PMI (OR, 0.50; 95% CI, 0.34-0.76; P = .001). CONCLUSIONS High-dose statin pretreatment can significantly reduce 30-day MACE and PMI for East Asian patients undergoing PCI.
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He QY, Yu XY, Xiao Z, Sun X, Zhu WF, Yi XQ, Chen Q, Zhang JH, Chen SX, Zhou X, Nie HY, Shang HC, Chen XF. Comparison of the Efficacy of Danhong Injections at Different Time-points During the Perioperative Period of Acute Myocardial Infarction: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Front Pharmacol 2021; 12:643446. [PMID: 33995051 PMCID: PMC8117241 DOI: 10.3389/fphar.2021.643446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: Danhong injections (DHI) are widely used in the treatment of acute myocardial infarction (AMI). As there are no guidelines for the timing of DHI in the peri-percutaneous coronary intervention (PCI) period for AMI, we investigated the effects of DHI timing. Methods: We reviewed reports published before September 30, 2020 in PubMed, embase, the Cochrane Central Register of Controlled Trials, the Chinese BioMedical database, Chinese VIP database, Wanfang database, and Chinese National Knowledge Infrastructure database. Only randomized controlled trials of DHI with percutaneous coronary intervention for AMI were included. Methodological quality was assessed using the Cochrane evaluation manual 5.3.3 criteria. A meta-analysis was performed, and forest plots were drawn. Results: We included 23 studies which all revealed that patients in DHI groups had better efficacy than control groups. Subgroup analysis revealed that DHI administered intraoperatively and continued postoperatively was more effective in increasing left ventricular ejection fraction when compared to other time-points (p < 0.001). The pre- and intraoperative use of DHI could improve reflow more effectively than conventional treatment, while the effect was not significant in the postoperative intervention study (p = 0.654). The 16 postoperative interventions revealed that the effect of DHI at 14 days was better than that at 7 and 10 days for hs-CRP (p = 0.013), the 10-days treatment produced better results for CK-MB than for the other treatments (p < 0.001) and a dosage of 30 ml proved most effective for IL-6 (p < 0.001). Conclusion: DHI proved to be superior to conventional Western medicine in reducing the incidence of adverse cardiac events, promoting reperfusion, improving cardiac function, reducing inflammatory factors, and protecting the myocardium. DHI should be administered early in the perioperative period and continued postoperatively because of its ability to improve cardiac function. Furthermore, in the PCI postoperative, 30 ml is recommended to inhibit IL-6 levels, for patients with high hs-CRP, a course of 14 days is most effective, for patients with obvious abnormalities of CK-MB, a 10-days course of treatment is recommended. However, due to the limited number and quality of the original randomized controlled trials, our conclusions need large, multi-centre RCTs to validation.
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Affiliation(s)
- Qing-Ying He
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xin-Yu Yu
- Preventive Treatment Center, Hongdu Hospital of Traditional Chinese Medicine Affiliated to Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zheng Xiao
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Sun
- Chinese Evidence-based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Feng Zhu
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xing-Qian Yi
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Qian Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jia-Hui Zhang
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Shu-Xian Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xu Zhou
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - He-Yun Nie
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Hong-Cai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Fan Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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10
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Wang C, Chen W, Yu M, Yang P. Efficacy of Trimetazidine in Limiting Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology 2021; 72:511-523. [PMID: 33472383 DOI: 10.1177/0003319720987745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We systematically searched the literature to assess the efficacy of trimetazidine in reducing periprocedural myocardial injury and improving postoperative left ventricular ejection fraction (LVEF) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). An electronic search was conducted based on the PubMed, Ovid, Scopus, Springer, CENTRAL, and Google Scholar databases; 14 randomized controlled trials (RCTs) were included. Our meta-analysis showed a significant reduction in cardiac troponin I (cTnI) levels with trimetazidine compared with controls (P < .00001) but not in serum creatine kinase-myocardial band levels (P = .49). There were significantly reduced odds of ischemic ST-T segment changes with trimetazidine (P = .0.03) but lack of significant difference in the incidence of anginal attacks between the 2 groups (P = .10). Results also suggest significantly higher LVEF with trimetazidine compared with controls (P < .00001). Meta-regression analysis indicated no influence of duration of trimetazidine therapy on cTnI levels. The administration of preprocedure trimetazidine may have a role in reducing periprocedural myocardial injury in patients with CAD undergoing PCI. Evidence also suggests that postoperative trimetazidine may improve LVEF in the short term. Lack of high-quality trials and the heterogeneity of studies limit the ability of our analysis to draw strong conclusions. Further well-designed RCTs are required to supplement current evidence.
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Affiliation(s)
- Chang Wang
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin, P. R. China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, P. R. China
| | - Weiwei Chen
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin, P. R. China.,Jilin Provincial Cardiovascular Research Institute, Jilin, P. R. China
| | - Ming Yu
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, P. R. China.,Jilin Provincial Cardiovascular Research Institute, Jilin, P. R. China
| | - Ping Yang
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, P. R. China.,Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin, P. R. China
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11
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Bostan MM, Stătescu C, Anghel L, Șerban IL, Cojocaru E, Sascău R. Post-Myocardial Infarction Ventricular Remodeling Biomarkers-The Key Link between Pathophysiology and Clinic. Biomolecules 2020; 10:E1587. [PMID: 33238444 PMCID: PMC7700609 DOI: 10.3390/biom10111587] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
Studies in recent years have shown increased interest in developing new methods of evaluation, but also in limiting post infarction ventricular remodeling, hoping to improve ventricular function and the further evolution of the patient. This is the point where biomarkers have proven effective in early detection of remodeling phenomena. There are six main processes that promote the remodeling and each of them has specific biomarkers that can be used in predicting the evolution (myocardial necrosis, neurohormonal activation, inflammatory reaction, hypertrophy and fibrosis, apoptosis, mixed processes). Some of the biomarkers such as creatine kinase-myocardial band (CK-MB), troponin, and N-terminal-pro type B natriuretic peptide (NT-proBNP) were so convincing that they immediately found their place in the post infarction patient evaluation protocol. Others that are related to more complex processes such as inflammatory biomarkers, atheroma plaque destabilization biomarkers, and microRNA are still being studied, but the results so far are promising. This article aims to review the markers used so far, but also the existing data on new markers that could be considered, taking into consideration the most important studies that have been conducted so far.
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Affiliation(s)
- Maria-Madălina Bostan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
| | - Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
| | | | - Elena Cojocaru
- Department of Morphofunctional Sciences I—Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania;
| | - Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
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12
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Garcia-Garcia HM, McFadden EP, von Birgelen C, Rademaker-Havinga T, Spitzer E, Kleiman NS, Cohen DJ, Kennedy KF, Camenzind E, Mauri L, Steg PG, Wijns W, Silber S, van Es GA, Serruys PW, Windecker S, Cutlip D, Vranckx P. Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2020; 12:1954-1962. [PMID: 31601389 DOI: 10.1016/j.jcin.2019.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to explore the association between biomarker elevation, with creatine kinase-myocardial band (CK-MB) or cardiac troponin (cTn), following percutaneous coronary intervention (PCI) and mortality in patients undergoing PCI for stable angina with normal baseline values. BACKGROUND Several studies have shown a strong association between post-PCI CK-MB elevation and subsequent mortality. However, the prognostic significance of troponin elevation following coronary intervention is still debated. METHODS Patient-level data from 5 contemporary coronary stent trials and 1 large registry were pooled. Mortality of patients with stable angina, with normal baseline biomarkers, was compared between patients with and those without different cutoff values of cTn and CK-MB. RESULTS A total of 13,452 patients were included in this pooled analysis. The overall percentage of patients with elevated biomarkers following PCI was 23.9% for CK-MB and 68.4% for cTn. In the patient cohort for whom both assays were available (n = 8,859), 2.4% had both CK-MB ≥5 × the upper limit of normal (ULN) and cTn ≥35 × ULN, while 92% had both CK-MB <5 × ULN and cTn <35 × ULN. Among patients with CK-MB ≥5 × ULN (n = 315), 212 (67.3%) also had cTn ≥35 × ULN. Conversely, 390 of patients (64.8%) who had cTn ≥35 × ULN did not have CK-MB ≥5 × ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB ≥5 × ULN, and 23 (8.8%) had cTn ≥35 × ULN. In the Cox multivariate analysis, in which the CK-MB and cTn ratios post-procedure were forced into the model, age, prior myocardial infarction, lesion complexity, hyperlipidemia, and CK-MB ratio (≥10) post-procedure were associated with increased 1-year mortality. CONCLUSIONS Following elective PCI in patients in stable condition treated with second-generation drug-eluting stent, CK-MB and cTn elevations remain common. After multivariate adjustment, there was an increased mortality rate with elevation of CK-MB after PCI, whereas cTn elevation was not independently associated with mortality at 1 year.
