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Nakamura R, Shiono Y, Honda K, Kunimoto H, Wada T, Fujimoto T, Ikuchi M, Ideguchi Y, Taruya A, Takahata M, Ozaki Y, Agematsu K, Tanaka A, Nishimura Y. Risk factors for unsuccessful restoration of coronary flow reserve after coronary bypass surgery. Int J Cardiol 2024; 414:132419. [PMID: 39098607 DOI: 10.1016/j.ijcard.2024.132419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Coronary flow reserve (CFR) is a strong predictor of cardiovascular events and prognosis in patients with coronary artery disease. This study aimed to evaluate preoperative factors associated with the unsuccessful restoration of CFR after coronary artery bypass grafting (CABG). METHODS Included in this study were the 65 patients who presented with functionally significant left anterior descending artery (LAD) lesions confirmed by both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), and who underwent successful CABG at our hospital within the study period. After CABG, graft patency was confirmed by coronary computed tomography angiography, and CFR in the LAD artery was measured by echocardiography. We defined postoperative CFR <2.5 as impaired CFR, and CFR ≥2.5 as preserved CFR. RESULTS Of the 65 patients, 14 patients (22%) showed impaired CFR, while 51 patients had preserved CFR. Patients with impaired CFR had significantly higher HbA1c (6.7% vs. 6.0%, P < 0.01), greater use of insulin (43% vs. 4%, P < 0.01), longer lesion length (33 mm vs. 25 mm, P = 0.044), and lower iFR (0.69 vs 0.81, P = 0.01) than those with preserved CFR, although both groups had comparable FFR (0.65 vs 0.64, P = 0.46). In receiver operating characteristic curve analysis, iFR had a significantly larger area under the curve than FFR in terms of the prediction of impaired CFR (0.74 vs 0.42, P = 0.01). CONCLUSIONS Poorly-controlled preoperative diabetes, greater reliance on insulin, longer lesion length and lower iFR were associated with postoperative impaired CFR, suggesting the involvement of microvascular dysfunction.
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Affiliation(s)
- Ryo Nakamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yasutsugu Shiono
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan.
| | - Hideki Kunimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Teruaki Wada
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Takahiro Fujimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Mizuho Ikuchi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yuya Ideguchi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Akira Taruya
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Masahiro Takahata
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yuichi Ozaki
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Kota Agematsu
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Atsushi Tanaka
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
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Panayotov P, Mileva N, Vassilev D. Current Challenges in Coronary Bifurcation Interventions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1439. [PMID: 39336480 PMCID: PMC11434469 DOI: 10.3390/medicina60091439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/30/2024]
Abstract
Coronary bifurcation lesions account for a significant proportion of all percutaneous coronary interventions (PCIs). Interventional treatment of coronary bifurcations is related to significant technical challenges, high complication rates, and worse angiographic and long-term clinical outcomes. This review covers the specific features and structure of coronary bifurcation and explores the main challenges in the interventional treatment of these lesions. This review evaluates various methodologies designed to address these lesions, considering factors such as plaque distribution and bifurcation geometry. It also emphasizes the limitations associated with current techniques. A novel combined optimization approach applied in the interventional treatment of coronary bifurcation may offer superior procedural and long-term outcomes. This combined technique could potentially address the drawbacks of each method, providing a more effective solution for optimizing stent placement in bifurcation lesions. Refining and evaluating these combined techniques is essential for improving clinical outcomes in patients with bifurcation lesions.
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Affiliation(s)
- Panayot Panayotov
- Department of Cardiology, Pulmonology and Endocrinology, Medical Faculty, Medical University of Pleven, 5800 Pleven, Bulgaria
- Medica Cor Hospital, 7013 Ruse, Bulgaria
| | | | - Dobrin Vassilev
- Medica Cor Hospital, 7013 Ruse, Bulgaria
- Faculty of Public Health and Healthcare, Ruse University "Angel Kanchev", 7017 Ruse, Bulgaria
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Sinan UY, Keskin Meric B, Bursa N, Moumin G, Kaya A, Arat Ozkan A. Evaluation of preprocedural statin loading on clinical outcomes in patients undergoing elective percutaneous coronary intervention. Front Cardiovasc Med 2024; 11:1435989. [PMID: 39228664 PMCID: PMC11368834 DOI: 10.3389/fcvm.2024.1435989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/01/2024] [Indexed: 09/05/2024] Open
Abstract
Background and aim High-dose statin therapy before percutaneous coronary intervention (PCI) is thought to reduce the occurrence of Peri-procedural Myocardial Infarction (PPMI), which is associated with increased mortality and prolonged hospitalization, especially in statin naïve patients. This study aims to investigate the effect of rosuvastatin loading dose on PPMI and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing elective PCI, considering their statin use. Methods One hundred sixty-five patients with stable coronary artery disease (CAD) without heart failure (HF) or chronic kidney disease (CKD) were included in the study. They were divided into two groups: patients already on statin treatment (n:126) and statin naive patients (n:39). Both groups were randomly assigned to high-dose (40 mg) rosuvastatin (n:86) or a non- loading dose group (n:79). The primary endpoint was the incidence of PPMI, and the secondary endpoint was MACCE. Results The mean age of study population was 59 ± 9.4 years with 77% being male (n = 127). The median follow-up (FU) time was 368 day. Thirty patients were diagnosed with PPMI after PCI (19 in the high-dose group and 11 in the no-loading-dose group). Meanwhile, less than half of study population (77 patients, 46.7%) had complex lesion type (B2, C) and 88 of those (53.3%) had simple lesion type (A, B1). PPMI was observed more frequently in statin-naive patients (23%) than in statin users (17%), although the difference was not statistically significant. Only two patients (1.2%) experienced MACCE during the FU period. One of these patients, who had a type C lesion, belonged to group A2 and underwent Target Vessel Revascularization (TVR) on the 391st day. The other patient, with a type B1 lesion, was in group A1 and was hospitalized due to Acute Coronary Syndrome (ACS) on the 40th day of FU. Conclusions Pre-procedural administration of high dose rosuvastatin in patients with stable coronary artery disease did not decrease PPMI, independent of chronic statin use.
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Affiliation(s)
- Umit Yasar Sinan
- Department of Cardiology, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Türkiye
| | - Bengisu Keskin Meric
- Department of Cardiology, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Türkiye
| | - Nurbanu Bursa
- Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Türkiye
| | - Gkiozde Moumin
- Department of Cardiology, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Türkiye
| | - Aysem Kaya
- Department of Biochemistry, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Türkiye
| | - Alev Arat Ozkan
- Department of Cardiology, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Türkiye
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Ueki Y, Kuwahara K. Periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention. J Cardiol 2023; 81:364-372. [PMID: 36375704 DOI: 10.1016/j.jjcc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
Percutaneous coronary intervention (PCI) in addition to guideline-directed medical therapy reduces the risk of spontaneous myocardial infarction (MI), urgent revascularization, and improves angina status; however, PCI is associated with an increased risk of periprocedural myocardial injury and MI. Numerous studies have investigated the mechanisms, predictors, and therapeutic strategies for periprocedural MI. Various definitions of periprocedural MI have been proposed by academic groups and professional societies requiring different cardiac biomarker thresholds and ancillary criteria for myocardial ischemia. The frequency and clinical significance of periprocedural MI substantially varies according to the definitions applied. In daily practice, accurate diagnosis of clinically-relevant periprocedural MI is essential because it may have a substantial impact on subsequent patient management. In the clinical trial setting, only clinically relevant periprocedural MI definitions should be applied as a clinical endpoint in order to avoid obscuring meaningful outcomes. In this review, we aim to summarize the mechanisms, predictors, frequency, and prognostic impact of periprocedural MI in patients undergoing PCI and to provide the current perspective on this issue.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University Hospital, Nagano, Japan.
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Hospital, Nagano, Japan
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Ismail R, Awad H, Allam R, Youssef O, Ibrahim M, Shehata B. Methylene blue versus vasopressin analog for refractory septic shock in the preterm neonate: A randomized controlled trial. J Neonatal Perinatal Med 2021; 15:265-273. [PMID: 34719443 DOI: 10.3233/npm-210824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Refractory septic shock in neonates is still associated with high mortality, necessitating an alternative therapy, despite all currently available treatments. This study aims to assess the vasopressor effect of methylene blue (MB) in comparison to terlipressin (TP) as adjuvant therapy for refractory septic shock in the preterm neonate. METHODS A double-blinded randomized controlled trial was conducted in the Neonatal Intensive Care Units at Ain Shams University, Egypt. Thirty preterm neonates with refractory septic shock were randomized to receive either MB or TP as an adjuvant to conventional therapy. Both MB and TP were administered as an intravenous loading dose followed by continuous intravenous infusion. The hemodynamic variables, functional echocardiographic variables, and oxidant stress marker were assessed over a 24 h period together with the side effects of MB. RESULTS MB causes significant improvement in mean arterial blood pressure with a significant decrease of the norepinephrine requirements (1.15±0.21μm/kg/min at baseline vs. 0.55±0.15μm/kg/min at 24 h). MB infusion causes an increase of the pulmonary pressure (44.73±8.53 mmHg at baseline vs. 47.27±7.91 mmHg after 24 h) without affecting the cardiac output. Serum malonaldehyde decreased from 5.45±1.30 nmol/mL at baseline to 4.40±0.90 nmol/mL at 24 h in the MB group. CONCLUSION Administration of MB to preterm infants with refractory septic shock showed rapid increases in systemic vascular resistance and arterial blood pressure with minimal side effects.
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Affiliation(s)
- R Ismail
- Associate Professor of Pediatrics, Faculty of Medicine, Ain Shams University
| | - H Awad
- Professor of Pediatrics, Faculty of Medicine, Ain Shams University
| | - R Allam
- Assistant Lecturer of Pediatrics, Faculty of Medicine, Ain Shams University
| | - O Youssef
- Professor of Pediatrics, Faculty of Medicine, Ain Shams University
| | - M Ibrahim
- Lecturer of Pediatrics, Faculty of Medicine, Ain Shams University
| | - B Shehata
- Lecturer of Pediatrics, Faculty of Medicine, Ain Shams University
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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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Wada T, Shiono Y, Kubo T, Honda K, Takahata M, Shimamura K, Yuzaki M, Tanimoto T, Matsuo Y, Tanaka A, Hozumi T, Nishimura Y, Akasaka T. Impact of instantaneous wave-free ratio on graft failure after coronary artery bypass graft surgery. Int J Cardiol 2020; 324:23-29. [PMID: 32966833 DOI: 10.1016/j.ijcard.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/24/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND We aimed to assess an impact of instantaneous wave-free ratio (iFR) on a graft failure after coronary artery bypass grafting (CABG). METHODS AND RESULTS A total of 131 coronary arteries from 88 patients who underwent invasive coronary angiography, intracoronary pressure measurements, CABG, and scheduled follow-up coronary computed tomography angiography within one year were investigated. All studied arteries had FFR <0.80. The rate of graft failure was significantly higher in vessels with negative iFR (>0.89) than in those with positive iFR (<0.89) (25.7% vs. 7.3%, p = 0.012). The graft failure rates increased as the preoperative iFR values rose (iFR <0.80, 3.3%; iFR: 0.80-0.84, 5.6%; iFR: 0.85-0.89, 16.0%; iFR: 0.90-0.94, 28.0%; and iFR: 0.95-1.00, 50.0%; p = 0.002). A cut-off value of iFR to predict graft failures was determined as 0.84 by receiver-operating characteristic curve analysis with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 88%, 62%, 25%, 97%, and 66%, respectively. CONCLUSIONS The risk of graft failure becomes higher, as the preoperative iFR increases. The graft failure is significantly more frequent when a bypass graft is anastomosed on vessels with negative iFR than those with positive iFR.