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Affiliation(s)
- Hector M Garcia-Garcia
- Cardialysis, Rotterdam, the Netherlands; Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Neal S Kleiman
- Interventional Cardiology, Houston Methodist DeBakey, Houston, Texas
| | - David J Cohen
- Mid America Heart Institute, University of Missouri, Kansas City, Missouri
| | - Kevin F Kennedy
- Mid America Heart Institute, University of Missouri, Kansas City, Missouri
| | | | - Laura Mauri
- Division of Cardiovascular Medicine, Baim Institute for Clinical Research, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Philippe Gabriel Steg
- FACT, DHU FIRE, Département de Cardiologie, INSERM U-1148, Université Paris Diderot, Paris, France; National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, United Kingdom
| | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Sigmund Silber
- Department of Cardiology, Heart Centre at the Isar, Munich, Germany
| | | | - Patrick W Serruys
- Centre for International Cardiovascular Health, Imperial College London, London, United Kingdom
| | | | - Donald Cutlip
- Baim Institute for Clinical Research, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis & Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium
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13
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Zhou Y, Chen Z, Ma J, Chen A, Lu D, Wu Y, Ren D, Zhang C, Dai C, Zhang Y, Qian J, Ge J. Incidence, predictors and clinical significance of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention. J Cardiol 2020; 76:309-316. [DOI: 10.1016/j.jjcc.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 01/09/2023]
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14
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Dou K, Zhang D, Pan H, Guo N, Li L, Li Y, Zhang Q, Liu B, Shen Z, Zhang B, Liu J, Han W, Wang Y, Zhao Y, Yang Y, Chen S, Xie L, Guan C, Kirtane AJ, Xu B. Active SB-P Versus Conventional Approach to the Protection of High-Risk Side Branches: The CIT-RESOLVE Trial. JACC Cardiovasc Interv 2020; 13:1112-1122. [PMID: 32381188 DOI: 10.1016/j.jcin.2020.01.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether an active side branch protection (SB-P) strategy is superior to the conventional strategy in reducing side branch (SB) occlusion in high-risk bifurcation treatment. BACKGROUND Accurate prediction of SB occlusion after main vessel stenting followed by the use of specific strategies to prevent occlusion would be beneficial during bifurcation intervention. METHODS Eligible patients who had a bifurcation lesions with high risk for occlusion as determined using the validated V-RESOLVE (Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention) score were randomized to an active SB-P strategy group (elective 2-stent strategy for large SBs and jailed balloon technique for small SBs) or a conventional strategy group (provisional stenting for large SBs and jailed wire technique for small SBs) in a 1:1 ratio stratified by SB vessel size. The primary endpoint of SB occlusion was defined as an angiography core laboratory-assessed decrease in TIMI (Thrombolysis In Myocardial Infarction) flow grade or absence of flow in the SB immediately after full apposition of the main vessel stent to the vessel wall. RESULTS A total of 335 subjects at 16 sites were randomized to the SB-P group (n = 168) and conventional group (n = 167). Patients in the SB-P versus conventional strategy group had a significantly lower rate of SB occlusion (7.7% [13 of 168] vs. 18.0% [30 of 167]; risk difference: -9.1%; 95% confidence interval: -13.1% to -1.8%; p = 0.006), driven mainly by the difference in the small SB subgroup (jailed balloon technique vs. jailed wire technique: 8.1% vs. 18.5%; p = 0.01). CONCLUSIONS An active SB-P strategy is superior to a conventional strategy in reducing SB occlusion when treating high-risk bifurcation lesions. (Conventional Versus Intentional Strategy in Patients With High Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention [CIT-RESOLVE]; NCT02644434).
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Affiliation(s)
- Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China; Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
| | - Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China; Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hongwei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ning Guo
- Department of Cardiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lang Li
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Bin Liu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, China
| | - Zhujun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Jian Liu
- Departments of Cardiology, Peking University People's Hospital, Beijing, China
| | - Wei Han
- Department of Cardiology, the Third Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Beijing, China; Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lihua Xie
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Medical Center/NewYork-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, New York
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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15
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Li Y, Pei H, Bulluck H, Zhou C, Hausenloy DJ. Periprocedural elevated myocardial biomarkers and clinical outcomes following elective percutaneous coronary intervention: a comprehensive dose-response meta-analysis of 44,972 patients from 24 prospective studies. EUROINTERVENTION 2020; 15:1444-1450. [PMID: 31829942 DOI: 10.4244/eij-d-19-00737] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The optimal cut-off value of isolated cardiac biomarker elevation for defining prognostically important percutaneous coronary intervention (PCI)-related myocardial injury is not known. We performed a meta-analysis to evaluate the dose-response relationship between isolated cardiac biomarker elevations and the risk of all-cause mortality following elective PCI. METHODS AND RESULTS Twenty-four prospective studies (44,972 patients) were included. Patients with an isolated elevation of cardiac biomarkers had an increased risk of all-cause mortality when compared to those with no elevations (cardiac troponin I: odds ratio [OR] 1.42, 95% confidence interval [CI]: 1.19-1.69; creatine kinase-MB isoenzyme [CK-MB]: OR 1.43, 95% CI: 1.19-1.70). For the dose-response analysis, elevations of cardiac troponin I >3x or CK-MB >1x the 99th percentile upper reference limit (URL) were associated with increased mortality (cardiac troponin I: OR 1.51, 95% CI: 1.05-2.17; CK-MB: OR 1.25, 95% CI: 1.05-1.48). The pooled OR of mortality for each 3xURL increment of cardiac troponin I or CK-MB was 1.33 (95% CI: 1.15-1.53) and 1.38 (95% CI: 1.30-1.47). CONCLUSIONS We found that a positive dose-response relationship between isolated cardiac troponin I and CK-MB with all-cause mortality and elevated cardiac troponin I >3x or CK-MB >1x the 99th percentile URL was associated with an increased risk of mortality.
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Affiliation(s)
- Yuehua Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Gaido L, D’Ascenzo F, Imori Y, Wojakowski W, Saglietto A, Figini F, Mattesini A, Trabattoni D, Rognoni A, Tomassini F, Bernardi A, Ryan N, Muscoli S, Helft G, De Filippo O, Parma R, De Luca L, Ugo F, Cerrato E, Montefusco A, Pennacchi M, Wańha W, Smolka G, de Lio G, Bruno F, Huczek Z, Boccuzzi G, Cortese B, Capodanno D, Omedè P, Mancone M, Nuñez-Gil I, Romeo F, Varbella F, Rinaldi M, Escaned J, Conrotto F, Burzotta F, Chieffo A, Perl L, D’Amico M, di Mario C, Sheiban I, Gagnor A, Giammaria M, De Ferrari GM. Impact of Kissing Balloon in Patients Treated With Ultrathin Stents for Left Main Lesions and Bifurcations. Circ Cardiovasc Interv 2020; 13:e008325. [DOI: 10.1161/circinterventions.119.008325] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background:
There are limited data regarding the impact of final kissing balloon (FKI) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations.
Methods:
All patients undergoing left main or bifurcations percutaneous coronary intervention enrolled in the RAIN registry (Very Thin Stents for Patients With MAIN or BiF in Real Life: The RAIN, a Multicenter Study) evaluating ultrathin stents were included. Major adverse cardiac event (a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) was the primary end point, while its components, along with target vessel revascularization, were the secondary end points. The main analysis was performed comparing patients with and without FKI after adjustment with inverse probability of treatment weighting. Subgroup analyses were performed according to FKI (short [<3 mm] versus long overlap), strategy (provisional versus 2-stent), routine versus bail-out FKI, and the use of imaging and proximal optimization technique.
Results:
Two thousand seven hundred forty-two patients were included. At 16 months (8–20) follow-up, inverse probability of treatment weighting adjusted rates of major adverse cardiac event were similar between FKI and no-FKI group (15.1% versus 15.5%;
P
=0.967), this result did not change with use of imaging, proximal optimization technique, or routine versus bail-out FKI. In the 2-stent subgroup, FKI was associated with lower rates of target vessel revascularization (7.8% versus 15.9%;
P
=0.030) and target lesion revascularization (7.3% versus 15.2%;
P
=0.032). Short overlap FKI was associated with a lower rate of target lesion revascularization compared with no FKI (2.6% versus 5.4%;
P
=0.034), while long overlap was not (6.8% versus 5.4%;
P
=0.567).
Conclusions:
In patients with bifurcations or unprotected left main treated with ultrathin stents, short overlap FKI is associated with less restenosis. In a 2-stent strategy, FKI was associated with less target vessel revascularization and restenosis.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03544294.
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Affiliation(s)
- Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Turin (L.G., A.G., M.G.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan (Y.I.)
| | - Wojciech Wojakowski
- Department of Cardiology, Medical University of Silesia, Katowice, Poland (W. Wojakowski, W. Wańha, G.S.)
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Filippo Figini
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (A. Mattesini, C.d.M.)
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, University of Milan, Italy (D.T.)
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della Carità, Novara, Italy (A.R.)
| | - Francesco Tomassini
- Department of Cardiology, Infermi Hospital, Rivoli, Italy (F.T., E.C., F.V.)
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy (F.T., E.C., F.V.)
| | - Alessandro Bernardi
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy (A.B., F.U., G.B.)
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain (N.R., I.N.-G., J.E.)
| | - Saverio Muscoli
- Department of Medicine, Università degli Studi di Roma ‘Tor Vergata’, Rome, Italy (S.M., F.R.)
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France (G.H.)
| | | | - Radoslaw Parma
- University Clinical Hospital, Warsaw, Poland (R.P., Z.H.)
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy (L.D.L., M.P.)
| | - Fabrizio Ugo
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy (A.B., F.U., G.B.)
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy (F.T., E.C., F.V.)
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy (F.T., E.C., F.V.)
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Mauro Pennacchi
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy (L.D.L., M.P.)
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland (W. Wojakowski, W. Wańha, G.S.)
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland (W. Wojakowski, W. Wańha, G.S.)
| | - Giulia de Lio
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Zenon Huczek
- University Clinical Hospital, Warsaw, Poland (R.P., Z.H.)
| | - Giacomo Boccuzzi
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy (A.B., F.U., G.B.)
| | | | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria “Policlinico-Vittorio Emanuele,” Catania, Italy (D.C.)
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Massimo Mancone
- Università degli Studi di ROMA “La Sapienza” (M.M.), Lazio, Italia
| | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain (N.R., I.N.-G., J.E.)
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma ‘Tor Vergata’, Rome, Italy (S.M., F.R.)
| | - Ferdiando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy (F.T., E.C., F.V.)
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy (F.T., E.C., F.V.)
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain (N.R., I.N.-G., J.E.)
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | | | | | - Leor Perl
- Rabin Medical Center, Department of Cardiology, Tel Aviv, Israel (L.P.)
| | - Maurizio D’Amico
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (A. Mattesini, C.d.M.)
| | - Imad Sheiban
- Pederzoli Hospital, Peschiera del Garda, Italy (I.S.)
| | - Andrea Gagnor
- Division of Cardiology, Ospedale Maria Vittoria, Turin (L.G., A.G., M.G.)
| | - Massimo Giammaria
- Division of Cardiology, Ospedale Maria Vittoria, Turin (L.G., A.G., M.G.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Science, Città della Salute e della Scienza, Turin (F.D., A.S., F.F., A. Montefusco, G.d.L., F.B., P.O., M.R., F.C., M.D., G.M.D.F.)
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17
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Koskinas KC, Ndrepepa G, Räber L, Karagiannis A, Kufner S, Zanchin T, Hieber J, Hunziker L, Mayer K, Byrne RA, Heg D, Windecker S, Kastrati A. Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions. Circ Cardiovasc Interv 2019; 11:e006752. [PMID: 30545257 DOI: 10.1161/circinterventions.118.006752] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions. METHODS AND RESULTS We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin. CONCLUSIONS In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.
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Affiliation(s)
- Konstantinos C Koskinas
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Lorenz Räber
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Alexios Karagiannis
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland (A.K., D.H.)
| | - Sebastian Kufner
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Thomas Zanchin
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Julia Hieber
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Lukas Hunziker
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Katharina Mayer
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Robert A Byrne
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (R.A.B., A.K.)
| | - Dik Heg
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland (A.K., D.H.)
| | - Stephan Windecker
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Adnan Kastrati
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (R.A.B., A.K.)
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18
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Curcumin for the prevention of myocardial injury following elective percutaneous coronary intervention; a pilot randomized clinical trial. Eur J Pharmacol 2019; 858:172471. [PMID: 31228455 DOI: 10.1016/j.ejphar.2019.172471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023]
Abstract
Due to the potential benefits of curcumin in the ischemic heart disease, this study was performed to evaluate whether pretreatment with curcumin may reduce myocardial injury following elective percutaneous coronary intervention (PCI). A randomized clinical trial was performed on 110 patients undergoing elective PCI. The intervention group (n = 55) received a single dose of 480 mg nanomicelle curcumin orally and the standard treatment before PCI, while the control group (n = 55) received only the standard treatment., Serum concentrations of CK-MB and troponin I was measured before, 8 and 24 h after the procedure to assess myocardial damage during PCI. The results showed that the raise of CK-MB in curcumin group was half of the control group (4 vs. 8 cases) but was not significant. There were no significant differences in CK-MB levels at 8 (P = .24) and 24 h (P = .37) after PCI between the curcumin and the control group. No significant difference was also found in troponin I levels at 8 (P = 1.0) and 24 h (P = .35) after PCI between the groups. This study did not support the potential cardioprotective benefit of curcumin against pre-procedural myocardial injury in patients undergoing elective PCI.
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19
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Toma A, Stähli BE, Gebhard C, Gick M, Minners J, Mashayekhi K, Avran A, Ferenc M, Buettner HJ, Neumann FJ. Clinical implications of periprocedural myocardial injury in patients undergoing percutaneous coronary intervention for chronic total occlusion: role of antegrade and retrograde crossing techniques. EUROINTERVENTION 2019; 13:2051-2059. [PMID: 28943496 DOI: 10.4244/eij-d-17-00338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Periprocedural myocardial injury (PMI) is frequently observed after percutaneous coronary interventions (PCI) for chronic total occlusion (CTO). We aimed to investigate the prognostic impact of PMI with the antegrade as compared to the retrograde crossing technique. METHODS AND RESULTS A total of 1,909 patients undergoing CTO PCI were stratified according to the presence/absence of PMI (elevation of cardiac troponin T [cTnT] >5x99th percentile of normal), and divided according to tertiles of the difference between peak and baseline cTnT within 24 hours (∆cTnT). The primary endpoint was all-cause mortality at a median follow-up of 3.1 (interquartile range 3.0-4.4) years. PMI occurred in 19.4% and 25.4% after antegrade (n=1,447) and retrograde (n=462) procedures (p<0.001). PMI was significantly associated with mortality after antegrade (adjusted HR 1.39, 95% CI: 1.02-1.88, p=0.04), but not retrograde CTO PCI (adjusted HR 0.93, 95% CI: 0.53-1.63, p=0.80, pint=0.02). With the antegrade, but not with the retrograde approach, mortality also increased with tertiles of ∆cTnT (T1: 11.0%, T2: 18.6%, T3: 21.6%, log-rank p<0.001). CONCLUSIONS Periprocedural myocardial injury was significantly associated with all-cause mortality following antegrade, but not retrograde CTO PCI. Hence, the higher risk of PMI following retrograde procedures did not translate into worse survival.
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Affiliation(s)
- Aurel Toma
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
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20
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Phrommintikul A, Chanchai R, Wongcharoen W. Effects of Curcuminoids on Myocardial Injury After Percutaneous Coronary Intervention. J Med Food 2019; 22:680-684. [PMID: 31045465 DOI: 10.1089/jmf.2018.4321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The rise of cardiac troponin post-percutaneous coronary intervention (PCI) is associated with a high risk of long-term cardiovascular events. Previous studies have shown that curcuminoids decreased myocardial injury post-coronary bypass graft surgery through anti-oxidant and anti-inflammatory effects. We sought to examine whether curcuminoids could prevent PCI-related myocardial injury. One-hundred enrolled patients receiving elective PCI were randomized to obtain curcuminoids or placebo 4 g/day at least 1 day before and after the scheduled PCI. Cardiac troponin-T and 12-lead electrocardiogram were evaluated before PCI and at 24 and 48 h post-PCI. The definitions of PCI-related myocardial injury and myocardial infarction were in line with the third universal definition of myocardial infarction. Baseline characteristics of patients and procedures did not differ between the curcuminoids and placebo groups. The mean age was 63.9 ± 10.8 years. The incidence of PCI-related myocardial injury was not different between curcuminoids and placebo groups (32% vs. 38%, P = .675). The peak high-sensitive cardiac troponin T levels after PCI were not different between the curcuminoids and placebo groups (201.0 ± 547.0 ng/L vs. 187.0 ± 703.9 ng/L respectively, P = .912). Further, the high-sensitive C-reactive protein levels post-PCI were similar in patients receiving curcuminoids and placebo (7.2 ± 18.8 mg/dL vs. 6.6 ± 17.5 mg/dL, respectively, P = .873). We found that short-term treatment with curcuminoids did not reduce the occurrence of PCI-related myocardial injury. We did not observe the role of anti-oxidative and anti-inflammatory effects of curcuminoids in the PCI-related myocardial injury.
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Affiliation(s)
- Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rattanachai Chanchai
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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21
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Abstract
"Periprocedural myocardial infarction (MI) occurs infrequently in the current era of percutaneous coronary interventions (PCI) and is associated with an increased risk of mortality and morbidity. Periprocedural MI can occur due to acute side branch occlusion, distal embolization, slow flow or no reflow phenomenon, abrupt vessel closure, and nonidentifiable mechanical processes. Therapeutic strategies to reduce the risk of periprocedural MI include dual antiplatelet therapy, intravenous cangrelor in the periprocedural setting, intravenous glycoprotein IIb/IIIa inhibitor in high-risk patients, anticoagulation with unfractionated heparin, low-molecular-weight heparin or bivalirudin, and embolic protection devices during saphenous vein graft interventions."
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Affiliation(s)
- David W Lee
- Division of Interventional Cardiology, University of North Carolina, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599, USA.
| | - Matthew A Cavender
- Division of Interventional Cardiology, University of North Carolina, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599, USA
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22
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Saritas T, Greber R, Venema B, Puelles VG, Ernst S, Blazek V, Floege J, Leonhardt S, Schlieper G. Non-invasive evaluation of coronary heart disease in patients with chronic kidney disease using photoplethysmography. Clin Kidney J 2019; 12:538-545. [PMID: 31384446 PMCID: PMC6671527 DOI: 10.1093/ckj/sfy135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background Chronic kidney disease (CKD) patients have an increased risk for coronary artery disease (CAD) and myocardial infarction. Therefore, there is a need to identify CKD patients at high risk of CAD. Coronary angiography, the gold standard for detecting CAD, carries a risk of serious adverse events. Methods Here, we assessed the validity of a novel non-invasive reflectance mode photoplethysmography (PPG) sensor for the evaluation of CAD in patients with advanced CKD. PPG signals were generated using green and infrared wavelengths and recorded from fingers of 98 patients. The detected signal has the shape of the pulse wave contour carrying information about the vascular system, that is, arterial stiffness. We studied four patient groups: (i) controls—patients without CKD or CAD; (ii) CKD alone; (iii) CAD alone (confirmed by coronary angiography); and (iv) CKD and CAD combined. Results With advancing age, we observed a steeper ascending signal during systole and greater signal decline during diastole (infrared wavelength: Slopes 4–6, P = 0.002, P = 0.003 and P = 0.014, respectively; green wavelength: Slopes 2–3, P = 0.006 and P = 0.005, respectively). Presence of CAD was associated with a slower signal decline during diastole in CKD patients compared with those without CAD (infrared wavelength: Slope 1, P = 0.012). CKD was associated with lower blood volume amplitude during each cardiac cycle compared with those without CKD (R-value, P = 0.022). Conclusions PPG signal analyses showed significant differences between our groups, and it may be a potentially useful tool for the detection of CAD in CKD patients.