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Affiliation(s)
- Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Higashioka D, Shiono Y, Kubo T, Kitabata H, Nishi T, Terada K, Emori H, Takahata M, Wada T, Shimamura K, Matsuo Y, Ino Y, Tanaka A, Hozumi T, Akasaka T. The inter-study reproducibility of instantaneous wave-free ratio and angiography coregistration. J Cardiol 2020; 75:507-512. [DOI: 10.1016/j.jjcc.2019.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023]
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Utility of Saline-Induced Resting Full-Cycle Ratio Compared with Resting Full-Cycle Ratio and Fractional Flow Reserve. J Interv Cardiol 2020; 2020:5787439. [PMID: 32327943 PMCID: PMC7166294 DOI: 10.1155/2020/5787439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/22/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background The saline-induced distal coronary pressure/aortic pressure ratio predicted fractional flow reserve (FFR). The resting full-cycle ratio (RFR) represents the maximal relative pressure difference in a cardiac cycle. Therefore, the present study aimed to compare the results of saline-induced RFR (sRFR) with FFR. Methods Seventy consecutive lesions with only moderate stenosis were included. The FFR, RFR, and sRFR values were compared. The sRFR was assessed using an intracoronary bolus infusion of saline (2 mL/s) for five heartbeats. The FFR was obtained after an intravenous injection of papaverine. Results Overall, the FFR, sRFR, and RFR values were 0.78 ± 0.12, 0.79 ± 0.13, and 0.83 ± 0.14, respectively. With regard to anatomical morphology were 40, 18, and 12 cases of focal, diffuse, and tandem lesion. There was a significant correlation between the sRFR and FFR (R = 0.96, p < 0.01). There were also significant correlations between the sRFR and FFR in the left coronary and right coronary artery (R = 0.95, p < 0.01 and R = 0.98, p < 0.01). Furthermore, significant correlations between sRFR and FFR were observed in not only focal but also in nonfocal lesion including tandem and diffuse lesions (R = 0.93, p < 0.01 and R = 0.97, p < 0.01). A close agreement on FFR and sRFR was shown using the Bland–Altman analysis (95% CI of agreement: −0.08–0.07). In the receiver operating characteristic curve analysis, the cutoff value of sRFR to predict an FFR of 0.80 was 0.81 (area under curve, 0.97; sensitivity 90.6%; and specificity 98.2%). Conclusion The sRFR can accurately and safely predict the FFR and might be effective for diagnosing ischemia.
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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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Impact of periprocedural biomarker elevation on mortality in stable angina pectoris patients undergoing elective coronary intervention: a systematic review and meta-analysis including 24 666 patients. Coron Artery Dis 2020; 31:137-146. [DOI: 10.1097/mca.0000000000000795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Giblett JP, Clarke S, Zhao T, McCormick LM, Braganza DM, Densem CG, O'Sullivan M, Adlam D, Clarke SC, Steele J, Fielding S, West NE, Villar SS, Hoole SP. The role of Glucagon-Like Peptide 1 Loading on periprocedural myocardial infarction During elective PCI (GOLD-PCI study): A randomized, placebo-controlled trial. Am Heart J 2019; 215:41-51. [PMID: 31277053 DOI: 10.1016/j.ahj.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incretin hormone glucagon-like peptide 1 (GLP-1) has been shown to protect against lethal ischemia-reperfusion injury in animal models and against nonlethal ischemia reperfusion injury in humans. Furthermore, GLP-1 receptor agonists have been shown to reduce major adverse cardiovascular and cerebrovascular events (MACCE) in large-scale studies. We sought to investigate whether GLP-1 reduced percutaneous coronary intervention (PCI)-associated myocardial infarction (PMI) during elective PCI. METHODS The study was a randomized, double-blind controlled trial in which patients undergoing elective PCI received an intravenous infusion of either GLP-1 at 1.2 pmol/kg/min or matched 0.9% saline placebo before and during the procedure. Randomization was performed in 1:1 fashion, with stratification for diabetes mellitus. Six-hour cardiac troponin I (cTnI) was measured with a primary end point of PMI defined as rise ≫×5 upper limit of normal (280 ng/L). Secondary end points included cTnI rise and MACCE at 12 months. RESULTS A total of 192 patients were randomized with 152 (79%) male and a mean age of 68.1 ± 8.9 years. No significant differences in patient demographics were noted between the groups. There was no difference in the rate of PMI between GLP-1 and placebo (9 [9.8%] vs 8 [8.3%], P = 1.0) or in the secondary end points of difference in median cTnI between groups (9.5 [0-88.5] vs 20 [0-58.5] ng/L, P = .25) and MACCE at 12 months (7 [7.3%] vs 9 [9.4%], P = .61). CONCLUSIONS In this randomized, placebo-controlled trial, GLP-1 did not reduce the low incidence of PMI or abrogate biomarker rise during elective PCI, nor did it influence the 12-month MACCE rate which also remained low. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov Number: NCT02127996https://clinicaltrials.gov/ct2/show/NCT02127996.
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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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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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Plitt A, Dangas G. Cardiac enzyme elevation after coronary revascularization. Catheter Cardiovasc Interv 2018; 91:224-225. [PMID: 29405598 DOI: 10.1002/ccd.27502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/11/2022]
Abstract
CK-MB elevation post-PCI correlates with procedural complications, diffuse atherosclerosis, and adverse long-term prognosis. Troponin elevation has an earlier pattern of rise than CK-MB and can be used as a surrogate. High sensitivity troponin can enable ruling out enzymatic elevation very early after PCI and facilitate discharge timing.
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Affiliation(s)
- Anna Plitt
- Department of Cardiology, Mount Sinai Heart, New York, New York
| | - George Dangas
- Department of Cardiology, Mount Sinai Heart, New York, New York
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Göksülük H, Atmaca Y, Uludağ MG, Kaya CT, Yıldırım O, Akbulut M, Özyüncü N, Erol C. Prevention of minor myocardial injury after elective percutaneous coronary intervention: comparison of ticagrelor versus clopidogrel. Acta Cardiol 2018; 73:1-7. [PMID: 29357752 DOI: 10.1080/00015385.2018.1429193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elective percutaneous coronary intervention (ePCI) may cause minor elevation of cardiac enzymes, so-called minor myocardial injury (MMI) which can be due to different pathophysiological mechanism (e.g. distal embolisation, side branch occlusion, increased platelet activation triggered by the intracoronary metallic stents). We aimed to compare the effectiveness of ticagrelor versus clopidogrel for the prevention of MMI and major adverse clinical events (MACEs) after ePCI. METHODS Study population consisted of two groups of patients based on the treatment: Group I, receiving clopidogrel (n = 104), Group II, receiving ticagrelor (n = 96). Cardiac troponin I (cTnI), CK-MB were studied before and 12 hours after the procedure. Elevation of cTnI greater than 0.06 ng/ml was considered as MMI. All patients were also evaluated for the MACEs (death, myocardial infarction, stroke and transient ischaemic attack). RESULTS Fifty-two of 200 patients (26%) had MMI after the procedure. The minor myocardial injury was significantly more prevalent in clopidogrel group than that of ticagrelor group (33% vs. 19%, p = .03). Myocardial infarction (MI) and MACEs were significantly higher in the clopidogrel group (15% vs. 6%, for MI, p = .04; 16% vs. 6%, for MACEs, p = .03, respectively). Multivariate analysis demonstrated antiplatelet treatment, saphenous graft intervention, type-C lesion as independent predictors of MMI. CONCLUSIONS Present study showed that the combination of ticagrelor and aspirin was more effective than combination of clopidogrel and aspirin in decreasing MMI and MACEs after elective stenting.