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Affiliation(s)
- Turgay Saritas
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany
| | - Ruth Greber
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany
| | - Boudewijn Venema
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Victor G Puelles
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany.,Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia.,III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Ernst
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany
| | - Vladimir Blazek
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany
| | - Steffen Leonhardt
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Georg Schlieper
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Germany.,Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
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23
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Tanaka H, Ohya M, Kubo S, Miura K, Otsuru S, Habara S, Tada T, Fuku Y, Goto T, Kadota K. Impact of retrograde approach on long-term clinical outcomes of patients undergoing coronary chronic total occlusion interventions. EUROINTERVENTION 2018; 14:e1183-e1191. [DOI: 10.4244/eij-d-18-00534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Kazmi DH, Kapoor A, Sinha A, Ambesh P, Kashyap S, Khanna R, Kumar S, Garg N, Tewari S, Goel PK. Role of metabolic manipulator trimetazidine in limiting percutaneous coronary intervention-induced myocardial injury. Indian Heart J 2018; 70 Suppl 3:S365-S371. [PMID: 30595291 PMCID: PMC6309873 DOI: 10.1016/j.ihj.2018.10.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Trimetazidine (TMZ) is a metabolic modulator that shifts substrate utilization from fatty acid to carbohydrates, thereby, increasing myocardial glucose oxidation and improving myocardial ischemia. We evaluated whether TMZ is effective in reducing myocardial injury after percutaneous coronary intervention (PCI). METHODS Patients with stable angina undergoing elective PCI were divided into two groups, one who received oral TMZ (35 mg BD) started 7 days before PCI (n = 48) and second who did not receive any TMZ (in addition to the standard therapy (n = 52)). Troponin-I (cTnI) and creatine kinase-MB (CK-MB) were measured before, 8, and 24 h after PCI. The primary end point was a difference in post-PCI cTnI and CK-MB levels (vs baseline). Frequency of cTnI release in the two groups, total amount of cTnI release, and difference in TIMI flow grade before and after the procedure were also assessed. RESULTS Baseline demographics in the groups were comparable. Despite similar baseline levels, post-procedural cTnI was lower at 8 h (0.13 vs 0.56 ng/ml, p = 0.03) and 24 h (0.2 vs 1.13 ng/ml, p = 0.004) in the TMZ group. Decline or no change in cTnI was significantly more common in the TMZ group (26% vs 2%, p < 0.01). Total cTnI released after PCI, as assessed by area under curve was significantly lower in the TMZ group (15.84 vs 3.32 ng h/ml, p = 0.005). Although CK-MB levels were also lower in the TMZ group, the difference was not statistically significant. Incidence of post-PCI TIMI 1 or 2 flow was significantly lesser in the TMZ group. CONCLUSIONS Oral TMZ started 7 days before PCI was effective in limiting PCI-induced myocardial injury with lower cTnI levels and higher prevalence of TIMI-3 flow.
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Affiliation(s)
| | | | | | - Paurush Ambesh
- Dietetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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25
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Choi HJ, Kim MC, Sim DS, Hong YJ, Kim JH, Jeong MH, Kim SH, Shin MG, Ahn Y. Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction. Ann Lab Med 2018; 38:538-544. [PMID: 30027697 PMCID: PMC6056391 DOI: 10.3343/alm.2018.38.6.538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/16/2018] [Accepted: 05/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. METHODS A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. RESULTS MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P=0.005). CONCLUSIONS A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.
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Affiliation(s)
- Hyun Jung Choi
- Departments of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Hyun Kim
- Departments of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Myung Geun Shin
- Departments of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
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26
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Association between changes in platelet reactivity during elective percutaneous coronary intervention and periprocedural myocardial infarction: A pilot study. J Cardiol 2018; 73:134-141. [PMID: 30201315 DOI: 10.1016/j.jjcc.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND High platelet reactivity before percutaneous coronary intervention (PCI) reportedly increases the risk of PCI-related myocardial infarction (PMI) following elective PCI. We conducted a pilot study to evaluate changes in platelet reactivity during PCI and their association with the incidence of PMI. METHODS In total, 133 consecutive patients undergoing elective PCI after pretreatment with dual antiplatelet therapy for at least 7 days were prospectively enrolled. Platelet reactivity was measured by the VerifyNow® assay (International Technidyne Corporation, Edison, NJ, USA) immediately before and after PCI. RESULTS Platelet reactivity significantly increased from 177.3 ± 53.4 P2Y12 reaction units (PRU) before PCI to 203.4 ± 52.8 PRU immediately after PCI (p < 0.001). Absolute changes in platelet reactivity were significantly greater in patients with than without PMI (32.4 ± 29.0 vs. 21.2 ± 24.8 PRU, respectively; p = 0.021). In the multivariable logistic regression analysis, the absolute change in PRU was an independent predictor of the incidence of PMI. Receiver operating characteristic curve analysis of the change in PRU during PCI for discriminating PMI showed a sensitivity, specificity, and the cut-off value of 46%, 76%, and 37 PRU, respectively (area under the curve = 0.607, p = 0.0235). When the patients were divided into two groups, namely a greater (change in PRU ≥ 37) and smaller (change in PRU < 37) increase group, the incidence rate of PMI was significantly higher in the greater than smaller increase group (59.1% vs. 34.8%, respectively; p = 0.008). Additional exploratory analyses by intracoronary imaging demonstrated that the proximal reference lumen area in the greater increase group was significantly smaller than that in the smaller increase group (6.5 ± 2.4 vs. 7.7 ± 3.1 mm2, respectively; p = 0.032). CONCLUSION An increase in platelet reactivity after elective PCI is possibly associated with PMI. This finding should be validated by a larger-scale study.
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Impact of paclitaxel-coated balloon versus newer-generation drug-eluting stent on periprocedural myocardial infarction in stable angina patients. Coron Artery Dis 2018; 29:403-408. [DOI: 10.1097/mca.0000000000000620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kallistratos MS, Poulimenos LE, Giannitsi S, Tsinivizov P, Manolis AJ. Trimetazidine in the Prevention of Tissue Ischemic Conditions. Angiology 2018; 70:291-298. [PMID: 29888611 DOI: 10.1177/0003319718780551] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trimetazidine (TMZ) is a metabolic agent with significant anti-ischemic properties. By inhibiting the terminal enzyme in the β-oxidation pathway, it shifts the energy substrate metabolism, enhancing glucose metabolism. Thus, it maintains the required energy production with less oxygen consumption, an effect necessary in cases of myocardi. Trimetazidine was recently reaccredited as add-on therapy for symptomatic treatment in patients with stable angina, not adequately controlled or intolerant to first-line therapy. Trimetazidine was included in the European Society of Cardioloy 2013 guidelines for the management of stable coronary artery disease. Although TMZ has been used in cardiology for >40 years, only a few studies have assessed its effects in patients with acute ischemic conditions. This review summarizes the current literature regarding the addition of TMZ in patients with acute ischemic conditions (acute myocardial infarction, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting). There is growing evidence from recent studies that the addition of TMZ in patients with such conditions is beneficial in terms of myocardial damage and major cardiac events as well as decreasing reperfusion injury and contrast-induced nephropathy.
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Affiliation(s)
| | | | - Sofia Giannitsi
- 1 Cardiology Department, Asklepieion General Hospital, Athens, Greece
| | - Pavlos Tsinivizov
- 1 Cardiology Department, Asklepieion General Hospital, Athens, Greece
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Reklou A, Doumas M, Imprialos K, Stavropoulos K, Patoulias D, Athyros VG. Reduction of Vascular Inflammation, LDL-C, or Both for the Protection from Cardiovascular Events? Open Cardiovasc Med J 2018; 12:29-40. [PMID: 29785212 PMCID: PMC5897979 DOI: 10.2174/1874192401812010029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Low density lipoprotein cholesterol (LDL-C) and low grade arterial inflammation are key pathogenic factors for atherosclerosis and its manifestation, cardiovascular disease (CVD). OBJECTIVE In this narrative review we assessed if decreasing LDL-C levels or inflammation or both is more effective in reducing CVD events. RESULTS In the Scandinavian Simvastatin Survival Study (4S), all statin trials of the 90s' and the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) the benefit came from the LDL-C reduction. In the GREak and Atorvastatin Coronary heart disease Evaluation (GREACE), the Treating to New Targets (TNT), and the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trials both mechanisms in combination produced significant benefits. In the Atorvastatin for Reduction of MYocardial Damage during Angioplasty (ARMYDA) trials and the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) with a human antibody targeting IL-1β with no lipid lowering effect, the reduction in arterial inflammation played the only beneficial role because there was no change in lipids levels. CONCLUSION Both LDL-C and inflammation reduction are beneficial to the reduction of CVD risk. However, canakinumab is a very expensive drug that only induced a 15% reduction in CVD events, thus drastically reducing the possibility for it to be used in clinical practice. Besides, canakinumab is associated with increased infections, some fatal. A potent statin with anti-inflammatory effects is probably the best choice for the majority of those needing hypolipidaemic drug therapy.
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Affiliation(s)
- Andromachi Reklou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
- George Washington University, Washington, DC, USA
| | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitris Patoulias
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
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Connolly M, Shand J, Kinnin M, Menown I, Kurth MJ, Lamont J, Mc Eneaney D. Heart-type fatty acid-binding protein (H-FABP) and highly sensitive troponin T (hsTnT) as markers of myocardial injury and cardiovascular events in elective percutaneous coronary intervention (PCI). QJM 2018; 111:33-38. [PMID: 29040663 DOI: 10.1093/qjmed/hcx193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/INTRODUCTION Type 4a myocardial infarction (MI) occurs when myocardial injury is combined with either symptoms suggestive of myocardial ischaemia, new left bundle branch block, angiographic loss of patency of a major artery or imaging suggestive of new loss of myocardium. Myocardial injury is defined as a rise of >5 x 99th upper reference limit (URL) of 14 ng/l (i.e. >70 ng/l) for highly sensitive troponin T (hsTnT) at 6 h if hsTnT was normal at baseline or >20% rise from 0 to 6 h if hsTnT was >14 ng/l at baseline. AIM To assess the prognostic value of biomarkers of myocardial injury following elective percutaneous coronary intervention (PCI). DESIGN A cohort of 209 patients were included of whom 144 (68.9%) were male, mean age was 68.8 years, 28 (13.4%) were smokers, 31 (14.8%) were diabetic, 199 (95.2%) had hypercholesterolaemia and 138 (66.0%) had hypertension. METHODS We evaluated hsTnT, heart-type fatty acid-binding protein (H-FABP), troponin I (TnI), creatine kinase MB type (CKMB), myoglobin, glycogen phosphorylase BB (GPBB) and carbonic anhydrase III (CA III) at 0, 4, 6 and 24 h following elective PCI. Patients were followed up at 1 year to assess for major adverse clinical events (MACE). RESULTS Myocardial injury was observed in 37 (17.7%) patients. Median hsTnT/H-FABP at 4 h were most predictive. MACE was noted in 6 (2.9%) patients, 3 had type 4a MI post PCI, P = 0.036. DISCUSSION/CONCLUSIONS Median 4 h hsTnT/H-FABP were most predictive of myocardial injury following PCI. H-FABP and hsTnT were predictive of MACE.
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Affiliation(s)
- M Connolly
- Cardiovascular Research Unit, Craigavon Cardiac Centre, Craigavon Area Hospital, Southern Trust, N Ireland BT63 5QQ, UK
| | - J Shand
- Cardiovascular Research Unit, Craigavon Cardiac Centre, Craigavon Area Hospital, Southern Trust, N Ireland BT63 5QQ, UK
| | - M Kinnin
- Cardiovascular Research Unit, Craigavon Cardiac Centre, Craigavon Area Hospital, Southern Trust, N Ireland BT63 5QQ, UK
| | - I Menown
- Cardiovascular Research Unit, Craigavon Cardiac Centre, Craigavon Area Hospital, Southern Trust, N Ireland BT63 5QQ, UK
| | - M J Kurth
- Research and Development Department, Randox Laboratories Ltd, Crumlin, N Ireland BT29 4QY, UK
| | - J Lamont
- Research and Development Department, Randox Laboratories Ltd, Crumlin, N Ireland BT29 4QY, UK
| | - D Mc Eneaney
- Cardiovascular Research Unit, Craigavon Cardiac Centre, Craigavon Area Hospital, Southern Trust, N Ireland BT63 5QQ, UK
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Okuya Y, Saito Y, Kitahara H, Nakayama T, Fujimoto Y, Kobayashi Y. Intraluminal Intensity of Blood Speckle on Intravascular Ultrasound, a Novel Predictor of Periprocedural Myocardial Injury After Coronary Stenting. Am J Cardiol 2017; 120:1084-1089. [PMID: 28781024 DOI: 10.1016/j.amjcard.2017.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Abstract
The difference in the intraluminal intensity of blood speckle (IBS) on integrated backscatter-intravascular ultrasound (IB-IVUS) across a coronary artery stenosis (i.e., ΔIBS) has previously shown a negative correlation with fractional flow reserve, reflecting an impaired coronary blood flow. Periprocedural myocardial injury (PMI) after coronary stenting has also been associated with coronary circulatory dysfunction. The aim of this study was to investigate the relation between ΔIBS after coronary stenting and PMI. A total of 180 patients who underwent elective coronary stenting under IVUS guidance for a single lesion were included. Intraluminal IBS was measured using IB-IVUS in cross sections at the ostium of the target vessel and at the distal reference of the stent. ΔIBS was calculated as (distal IBS value) - (ostium IBS value). PMI was defined as an elevation of troponin I >5 times the 99th percentile upper reference limit (>0.45 ng/ml) within 24 hours after the procedure. The mean ΔIBS after coronary stenting was 6.52 ± 5.71. There was a significantly greater use of the rotational atherectomy, the number of stents, the total stent length, and ΔIBS in patients with PMI than those without. In the receiver operating characteristic curve analysis, ΔIBS significantly predicted PMI (area under the curve 0.64, best cut-off value 7.88, p = 0.001). Multiple logistic regression analysis determined that the total stent length, the use of rotational atherectomy, and ΔIBS were independent predictors of PMI. In conclusion, greater ΔIBS assessed by IB-IVUS was significantly associated with PMI after coronary stenting in patients with a stable coronary artery disease.
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Affiliation(s)
- Yoshiyuki Okuya
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Aslanabadi N, Jafaripor I, Sadeghi S, Hamishehkar H, Ghaffari S, Toluey M, Azizi H, Entezari-Maleki T. Effect of Vitamin D in the Prevention of Myocardial Injury Following Elective Percutaneous Coronary Intervention: A Pilot Randomized Clinical Trial. J Clin Pharmacol 2017; 58:144-151. [PMID: 28841229 DOI: 10.1002/jcph.989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/29/2017] [Indexed: 11/06/2022]
Abstract
Myocardial injury following elective percutaneous coronary intervention (PCI) occurs in about one-third of patients and is associated with mortality. Platelet aggregation, thrombosis formation, and inflammation are the main causes of cardiac injury during PCI. Vitamin D plays a key role in the cardiovascular system by exerting antiplatelet, anticoagulant, and anti-inflammatory properties. There is no published study that investigated the effect of vitamin D in the prevention of cardiac injury following elective PCI. In a randomized clinical trial, 99 patients admitted for elective PCI were randomized into vitamin D (n = 52) and control (n = 47) groups. The intervention group received 300 000 IU vitamin D orally 12 hours before PCI. The cardiac biomarkers were checked at baseline, 8 and 24 hours after PCI. hs-CRP was also measured at baseline and after 24 hours. The increase in CK-MB was documented in 20 patients (42%) in the control group and 18 patients (34.6%) in the intervention group (P = .417). Furthermore, the increase in cTnI occurred in 4 patients (8%) and 2 patients (3.3%) in the control and intervention groups, respectively (P = .419). No significant changes were noted in the level of cardiac biomarkers. In the vitamin D group, the mean difference in CK-MB between 8 and 24 hours was significantly lower (P = .048). The mean difference in hs-CRP was significantly lower in the vitamin D group (P = .045). This study could not show a clear effect of vitamin D in the prevention of cardiac injury during elective PCI. Further outcome-based studies are needed to describe the role of vitamin D in the prevention of periprocedural myocardial injury.
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Affiliation(s)
- Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Iraj Jafaripor
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Selda Sadeghi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Toluey
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Azizi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taher Entezari-Maleki
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Zeng RX, Li S, Zhang MZ, Li XL, Zhu CG, Guo YL, Zhang Y, Li JJ. Remnant cholesterol predicts periprocedural myocardial injury following percutaneous coronary intervention in poorly-controlled type 2 diabetes. J Cardiol 2017; 70:113-120. [PMID: 28209463 DOI: 10.1016/j.jjcc.2016.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/26/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Remnant cholesterol (RC) is receiving increasing attention regarding its relation to cardiovascular risk. Whether RC is associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in type 2 diabetes (T2D) is currently unknown. METHODS We prospectively enrolled 1182 consecutive T2D patients who were scheduled for PCI but with baseline normal preprocedural cardiac troponin I (cTnI). Patients were divided according to their glycemic control status: group A [glycated hemoglobin (HbA1c)<7%, n=563] and group B (HbA1c≥7%, n=619). PMI was evaluated by cTnI analysis within 24h. The associations of preprocedural RC and the RC to high-density lipoprotein cholesterol ratio (RC/HDL-C) with PMI were investigated. RESULTS The associations of RC and RC/HDL-C with PMI were observed in group B (both p<0.05) but not in group A (both p>0.05). Patients in group B, a 1-SD increase of RC produced 30% and 32% increased risk for postprocedural cTnI>3× upper limit of normal (ULN) and >5×ULN, respectively. The odds ratios for RC/HDL-C were the highest compared with any cholesterol fractions including total cholesterol (TC)/HDL-C, low density lipoprotein cholesterol (LDL-C)/HDL-C, nonHDL-C/HDL-C, and triglyceride/HDL-C with 1.43 [95% confidence interval (CI): 1.10-1.88] for >3× ULN and 1.49 (95% CI: 1.13-1.97) for >5× ULN. However, no such associations were found in group A. Furthermore, patients with RC >27.46mg/dL (third tertile) [RC≤14.15mg/dL (first tertile) as reference] were associated with a 1.57-fold and 2-fold increased risk for >3× ULN and >5× ULN in group B, respectively. CONCLUSIONS RC and RC/HDL-C might be valuable, independent predictors for PMI in poorly-controlled diabetic patients undergoing PCI.