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Affiliation(s)
| | - Yusuf Atmaca
- a Cardiology Department , Ankara University , Ankara , Turkey
| | | | | | - Onur Yıldırım
- a Cardiology Department , Ankara University , Ankara , Turkey
| | - Müge Akbulut
- a Cardiology Department , Ankara University , Ankara , Turkey
| | - Nil Özyüncü
- a Cardiology Department , Ankara University , Ankara , Turkey
| | - Cetin Erol
- a Cardiology Department , Ankara University , Ankara , Turkey
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Lee T, Murai T, Isobe M, Kakuta T. Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non-ST segment elevation acute coronary syndrome. Catheter Cardiovasc Interv 2017; 90:905-914. [PMID: 28303685 DOI: 10.1002/ccd.27037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/26/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to use optical coherence tomography (OCT) to study the relationship between plaque morphology prior to percutaneous coronary intervention (PCI) and post-PCI cardiac troponin (cTn) elevations in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Furthermore, the relationship between these findings and the adverse cardiac events during follow-up was assessed. BACKGROUND Association between post-PCI cTn elevations and OCT findings in NSTE-ACS patients is unclear. METHODS We evaluated 167 patients with stable or falling cTn values after admission who underwent PCI. Periprocedural myocardial injury (PMI) was defined as an cTn increase of more than 70× upper limit of normal (ULN) in troponin-negative patients before PCI, or more than new 70× ULN elevation from the previous nadir level in pre-PCI troponin-positive patients. Clinical and OCT findings were compared between patients with (n = 48, 29%) and without (n = 119, 71%) PMI. RESULTS PMI was associated with age, prior PCI, low estimated glomerular filtration rate (eGFR), OCT-derived thin-cap fibroatheroma (TCFA), plaque rupture, and lipid length. In multivariable analysis, TCFA (odds ratio [OR], 2.88; P = 0.011), eGFR (OR, 0.97, P = 0.003), and lipid length (OR, 1.12, P = 0.020) were independent predictors of PMI. At a median follow-up of 38 months, event-free survival was significantly worse in patients with PMI (log-rank test χ2 = 6.47, P = 0.011). CONCLUSIONS OCT analysis showed that PMI occurs more frequently in lesions with TCFA in NSTE-ACS patients, and may identify patients having a higher risk of adverse cardiac events during follow-up. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Tetsumin Lee
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.,Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Mitsuaki Isobe
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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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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Vieira de Melo RM, Hueb W, Nomura CH, Ribeiro da Silva EE, Villa AV, Oikawa FTC, da Costa LMA, Rezende PC, Garzillo CL, Lima EG, Franchini Ramires JA, Kalil Filho R. Biomarker release after percutaneous coronary intervention in patients without established myocardial infarction as assessed by cardiac magnetic resonance with late gadolinium enhancement. Catheter Cardiovasc Interv 2017; 90:87-93. [DOI: 10.1002/ccd.27125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/05/2017] [Accepted: 04/23/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - Whady Hueb
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cesar Higa Nomura
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Alexandre Volney Villa
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | | | - Paulo Cury Rezende
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cibele Larrosa Garzillo
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Eduardo Gomes Lima
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Roberto Kalil Filho
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
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Shiono Y, Kubo T, Honda K, Katayama Y, Aoki H, Satogami K, Kashiyama K, Taruya A, Nishiguchi T, Kuroi A, Orii M, Kameyama T, Yamano T, Yamaguchi T, Matsuo Y, Ino Y, Tanaka A, Hozumi T, Nishimura Y, Okamura Y, Akasaka T. Impact of functional focal versus diffuse coronary artery disease on bypass graft patency. Int J Cardiol 2016; 222:16-21. [DOI: 10.1016/j.ijcard.2016.07.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
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Chang CC, Chen YC, Ong ET, Chen WC, Chang CH, Chen KJ, Chiang CW. Chest pain after percutaneous coronary intervention in patients with stable angina. Clin Interv Aging 2016; 11:1123-8. [PMID: 27574412 PMCID: PMC4993255 DOI: 10.2147/cia.s103605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has been widely used to treat acute coronary syndrome but is only recommended as an additional treatment to medical therapy and risk modification in patients with refractory or progressing angina. The number of PCI in this patient population is still increasing. Post-PCI chest pain (PPCP) is one of the common problems of PCI. Its presentation and causes in patients with stable angina are poorly understood. PATIENTS AND METHODS This study retrospectively collected clinical information of 167 patients who had stable angina and underwent elective PCI, including 70 patients with PPCP 24 hours after procedure and 97 patients without PPCP. The incidence and predictors of PPCP were analyzed. RESULTS The incidence of PPCP was 41.9% (70/167). Compared with non-PPCP patients, PPCP patients had more abnormal post-PCI electrocardiogram (ECG) changes (new Q-waves, ST-segment shifts, or T-waves inversion) and serum cardiac troponin I (cTnI) elevation, more PCI vessels, and stent placement (all P<0.05). More PPCP patients required repeat revascularization than non-PPCP patients after PCI (P=0.043). PPCP was correlated with abnormal post-PCI ECG changes (P<0.0001), cTnI elevation (P<0.0001), post-PCI serum level of cTnI (P<0.0001), number of stents placed (P=0.009), and pre-PCI cTnI level (P=0.049). The strongest predictors of PPCP were abnormal post-PCI ECG changes (P<0.0001), post-PCI cTnI level (P<0.0001), and cTnI elevation (P<0.0001), followed by the number of stents placed (P=0.048). CONCLUSION PPCP is common in patients with stable angina in our cohort. It is associated with abnormal ECG changes, cTnI elevation, and number of stents placed.
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Affiliation(s)
- Chao-Chien Chang
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan, ROC; Department of Pharmacology, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yueh-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Ren-Ai branch, Taipai, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Eng-Thiam Ong
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Wei-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Chia-Hsiu Chang
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Kuan-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Wen Chiang
- Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
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Auguadro C, Scalise F, Manfredi M, Casali V, Novelli E, Specchia G. The prognostic role of troponin I elevation after elective percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2016; 16:149-55. [PMID: 25010505 DOI: 10.2459/jcm.0000000000000058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the prognostic role of isolated troponin I (TnI) elevation after elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease. BACKGROUND The prognostic role of minor troponin elevation after PCI is controversial. METHODS A total of 1532 consecutive patients who underwent elective PCI were included. Follow-up data were obtained for 1432 of 1532 (93.4%) patients. The events taken into account in the follow-up included total mortality, cardiac death, hospitalization for acute myocardial infarction and/or unstable angina. RESULTS The following variables were identified as predictive of major adverse cardiac events (MACE) by univariate analysis: age 75 years at least (P = 0.012), ejection fraction less than 50% (P = 0.001), prior myocardial infarction (P = 0.031) and TnI 1.0 ng/ml at least after PCI (P = 0.04). The Cox-regression model identified the TnI elevation after PCI, the older age and the ejection fraction as independent predictors of MACE during follow-up (TnI: P = 0.042; older age: P = 0.001; ejection fraction: P = 0.003). In a subgroup of patients with preserved ejection fraction, the incidence of MACE was significantly higher in those with TnI of at least 1.0 ng/ml at least than in the ones with TnI less than 1.0 ng/ml, with the highest incidence among the older cohort. The multivariate analysis confirmed the TnI elevation 1.0 ng/ml at least after PCI and the older age as predictors of MACE. CONCLUSION This study documented that in clinically stable patients, minor TnI elevations after elective PCI are independent predictors of MACE during follow-up, as are older age and reduced ejection fraction. Additionally, TnI elevation was a predictor of MACE during follow-up in a subset of patients with preserved ejection fraction. The combination of TnI elevation and older age confers the highest risk of MACE.
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Affiliation(s)
- Carla Auguadro
- aCardiovascular Catheterization Laboratory, Policlinico di Monza bBiostatistics Unit, Policlinico di Monza cDepartment of Cardiology, Policlinico di Monza, Monza, Italy
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Fujita J, Kohsaka S, Ueda I, Inohara T, Maekawa Y, Kawamura A, Kanazawa H, Hayashida K, Tabei R, Tohyama S, Seki T, Suzuki M, Sano M, Fukuda K. The Prevalence of Clinically Significant Ischemia in Patients Undergoing Percutaneous Coronary Intervention: A Report from the Multicenter Registry. PLoS One 2015; 10:e0133568. [PMID: 26231033 PMCID: PMC4521937 DOI: 10.1371/journal.pone.0133568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Myocardial perfusion scintigraphy (MPS) plays an important role in the evaluation and quantification of myocardial ischemia, and those with significant ischemia (SI) benefit most from revascularization procedures. This study aimed to identify the clinical factors and anatomical features associated with SI in patients with stable ischemic heart disease (SIHD). Methods and Results Data were analyzed from 4197 SIHD patients undergoing percutaneous coronary intervention (PCI). Ischemia was based on MPS findings prior to PCI, with SI defined as an ischemic region of more than 10% of the total left ventricular area. Logistic regression analysis was performed to identify any clinical factors associated with SI. MPS was used to evaluate 1070 (25.5%) patients pre-procedurally. Patients with a history of heart failure, stroke, or anginal symptoms with Canadian Cardiovascular Society class 2 or more were more likely to have SI (odds ratio [OR] 1.63, p = 0.025, OR: 1.85, p = 0.009, and OR: 1.49, p = 0.003, respectively). When angiographic variables were considered, a proximal left anterior descending artery (pLAD) lesion was the sole factor associated with SI (OR: 1.45, p = 0.012). Importantly, those with SI had more in-hospital complications (p = 0.006), most notably post-PCI infarcts (p = 0.008). Conclusions Patients’ background data, such as stronger anginal symptoms or a pLAD lesion, were associated with SI. Patients with SI must be treated with PCI to improve their long-term prognosis; however, procedure-related complications happen more frequently in SI patients than in non-SI patients. Physicians must give their full attention when performing the PCI procedure in SI patients to minimize their complication rate.
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Affiliation(s)
- Jun Fujita
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
- * E-mail: (JF); (SK)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
- * E-mail: (JF); (SK)
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Akio Kawamura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Ryota Tabei
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Shugo Tohyama
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Tomohisa Seki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Masahiro Suzuki
- National Hospital Organization Saitama National Hospital, 2–1 Suwa, Wako-shi, Saitama, 351–0102, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
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Kini AS, Motoyama S, Vengrenyuk Y, Feig JE, Pena J, Baber U, Bhat AM, Moreno P, Kovacic JC, Narula J, Sharma SK. Multimodality Intravascular Imaging to Predict Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2015; 8:937-45. [DOI: 10.1016/j.jcin.2015.03.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/24/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022]
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Zhong X, Li H, Yang H, Yao K, Liu X, Hu K, Qian J, Ge L, Ge J. Clinical outcomes and risk factors of periprocedural myocardial injury after successful percutaneous coronary intervention for chronic total occlusions. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Percutaneous Mechanical Ventricular Support in Acute Cardiac Care: A UK Quaternary Centre Experience Using 2.5L, 3.8L and 5.0L Impella Catheters. Cardiol Ther 2014; 4:47-58. [PMID: 25515965 PMCID: PMC4472647 DOI: 10.1007/s40119-014-0033-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Indexed: 02/02/2023] Open
Abstract
Aims The Impella is a percutaneous ventricular assist device. The majority of published data describes the 2.5L and 5.0L devices, and little data is available for the newer 3.8L device. We examined the indications and outcomes from our single-centre “real-world” registry at The Queen Elizabeth Hospital, Birmingham, UK, using all three pump sizes. Methods and Results Records from all patients who underwent attempted Impella-assisted procedures at our centre were examined retrospectively. Impella implantation was attempted in 49 patients (mean age 72 ± 13 years; 80% male) and was successful in 48 (98%). 45 patients underwent high-risk percutaneous coronary intervention (PCI), one patient underwent balloon aortic valvuloplasty and 3 patients had Impella as a bridge to cardiac transplantation. The 2.5L and 3.8L devices were used in 36 (75%) and 11 (23%) patients, respectively, while one patient (2%) had the 5L device. Vascular complications occurred in only one patient (2%) and stroke and peri-procedural myocardial infarction occurred in one patient (2%), while in-hospital mortality was 20% (10/49). Conclusions In this large real-world registry, we have demonstrated the safety and feasibility of the Impella device for a wide range of indications. This includes the first series of the 3.8L device which provides superior support with no increase in vascular complications. Electronic supplementary material The online version of this article (doi:10.1007/s40119-014-0033-8) contains supplementary material, which is available to authorized users.