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Affiliation(s)
- Rui-Xiang Zeng
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min-Zhou Zhang
- Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Zhang D, Li Y, Yin D, He Y, Chen C, Song C, Yan R, Zhu C, Xu B, Dou K. Risk stratification of periprocedural myocardial infarction after percutaneous coronary intervention: Analysis based on the SCAI definition. Catheter Cardiovasc Interv 2017; 89:534-540. [PMID: 28191726 DOI: 10.1002/ccd.26939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Dong Zhang
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Yiping Li
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Dong Yin
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Yuan He
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Changzhe Chen
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Chenxi Song
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Ruohua Yan
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Chen'gang Zhu
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Bo Xu
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Kefei Dou
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
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Aslanabadi N, Safaie N, Asgharzadeh Y, Houshmand F, Ghaffari S, Garjani A, Dousti S, Hamishehkar H, Entezari-Maleki T. The randomized clinical trial of coenzyme Q10 for the prevention of periprocedural myocardial injury following elective percutaneous coronary intervention. Cardiovasc Ther 2017; 34:254-60. [PMID: 27214383 DOI: 10.1111/1755-5922.12195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) is an important therapeutic concern with remaining some mortality and morbidity. To the best of our knowledge, there is no published study that investigates the potential benefit of CoQ10 in preventing PMI following elective PCI. METHODS In a randomized, clinical trial, 100 patients who scheduled for elective PCI were allocated in to the intervention (n=50) and control group (n=50). The intervention received a 300 mg loading dose CoQ10 12 hours before procedure. The level of CK-MB and troponin-I was measured before procedure, and 8 and 24 hours after. Furthermore, hs-CRP was measured at baseline and 24 hours after. All patients were assessed for the incidence of major adverse cardiac effects (MACEs) after 1 month. RESULTS The CK-MB elevation (above the upper limit normal) was occurred in 22% (n=11) of CoQ10 and 20% (n=10) of control (P=.806). The elevation of troponin-I was documented in 8% (n=4) of both groups. No significant change in the level of cardiac biomarkers was noted. However, the significant reduction in hs-CRP level was occurred in CoQ10 group (P=.032). CONCLUSION The results showed that pretreatment with 300 mg CoQ10 12 hours before procedure could not reduce PMI following elective PCI, however, significantly decreased hs-CRP.
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Affiliation(s)
- Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Safaie
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Asgharzadeh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Houshmand
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Garjani
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samaneh Dousti
- Department of Pediatrics, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taher Entezari-Maleki
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Her AY, Cho KI, Singh GB, Garg S, Kim YH, Koo BK, Shin ES. A Comparison of Peri-Procedural Myocardial Infarction between Paclitaxel-Coated Balloon and Drug-Eluting Stent on De Novo Coronary Lesions. Yonsei Med J 2017; 58:99-104. [PMID: 27873501 PMCID: PMC5122659 DOI: 10.3349/ymj.2017.58.1.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients. MATERIALS AND METHODS In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours after percutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT). RESULTS One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidence interval: 3.44-533.87, p=0.004). CONCLUSION Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES.
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Affiliation(s)
- Ae Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Gillian Balbir Singh
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Tricoci P. Consensus or Controversy?: Evolution of Criteria for Myocardial Infarction After Percutaneous Coronary Intervention. Clin Chem 2017; 63:82-90. [DOI: 10.1373/clinchem.2016.255208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/20/2016] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The definition and the clinical implications of myocardial infarction (MI) occurring in the setting of percutaneous coronary intervention have been subjects of unresolved controversy. As a result of the use of more sensitive diagnostic tools such as cardiac troponin, the expanding evidence, and the ensuing debate, the definition of procedural MI (pMI) has evolved, leading to several revisions, different proposed definitions, and lack of standardization in randomized clinical trials.
CONTENT
In this review, we will describe the key clinical data on cardiac biomarkers, creatine kinase isoenzyme MB and cTn, in the setting of percutaneous coronary intervention and the main issues that have lead to various consensus documents with a proposed definition of pMI. We will focus on the rationale of the current “Third Universal Definition of Myocardial Infarction” and of the alternative approach proposed by the Society for Cardiovascular Angiography and Interventions.
SUMMARY
The definition of pMI is an evolving field where the Third Universal MI definition represents the best attempt to date to incorporate available evidence along with scientific and clinical judgment into criteria to ensure adequate specificity in the diagnosis and the relevant prognostic significance, while trying to maintain sensitivity. Questions on the recommended criteria and their practical implementation remain, but the Third Universal definition document represents an important milestone toward a better standardization and enhanced consensus on the pMI definition.
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Affiliation(s)
- Pierluigi Tricoci
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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Stähli BE, Gebhard C, Duchatelle V, Cournoyer D, Petroni T, Tanguay JF, Robb S, Mann J, Guertin MC, Wright RS, L L'Allier P, Tardif JC. Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights From the SELECT-ACS Trial. J Am Heart Assoc 2016; 5:e004255. [PMID: 27852589 PMCID: PMC5210344 DOI: 10.1161/jaha.116.004255] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention for Non-ST-Segment Elevation Myocardial Infarction (SELECT-ACS) trial suggested beneficial effects of inclacumab, a monoclonal antibody directed against P-selectin, on periprocedural myocardial damage. This study evaluated the effect of inclacumab on myocardial damage according to varying time intervals between study drug infusion and percutaneous coronary intervention (PCI). METHODS AND RESULTS Patients (n=544) enrolled in the SELECT-ACS trial and randomized to receive 1 infusion of placebo or inclacumab (5 or 20 mg/kg, administered between 1 and 24 hours before PCI) were divided according to the time interval between study drug infusion and PCI. The primary end point was the change in troponin I from baseline at 16 and 24 hours after PCI. In patients receiving inclacumab 20 mg/kg with a short (less than median) time interval between infusion and PCI, placebo-adjusted geometric mean percent changes in troponin I, creatine kinase-myocardial band, and peak troponin I at 24 hours were -45.6% (P=0.005), -30.7% (P=0.01), and -37.3% (P=0.02), respectively. No significant changes were observed in patients with a long (greater than median) time interval between infusion and PCI. Placebo-adjusted geometric mean percent changes in troponin I and creatine kinase-myocardial band were -43.5% (P=0.02) and -26.0% (P=0.07), respectively, when inclacumab 20 mg/kg was administered between 1 and 3 hours before PCI, whereas the drug had no effect with longer intervals. CONCLUSIONS Inclacumab 20 mg/kg significantly reduces myocardial damage after PCI in patients with non-ST-segment elevation myocardial infarction, and benefits are larger when the infusion is administered <3 hours before PCI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01327183.
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Affiliation(s)
- Barbara E Stähli
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | | | - Daniel Cournoyer
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Thibaut Petroni
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
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Jin P, Zhou Q, Song S, Xu J, Zhang M, Zhu M, Kang M, Shi X, Shi J, Lu D, Li J. Elevated preoperative HMGB1 as predictor of myocardial injury post-percutaneous coronary intervention. Medicine (Baltimore) 2016; 95:e5149. [PMID: 27861339 PMCID: PMC5120896 DOI: 10.1097/md.0000000000005149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this study, we evaluated the impact of preoperative high mobility group box 1 (HMGB1) on myocardial injury post-percutaneous coronary intervention.We evaluated 302 consecutive patients who underwent percutaneous coronary intervention. They were divided into equal tertiles based on their preoperative HMGB1 levels. Creatine kinase-MB and troponin I levels were measured at baseline, 8- and 24-hours after the procedure, while clinical outcomes were followed up for 1 year.The occurrence of post-procedural myocardial injury was significantly higher in the tertile comprising of patients with elevated HMGB1 levels. Moreover, these patients showed significantly higher post-procedural peak values of creatine kinase-MB and troponin I in comparison to patients with lower HMGB1 levels. Event-free survival was significantly associated with HMGB1 levels, with worst event-free survival in patients with elevated HMGB1 levels.Elevated preoperative HMGB1 was a predictor of myocardial injury after percutaneous coronary intervention, and was associated with the worst clinical outcomes during 1-year follow up.
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Affiliation(s)
- Peng Jin
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Qi Zhou
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Shujiang Song
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Jinpeng Xu
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Minli Zhang
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Ming Zhu
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Meili Kang
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Xiangming Shi
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Junting Shi
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Di Lu
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Jing Li
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
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Frumkin K, Bloom AS. Ischemic Conditioning: Implications for Emergency Medicine. Ann Emerg Med 2016; 68:268-74. [DOI: 10.1016/j.annemergmed.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 01/22/2023]
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Jiao Y, Hu F, Zhang Z, Gong K, Sun X, Li A, Liu N. Efficacy and Safety of Loading-Dose Rosuvastatin Therapy in Elderly Patients with Acute Coronary Syndromes Undergoing Elective Percutaneous Coronary Intervention. Clin Drug Investig 2016; 35:777-84. [PMID: 26387028 DOI: 10.1007/s40261-015-0335-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this work was to investigate the efficacy and safety of loading-dose rosuvastatin therapy in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing elective percutaneous coronary intervention (PCI). METHODS A total of 126 patients (≥70 years old) with NSTEACS were randomly divided into two groups: (1) loading-dose rosuvastatin-treated group, treated with rosuvastatin 20 mg 12 h prior to PCI, with a second dose administered just before PCI (n = 62), and (2) control-treated group, treated with the standard method according to ACC/AHA guidelines in UAP/NSTEMI 2007 (n = 64). All patients were required to take rosuvastatin 10 mg once a day starting 24 h after the surgery irrespective of the initial randomization assignment. The serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLox-1), high-sensitivity C-reactive protein (hs-CRP), creatinine kinase (CK)-MB, cardiac troponin I (cTnI), and brain natriuretic peptide (BNP) levels were measured prior to PCI and at 24 h and 30 days after PCI in both groups. The left ventricular ejection fraction (LVEF) levels were recorded prior to PCI and 30 days after PCI in both groups. RESULTS Compared to pre-PCI, the serum sLox-1, hs-CRP, CK-MB, and cTnI levels were increased at 24 h after PCI (all p < 0.05) in both groups. However, the increased sLox-1, hs-CRP, CK-MB, and cTnI values were significantly lower in the loading-dose rosuvastatin-treated group than in the control-treated group (p < 0.05). In addition the serum sLox-1 and hs-CRP levels were lower in the loading-dose rosuvastatin-treated group than in the control-treated group at 30 days after PCI. However, the decreased values of sLox-1and hs-CRP from 24 h after PCI to 30 days after PCI did not show any significant difference between the two groups. No significant difference was found in the serum ALT and Scr levels between the two groups before and after PCI. Compared to the control-treated group, the serum BNP level decreased (p < 0.05) and LVEF (p < 0.05) increased in the loading-dose rosuvastatin-treated group at 30 days after PCI. CONCLUSION The loading-dose rosuvastatin therapy in elderly patients with non-ST-segment elevation acute coronary syndromes undergoing elective PCI can attenuate the increase in serum hs-CRP, sLox-1, CK-MB, and cTnI levels, reduce myocardial injury and inflammatory reaction caused by PCI, and improve the LVEF level at 30 days after PCI, ensuring an effective and safe therapy.
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Affiliation(s)
- Yungen Jiao
- Department of Cardiology, Institute of Cardiovascular Disease, Zhongda Hospital of Southeast University Medical School, Southeast University, Nanjing, 210000, China
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Feng Hu
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Zhengang Zhang
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Kaizheng Gong
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Xiaoning Sun
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Aihua Li
- Department of Cardiology, First People's Hospital of Yangzhou, The Second Clinical Medical School of Yangzhou University, Yangzhou, 225400, China
| | - Naifeng Liu
- Department of Cardiology, Institute of Cardiovascular Disease, Zhongda Hospital of Southeast University Medical School, Southeast University, Nanjing, 210000, China.
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Izgi A, Tanalp AC, Kirma C, Dundar C, Oduncu V, Akcakoyun M, Ozveren O, Mutlu B. Predictors and Prognostic Significance of Troponin-I Release following Elective Coronary Angioplasty. J Int Med Res 2016; 34:612-23. [PMID: 17294993 DOI: 10.1177/147323000603400606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to investigate the predictors and prognostic significance of post-procedural cardiac troponin (cTn)-I elevations in a consecutive series of patients who underwent elective percutaneous coronary intervention (PCI). cTn-I was measured in 100 patients immediately before and within 24 h after the elective PCI. Post-procedural cTn-I elevation was observed in 27 of the 100 patients. In multivariate analysis, basal haemoglobin values and the number of repeated balloon dilatations were found to be independent predictors of cTn-I elevation. During the follow-up period of 12 ± 1.2 months, the cTn-I-positive group had more major adverse cardiovascular events than the cTn-I-negative group (33.3% versus 16.4%, respectively), but the difference was not significant. An increase in cTn-I levels following elective PCI procedures was frequent but did not predict a poor long-term outcome.
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Affiliation(s)
- A Izgi
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Kartal, Istanbul, Turkey.
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Lam MK, Tandjung K, Sen H, Basalus MWZ, van Houwelingen KG, Stoel MG, Louwerenburg JW, Linssen GCM, Saïd SAM, Nienhuis MB, de Man FHAF, van der Palen J, von Birgelen C. Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial. EUROINTERVENTION 2016; 11:180-7. [PMID: 24602919 DOI: 10.4244/eijv11i2a32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To investigate the prognostic value of coronary dominance for various adverse clinical events following the implantation of drug-eluting stents. METHODS AND RESULTS We assessed two-year follow-up data of 1,387 patients from the randomised TWENTE trial. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left and non-left dominance (i.e., right and balanced). Target vessel-related myocardial infarction (MI) was defined according to the updated Academic Research Consortium (ARC) definition (2x upper reference limit of creatine kinase [CK], confirmed by CK-MB elevation), and periprocedural MI (PMI) as MI ≤48 hours following PCI. One hundred and thirty-six patients (9.8%) had left and 1,251 (90.2%) non-left dominance. Target lesions were more frequently located in dominant arteries (p<0.005). Left dominance was associated with more severe calcifications (p=0.006) and more bifurcation lesions (p=0.031). Non-left dominance tended to be less frequent in men (p=0.09). Left coronary dominance was associated with more target vessel-related MI (14 [10.3%] vs. 62 [5.0%], p=0.009). Left dominance independently predicted PMI (adjusted HR 2.19, 95% CI: 1.15-4.15, p=0.017), while no difference in other clinical endpoints was observed between dominance groups. CONCLUSIONS In the population of the TWENTE trial, we observed a higher incidence of periprocedural myocardial infarction in patients who had left coronary dominance.
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Affiliation(s)
- Ming Kai Lam
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Rise of serum troponin levels following uncomplicated elective percutaneous coronary interventions in patients without clinical and procedural signs suggestive of myocardial necrosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:41-8. [PMID: 26966448 PMCID: PMC4777705 DOI: 10.5114/pwki.2016.56948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The new definition of periprocedural myocardial infarction (type 4a MI) excludes patients without angina and electrocardiographic or echocardiographic changes suggestive of myocardial ischemia even though significant serum troponin elevations occur following percutaneous coronary intervention (PCI). AIM To evaluate the incidence and predictors of serum troponin rise following elective PCI in patients without clinical and procedural signs suggestive of myocardial necrosis by using a high-sensitivite troponin assay (hsTnT). MATERIAL AND METHODS Three hundred and four patients (mean age: 60.8 ±8.8 years, 204 male) undergoing elective PCI were enrolled. Patients with periprocedural angina, electrocardiographic or echocardiographic signs indicating myocardial ischemia or a visible procedural complication such as dissection or side branch occlusion were excluded. Mild-moderate periprocedural myocardial injury (PMI) and severe PMI were defined as post-PCI (12 h later) elevation of serum hsTnT concentrations to the range of 14-70 ng/l and > 70 ng/l, respectively. RESULTS The median pre-procedural hsTnT level was 9.7 ng/l (interquartile range: 7.1-12.2 ng/l). Serum hsTnT concentration elevated (p < 0.001) to 19.4 ng/l (IQR: 12.0-38.8 ng/l) 12 h after PCI. Mild-moderate PMI and severe PMI were detected in 49.3% and 12.2% of patients, respectively. Post-procedural hsTnT levels were significantly higher in multivessel PCI, overlapping stenting, predilatation and postdilatation subgroups. In addition, post-procedural hsTnT levels were correlated (r = 0.340; p < 0.001) with the stent lengths. CONCLUSIONS High-sensitivite troponin measurements indicate a high incidence of PMI even though no clinical or procedural signs suggestive of myocardial ischemia exist. Multivessel PCI, overlapping stenting, predilatation, postdilatation and longer stent length are associated with PMI following elective PCI.
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Jang WJ, Yang JH, Choi SH, Song YB, Hahn JY, Kim WS, Lee YT, Kim BS, Gwon HC. Association of periprocedural myocardial infarction with long-term survival in patients treated with coronary revascularization therapy of chronic total occlusion. Catheter Cardiovasc Interv 2015; 87:1042-9. [DOI: 10.1002/ccd.26286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/03/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine; Samsung Changwon Hospital, Sungkyunkwan University School of Medicine; Changwon Republic of Korea
| | - Jeong Hoon Yang
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Seung-Hyuk Choi
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Young Bin Song
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Joo-Yong Hahn
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Wook Sung Kim
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Young Tak Lee
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Bum-Sung Kim
- Division of Cardiology, Department of Medicine; Konkuk University Medical Center; Seoul Republic of Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
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Zhai C, Cong H, Liu Y, Zhang Y, Liu X, Zhang H, Ren Z. Effect of High-Dose Statin Pretreatment on the Incidence of Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention: Grading the Evidence Through a Cumulative Meta-analysis. Clin Cardiol 2015; 38:668-78. [PMID: 26442621 DOI: 10.1002/clc.22471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/30/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Previous studies have showed that high-dose statin pretreatment could reduce the incidence of periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI). However, previous analyses have not performed reliable grading of evidence. HYPOTHESIS In previous analyses, it supposed that the high-dose statin pretreatment was effective in reduction of the rate of PMI. In this analysis, we evaluated the effect of high-dose statin pretreatment on the reduction of rate of PMI based on a cumulative meta-analysis and grading of evidence. METHODS We assembled the relevant published randomized controlled trials that compared the efficacy of high-dose statin pretreatment prior to PCI. We evaluated the risk of PMI by a cumulative meta-analysis, with subgroups stratified by clinical classifications and different statin histories, and we conducted explicit grading of evidence. RESULTS High-dose statin pretreatment caused a 55% reduction in PMI through this cumulative meta-analysis of 23 RCTs (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.37-0.54). The effect of high-dose statin pretreatment was significant for the stable angina subgroup (OR: 0.42, 95% CI: 0.32-0.56), ACS subgroup (OR: 0.43, 95% CI: 0.29-0.64), and the mixed presentation subgroup (OR: 0.50, 95% CI: 0.36-0.70). In different statin therapy histories, high-dose statin pretreatment reduced incidence of PMI 55% in the statin-naive subgroup (OR: 0.45, 95% CI: 0.36-0.56) and 54% in the low-dose statin subgroup (OR: 0.46, 95% CI: 0.32-0.66). The GRADE system indicated that the overall evidence quality was moderate. This finding may strengthen the confidence in any recommendations. CONCLUSIONS High-dose statin pretreatment can reduce the rate of PMI, irrespective of either the clinical presentation or previous statin-treatment history. Importantly, the overall GRADE evidence quality was moderate.