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Akin I, Khattab AA, Büttner HJ, Toelg R, Geist V, Neumann FJ, Richardt G, Abdel-Wahab M. Comparison of bivalirudin and heparin in patients undergoing rotational atherectomy: a subanalysis of the randomised ROTAXUS trial. EUROINTERVENTION 2014; 10:458-65. [DOI: 10.4244/eijv10i4a79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhang M, He H, Wang ZM, Xu Z, Zhou N, Tao Z, Chen B, Li C, Zhu T, Yang D, Wang L, Yang Z. Diagnostic and prognostic value of minor elevated cardiac troponin levels for percutaneous coronary intervention-related myocardial injury: a prospective, single-center and double-blind study. J Biomed Res 2014; 28:98-107. [PMID: 24683407 PMCID: PMC3968280 DOI: 10.7555/jbr.28.20130124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/17/2013] [Accepted: 12/29/2013] [Indexed: 12/16/2022] Open
Abstract
Cardiac troponin-I (cTnI) and -T (cTnT) are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention (PCI)-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT (cTns) in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26±9 months to observe the incidence of major adverse cardiac events (MACEs). Our results showed that post-PCI cTnI and/or cTnT levels were increased to more than the 99th percentile upper reference limit (URL) in 133 (13.2%) patients, among which 22 (2.2%) were more than 5 × 99th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 (P = 0.33, 95%CI: 0.74–2.46). In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.
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Affiliation(s)
- Min Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Huiwei He
- Department of Geriatrics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Ze-Mu Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhihui Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ningtian Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhengxian Tao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Bo Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Chunjian Li
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Tiebing Zhu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Di Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Liansheng Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhijian Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China; ; Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Grobben RB, Nathoe HM, Januzzi JL, van Kimmenade RRJ. Cardiac markers following cardiac surgery and percutaneous coronary intervention. Clin Lab Med 2014; 34:99-111, vii. [PMID: 24507790 DOI: 10.1016/j.cll.2013.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Differentiation between procedure-related necrosis and postprocedural myocardial infarction (MI) is challenging because of the inherent association of these procedures to varying levels of myocardial injury. To improve risk stratification of patients at risk of an acute MI, the universal definition of MI implemented cardiac biomarker thresholds. The cutoff points for these thresholds, however, are largely arbitrary and lack therapeutic implications. Measurement of cardiac marker concentrations after percutaneous coronary intervention and cardiac surgery should, therefore, be used as a marker of baseline risk, atherosclerosis burden, and procedural complexity rather than a conclusive marker to diagnose acute MI.
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Affiliation(s)
- Remco B Grobben
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - James L Januzzi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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Dangas GD, Kini AS, Sharma SK, Henriques JP, Claessen BE, Dixon SR, Massaro JM, Palacios I, Popma JJ, Ohman EM, Stone GW, O'Neill WW. Impact of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump on prognostically important clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (from the PROTECT II randomized trial). Am J Cardiol 2014; 113:222-8. [PMID: 24527505 DOI: 10.1016/j.amjcard.2013.09.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A periprocedural myocardial infarction, defined as the advent of new Q-waves or a creatine kinase-MB elevation >83 normal has been previously validated as predictive of subsequent mortality. We examined the effects of using this clinically relevant definition of periprocedural myocardial infarction instead of the original protocol definition on outcomes in the recent PROTECT II [A Prospective, Multi-center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump (IABP) in Patients Undergoing Non Emergent High Risk PCI] trial. In this trial, patients who were undergoing high-risk percutaneous coronary intervention (PCI) were randomized to either an intraaortic balloon pump (IABP, n[211) or a left ventricular assist device (Impella, n[216). All eligible patients per study protocol were included in the analysis. Patient outcomes were compared up to 90 days, the longest available follow-up, on the composite end points of major adverse events (MAE) and major adverse cardiac and cerebral events (MACCE [ death, stroke, myocardial infarction, and repeat revascularization). At 90 days, the rates of both composite end points were lower in the Impella group compared with the IABP group (MAE, 37% vs 49%, p [ 0.014 respectively; MACCE, 22% vs 31%, p [ 0.034 respectively). There were no differences in death or large myocardial infarction between the 2 arms. By multivariable analysis, treatment with Impella as opposed to IABP was an independent predictor for freedom from MAE (odds ratio[0.75 [95% confidence interval 0.61 to 0.92], p[0.007) andMACCE (odds ratio[0.76 [95% confidence interval 0.61 to 0.96], p[0.020) at 90 days postprocedure. In conclusion, hemodynamic support with Impella compared with IABP during high-risk PCI in the PROTECT-II trial resulted in improved event-free survival at 3-month follow-up; this finding was further supported by multivariate analyses.
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31
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Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI). J Am Coll Cardiol 2013; 62:1563-70. [PMID: 24135581 DOI: 10.1016/j.jacc.2013.08.720] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 12/22/2022]
Abstract
Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5), which are of uncertain prognostic importance. In addition, for both the MI types, cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than using an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a "clinically relevant MI." The present document introduces a new definition for "clinically relevant MI" after coronary revascularization (PCI or CABG), which is applicable for use in clinical trials, patient care, and quality outcomes assessment.
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32
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Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (SCAI). Catheter Cardiovasc Interv 2013; 83:27-36. [DOI: 10.1002/ccd.25135] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lloyd W. Klein
- Division of Cardiology, Department of Medicine; Rush University; Chicago Illinois
| | - Binita Shah
- Division of Cardiology; New York University School of Medicine; New York
| | | | | | | | | | | | | | - Gregg W. Stone
- Columbia University Medical Center, New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York City New York
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Hwang J, Lee HC, Kim BW, Yang MJ, Park JS, Park JH, Lee HW, Oh J, Choi JH, Cha KS, Hong TJ, Song S, Kim SP. The effect on periprocedural myocardial infarction of intra-coronary nicorandil prior to percutaneous coronary intervention in stable and unstable angina. J Cardiol 2013; 62:77-81. [DOI: 10.1016/j.jjcc.2013.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/30/2013] [Accepted: 03/06/2013] [Indexed: 11/26/2022]
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34
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Vatankulu MA, Murat SN, Demircelik B, Turfan M, Sonmez O, Duran M, Bacaksiz A, Ornek E, Tasal A, Goktekin O. Effect of estimated glomerular filtration rate on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention. Ren Fail 2013; 35:931-5. [DOI: 10.3109/0886022x.2013.808132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Barbash IM, Dvir D, Ben-Dor I, Badr S, Okubagzi P, Torguson R, Corso PJ, Xue Z, Satler LF, Pichard AD, Waksman R. Prevalence and effect of myocardial injury after transcatheter aortic valve replacement. Am J Cardiol 2013; 111:1337-43. [PMID: 23415511 DOI: 10.1016/j.amjcard.2012.12.059] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 12/23/2012] [Accepted: 12/23/2012] [Indexed: 11/24/2022]
Abstract
The incidence and prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR) have not been consistently studied. We aimed to assess the incidence and extent of myocardial injury after TAVR performed using transfemoral and transapical approaches. The clinical data from patients with aortic stenosis who underwent TAVR were retrospectively analyzed. The myocardial necrosis markers cardiac troponin I and creatine kinase (CK)-MB were assessed during hospitalization. Of the 150 TAVR patients, 95% and 50% had an abnormally elevated cardiac troponin I and CK-MB level, respectively. The transapical patients had significantly greater elevations of both cardiac troponin I (13.8 ± 14.0 vs 2.5 ± 5.8 ng/ml, p <0.001) and CK-MB (28.4 ± 24.2 vs 7.4 ± 8.6 ng/ml, p ≤0.001). On receiver operating curve analysis, postprocedural CK-MB (twofold increase) had high predictive power for 30-day mortality (area under the curve 0.85, p <0.001). Patients with high CK-MB levels had greater rates of postprocedural kidney injury (22% vs 6%, p = 0.026), in-hospital (22% vs 0%, p <0.001), 30-day (27% vs 1.5%, p <0.001), and 1-year mortality (41% vs 18%, p = 0.01). Baseline renal failure and no β-blocker treatment on admission were independent predictors of an elevated postprocedural CK-MB level. In conclusion, a cardiac biomarker increase after TAVR was common and more frequent among transapical access patients. A twofold increase (>7 ng/ml) in CK-MB after transfemoral TAVR was a surrogate for poor long-term outcomes.
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36
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Ambrosi P. Effets cliniques à court terme des statines initiées avant une intervention. Presse Med 2013; 42:261-8. [DOI: 10.1016/j.lpm.2012.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/21/2012] [Accepted: 05/10/2012] [Indexed: 11/24/2022] Open
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Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DS, Cho KI, Kim BH, Je HG, Park YH. Prognostic value of creatine kinase-myocardial band isoenzyme elevation following percutaneous coronary intervention: a meta-analysis. Catheter Cardiovasc Interv 2012; 81:959-67. [PMID: 22744792 DOI: 10.1002/ccd.24542] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 06/24/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess whether different degrees of creatine kinase-myocardial band isoenzyme (CK-MB) elevation after percutaneous coronary intervention (PCI) affect the subsequent risk of death. BACKGROUND While there is consensus that extensive cardiac enzyme elevation increase mortality significantly, there is uncertainty about the exact clinical impact of smaller CK-MB elevations after PCI. METHODS The published literature was scanned by formal searches of electronic databases such as PubMed and MEDLINE from January 1999 to October 2011. Risk ratio (RR) was used as summary estimate. RESULTS Ten studies have been included totaling 48,022 patients who underwent PCI (12,246 patients with CK-MB elevation and 35,776 patients without CK-MB elevation). Mean followup duration for each study ranged from 6 to 48 months. CK-MB elevation >1× the upper limit of normal (ULN) conferred a significant increase in the risk of mortality with an overall RR of 1.74 (95% confidence interval [CI], 1.42 to 2.13, P < 0.001). Compared with patients without CK-MB elevation, there was a dose-response relationship with RR for death being 1.48 (95% CI, 1.25-1.77, P < 0.001) with CK-MB elevation 1 to <3× ULN, 1.71 (95% CI, 1.23-2.37, P = 0.001) with CK-MB elevation 3 to 5× ULN, and 2.83 (95% CI, 1.98-4.04, P < 0.001) with CK-MB elevation ≥ 5× ULN. CONCLUSIONS Even a small increase in CK-MB levels after PCI is associated with significantly higher risk of late mortality. Monitoring cardiac enzymes after PCI may help predict the long term clinical outcome.
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Affiliation(s)
- Jae-Sik Jang
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
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38
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Sardi GL, Laynez-Carnicero A, Torguson R, Xue Z, Suddath WO, Kent KM, Satler LF, Pichard AD, Lindsay J, Waksman R. The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 81:949-56. [PMID: 22888029 DOI: 10.1002/ccd.24581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/17/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to compare percutaneous coronary intervention (PCI) with direct stenting (DS) to balloon predilatation (PD) for patients undergoing elective PCI to determine whether there is an independent value for DS with regard to clinical outcomes. BACKGROUND The safety of PCI with DS has been established, but the independent advantages of this technique are not entirely clear. METHODS Patients undergoing elective PCI from January 2000 to December 2010 were included. The postprocedural and late clinical outcomes of 444 patients who underwent PCI with DS were compared with a propensity-matched population of 444 subjects treated with PD. RESULTS The two groups were well matched to 27 baseline clinical, procedural, and angiographic characteristics, thus allowing for a more accurate evaluation of the independent value of the stenting technique. Intravascular ultrasound was used in more than 60% of interventions in both groups. PCI performed with PD were longer (DS 45 ± 19.28 vs. PD 56 ± 23.72 minutes, P = 0.001), used more contrast (DS 154 ± 65.88 vs. PD 186 ± 92.84 cc, P = 0.001), and more frequently used balloon postdilation (DS 0% vs. PD 27.3%, P = 0.001). The incidence of periprocedural myocardial infarction (PPMI) was similar between DS- and PD patients (5.3% vs. 5.4%, P = 0.91). Likewise, the 1-year rates of major adverse cardiac events (8.4% vs. 6.3%, P = 0.25), target lesion revascularization (3.9% vs. 2.5%, P = 0.24), and definite stent thrombosis (0.2% vs. 0.9%, P = 0.37) were similar among DS and PD patients, respectively. CONCLUSION During elective PCI, DS decreases overall procedure time and resource utilization, but fails to reveal an independent clinical advantage as there is no demonstrable benefit in regard to the incidence of PPMI, restenosis, or overall clinical outcomes up to 1-year of follow-up.