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Affiliation(s)
- ChuanNan Zhai
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.,Department of Cardiology, Tianjin Gongan Hospital, Tianjin, China
| | - HongLiang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - YuJie Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ying Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - XianFeng Liu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - ZhiJing Ren
- Graduate School, Tianjin Medical University, Tianjin, China
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The influence of aortic valve calcification on the risk of periprocedural myocardial injury after elective coronary intervention. Aging Clin Exp Res 2015; 27:631-6. [PMID: 25739835 DOI: 10.1007/s40520-015-0336-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/12/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aortic valve calcification (AVC) is a common progressive condition that involves several inflammatory and atherosclerotic mediators. However, it is unclear whether the occurrence of periprocedural myocardial injury (PMI) after elective coronary intervention is associated with AVC in stable coronary artery disease (CAD) patients. METHODS A total of 530 stable CAD patients who underwent elective coronary intervention were enrolled in this clinical study. High sensitive cardiac troponin T (hs-cTnT) was detected before and after the procedure. PMI was defined as hs-cTnT after coronary intervention higher than 99th percentile upper reference limit (URL). All patients underwent echocardiography to detect the occurrence of AVC. Univariate and multivariate analyses were applied to analyze risk factors of PMI. RESULTS A total of 210 patients (39.6 %) were diagnosed with PMI after elective coronary intervention. Compared with non-AVC patients (n = 386), AVC patients (n = 144) had higher rate of PMI (64.6 vs. 30.3 %, P < 0.01). CAD patients with AVC had higher Gensini score (39.9 ± 26.6 vs. 34.2 ± 22.1, P < 0.05) and more number of implanted stents (1.7 ± 0.8 vs. 1.5 ± 0.7, P < 0.05). After stratification by classic risk factors of CAD (such as age, male gender and diabetes) in subgroup analyses, we found that AVC patients had increased risk of PMI compared with non-AVC patients. Importantly, even after being adjusted by multivariate analysis, AVC still independently increased the risk of PMI (OR = 3.329, 95 % CI = 2.087-5.308, P < 0.01). CONCLUSION AVC significantly increased the risk of PMI after elective coronary intervention. It could be one of the independent predictors for PMI in stable CAD patients.
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Xie W, Li P, Wang Z, Chen J, Lin Z, Liang X, Mo Y. Rosuvastatin may reduce the incidence of cardiovascular events in patients with acute coronary syndromes receiving percutaneous coronary intervention by suppressing miR-155/SHIP-1 signaling pathway. Cardiovasc Ther 2015; 32:276-82. [PMID: 25319951 DOI: 10.1111/1755-5922.12098] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The beneficial effect of rosuvastatin against percutaneous coronary intervention (PCI) related procedural myocardial injury has been determined mostly in patients with acute coronary syndromes (ACS). However, the detailed therapeutic mechanism has not been well studied. METHODS Patients with ACS receiving PCI (n = 159) were randomized to control group (placebo treatment) or to rosuvastatin group (20 mg 12 h before PCI, and a further 20 mg 2 h preprocedure dose). Levels of INF-γ, TNF-α, IL-6, miR-155/SHIP-1, and CD4(+)FoxP3(+)Treg in peripheral blood were detected before PCI and 24 h after PCI. Clinical data of these patients were also collected in this prospective study. RESULTS Compared with placebo, rosuvastatin treatment significantly reduced the incidence of periprocedural myocardial infarction (PMI) and levels of cardiac troponin I (cTnI) associated with decreased relative expression of serum miR-155, levels of inflammatory cytokines (INF-γ, TNF-α, and IL-6), increased SHIP-1 expression and CD4(+)FoxP3(+)Treg percentage values (P < 0.05). In addition, patients with rosuvastatin pretreatment also reduced incidence of 30 days major adverse cardiac events (MACE) compared to the patients with placebo treatment (16 patients vs. 28 patients, P = 0.038). CONCLUSIONS Our study suggests that high loading dose rosuvastatin pretreatment may reduce the incidence of cardiovascular events and levels of inflammatory markers in patients with ACS receiving PCI, which may be explained at least in part, by mechanism involving suppression of miR-155/SHIP-1 signaling pathway.
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Affiliation(s)
- Wenchao Xie
- Department of Cardiology, Yulin First People's Hospital, Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
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Paradis JM, Maniar HS, Lasala JM, Kodali S, Williams M, Lindman BR, Damiano RJ, Moon MR, Makkar RR, Thourani VH, Babaliaros V, Xu K, Ayele GM, Svensson L, Leon MB, Zajarias A. Clinical and Functional Outcomes Associated With Myocardial Injury After Transfemoral and Transapical Transcatheter Aortic Valve Replacement: A Subanalysis From the PARTNER Trial (Placement of Aortic Transcatheter Valves). JACC Cardiovasc Interv 2015; 8:1468-1479. [PMID: 26404200 PMCID: PMC4624400 DOI: 10.1016/j.jcin.2015.06.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to clarify the clinical and echocardiographic prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR). BACKGROUND The clinical significance of cardiac biomarker elevation after TAVR remains unclear. METHODS Patients treated with TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial were divided into tertiles (T1, T2, T3) based on the difference between the values on post-procedure day 1 and the baseline values of 2 cardiac biomarkers: cardiac troponin I (ΔcTnI); and creatine kinase-myocardial band (ΔCK-MB) fraction. Patients were stratified according to their access route: transfemoral (TF) (n = 1,840) or transapical (TA) (n = 1,173). RESULTS At 30 days after TF-TAVR, patients in the highest tertile (T3) of cardiac biomarker elevation had a higher rate of all-cause mortality (ΔcTnI: T3: 5.4% vs. T1: 0.5%, p = 0.006; ΔCK-MB: T3: 5.7% vs. T1: 0.9%, p = 0.006) and cardiovascular mortality (ΔcTnI: T3: 4.9% vs. T1: 0.5%, p = 0.01; ΔCK-MB: T3: 3.9% vs. T1: 0.5%, p = 0.02). At 1 year, only patients in the highest CK-MB tertile had higher rates of all-cause (25.4% vs. 16.8%, p = 0.02) and cardiovascular (10.3% vs. 5.0%) mortality. Multivariable analysis demonstrated that greater release of cardiac biomarkers was independently associated with increased mortality in the TF population. After TA-TAVR, being in the highest tertile of cardiac biomarker elevation had no influence on clinical and echocardiographic outcomes at 30 days and 1 year. CONCLUSIONS After TF-TAVR, a greater degree of myocardial injury was associated with higher rates of 30-day all-cause and cardiovascular mortality. At 1 year, being in the highest tertile of ΔCK-MB was correlated with a higher rate of all-cause and cardiac mortality. Finally, the level of myocardial injury after TA-TAVR had no impact on clinical and echocardiographic outcomes.
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Affiliation(s)
- Jean-Michel Paradis
- Quebec Heart and Lung Institute, Quebec, Canada; Cardiovascular Research Foundation, New York, New York.
| | - Hersh S Maniar
- Washington University School of Medicine, St Louis, Missouri
| | - John M Lasala
- Washington University School of Medicine, St Louis, Missouri
| | - Susheel Kodali
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Mathew Williams
- New York University Langone Medical Center, New York, New York
| | - Brian R Lindman
- Washington University School of Medicine, St Louis, Missouri
| | - Ralph J Damiano
- Washington University School of Medicine, St Louis, Missouri
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Missouri
| | - Raj R Makkar
- Cedars Sinai Heart Institute, Los Angeles, California
| | | | | | - Ke Xu
- Cardiovascular Research Foundation, New York, New York
| | | | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Alan Zajarias
- Washington University School of Medicine, St Louis, Missouri
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50
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Zeng RX, Li XL, Zhang MZ, Wang XW, Guo YL, Zhu CG, Ren Y, Li S, Zhang Y, Liu G, Xu RX, Dong Q, Li JJ. Preprocedural N-terminal pro-B-type natriuretic peptide as a useful marker for predicting periprocedural myocardial injury following percutaneous coronary intervention in diabetic patients without cardiac dysfunction. Scandinavian Journal of Clinical and Laboratory Investigation 2015. [PMID: 26203960 DOI: 10.3109/00365513.2015.1060518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Elevated preprocedural N-term pro-B-type natriuretic peptide (NT-pro-BNP) and postprocedural cardiac troponin I (cTnI) are related to a poor cardiac outcome in the non-diabetic population. We hypothesized that preprocedural NT-pro-BNP might be a useful marker in predicting periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) in type 2 diabetes (T2D). METHODS We prospectively enrolled 1194 consecutive diabetic patients with normal cardiac function and preprocedural cTnI who were successfully undergoing elective PCI. Preprocedural NT-pro-BNP levels were assessed at admission, and PMI was evaluated by analysis of cTnI within 24 hours. The relationship between preprocedural NT-pro-BNP levels and the peak values of cTnI after PCI was examined. RESULTS Patients with high baseline NT-pro-BNP levels had higher postprocedural cTnI levels (β = 0.123, p < 0.001). In the multivariable model, NT-pro-BNP was associated with higher risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN, OR, 3.13; 95% CI, 1.51-6.50; p = 0.002), 3 × ULN (OR, 2.44; 95% CI, 1.17-5.08; p = 0.018), 5 × ULN (OR, 3.18; 95% CI, 1.44-7.0; p = 0.004), respectively. Moreover, the incidence of cTnI elevation was higher in patients with the upper tertile of NT-pro-BNP levels than that in ones with the lower tertile of NT-pro-BNP levels (> 1 × ULN: 63.1% vs. 50.0%, p < 0.001; > 3 × ULN: 39.2% vs. 31.9%, p = 0.032; > 5 × ULN: 30.4% vs. 21.9%, p < 0.006; respectively). CONCLUSIONS Our data, for the first time, demonstrated that increased preprocedural NT-pro-BNP levels were strongly and independently associated with a higher risk of PMI, suggesting that baseline NT-pro-BNP level might be a useful marker for predicting PMI following PCI in diabetic patients without cardiac dysfunction.
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Affiliation(s)
- Rui-Xiang Zeng
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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