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Affiliation(s)
- Gabriel L Sardi
- Division of Cardiology, Washington Hospital Center, Washington, District of Columbia 20010, USA
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39
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Balin M, Çelik A, Kobat MA, Baydas A. Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 levels predict percutaneous coronary intervention-related periprocedural myocardial infarction in stable patients undergoing elective native single-vessel PCI. J Thromb Thrombolysis 2012; 34:483-90. [DOI: 10.1007/s11239-012-0770-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Lim CCS, van Gaal WJ, Testa L, Cuculi F, Arnold JR, Karamitsos T, Francis JM, Petersen SE, Digby JE, Westaby S, Antoniades C, Kharbanda RK, Burrell LM, Neubauer S, Banning AP. With the "universal definition," measurement of creatine kinase-myocardial band rather than troponin allows more accurate diagnosis of periprocedural necrosis and infarction after coronary intervention. J Am Coll Cardiol 2011; 57:653-61. [PMID: 21292125 DOI: 10.1016/j.jacc.2010.07.058] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 06/22/2010] [Accepted: 07/06/2010] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We aimed to assess the differential implications of creatine kinase-myocardial band (CK-MB) and troponin measurement with the universal definition of periprocedural injury after percutaneous coronary intervention. BACKGROUND Differentiation between definitions of periprocedural necrosis and periprocedural infarction has practical, sociological, and research implications. Troponin is the recommended biomarker, but there has been debate about the recommended diagnostic thresholds. METHODS Thirty-two patients undergoing multivessel percutaneous coronary intervention and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging in a prospective study had cardiac troponin I, CK-MB, and inflammatory markers (C-reactive protein, serum amyloid A, myeloperoxidase, tumor necrosis factor alpha) measured at baseline, 1 h, 6 h, 12 h, and 24 h after the procedure. Three "periprocedural injury" groups were defined with the universal definition: G1: no injury (biomarker <99th percentile); G2: periprocedural necrosis (1 to 3 × 99th percentile); G3: myocardial infarction (MI) type 4a (>3 × 99th percentile). Differences in inflammatory profiles were analyzed. RESULTS With CK-MB there were 17, 10, and 5 patients in groups 1, 2, and 3, respectively. Patients with CK-MB-defined MI type 4a closely approximated patients with new CMR-LGE injury. Groups defined with CK-MB showed progressively increasing percentage change in C-reactive protein and serum amyloid A, reflecting increasing inflammatory response (p < 0.05). Using cardiac troponin I resulted in 26 patients defined as MI type 4a, but only a small minority had evidence of abnormality on CMR-LGE, and only 3 patients were defined as necrosis. No differences in inflammatory response were evident when groups were defined with troponin. CONCLUSIONS Measuring CK-MB is more clinically relevant for diagnosing MI type 4a, when applying the universal definition. Current troponin thresholds are oversensitive with the arbitrary limit of 3 × 99th percentile failing to discriminate between periprocedural necrosis and MI type 4a. (Myocardial Injury following Coronary Artery bypass Surgery versus Angioplasty: a randomised controlled trial using biochemical markers and cardiovascular magnetic resonance imaging; ISRCTN25699844).
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Affiliation(s)
- Chris C S Lim
- Oxford Heart Centre, John Radcliffe Hospital, United Kingdom
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Feldman DN, Kim L, Rene AG, Minutello RM, Bergman G, Wong SC. Prognostic value of cardiac troponin-I or troponin-T elevation following nonemergent percutaneous coronary intervention: a meta-analysis. Catheter Cardiovasc Interv 2011; 77:1020-30. [PMID: 21574239 DOI: 10.1002/ccd.22962] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/03/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this meta-analysis was to assess the prevalence and prognostic value regarding mortality of cTnT or cTnI elevations after nonemergent percutaneous coronary intervention (PCI) in a large number of cohort/registry studies. BACKGROUND Routine cardiac troponin measurement after elective PCI has been controversial among interventionalists. Recent studies have provided conflicting data in regard to predictive value of cardiac troponin-T (cTnT) and troponin-I (cTnI) elevation after non-emergent PCI. METHODS Electronic and manual searches were conducted of all published studies reporting on the prognostic impact of cTnT or cTnI elevation after elective PCI. A meta-analysis was performed with all-cause mortality at follow-up as the primary endpoint. RESULTS We identified 22 studies, involving 22,353 patients, published between 1998 and 2009. Postprocedural cTnT and cTnI were elevated in 25.9% and 34.3% of patients, respectively. Follow-up period ranged from 3 to 67 months (mean: 17.7 ± 14.9 months). The results showed no heterogeneity among the trials (Q-test: 25.39; I(2) : 17%; P = 0.23). No publication bias was detected (Egger's test: P = 0.16). The long-term all-cause mortality in patients with cTnI or cTnT elevation after PCI (5.8%) was significantly higher when compared to patients without cTnI or cTnT elevation (4.4%); OR 1.45 (95% CI: 1.22-1.72), P < 0.01. In addition, the postprocedural composite adverse clinical events of all-cause mortality or myocardial infarction (MI) in patients with cTnI or cTnT elevation after PCI (9.2%) was significantly higher when compared to patients without cTnI or cTnT elevation (5.3%); OR 1.77 (95% CI: 1.48-2.11), P < 0.01. CONCLUSIONS The current meta-analysis indicates that cTnI or cTnT elevation after nonemergent PCI is indicative of an increase in long-term all-cause mortality as well as the composite adverse events of all-cause mortality and MI. Efforts to routinely monitor periprocedural cTn levels along with more intensive outpatient monitoring/treatment of patients with cTn elevations may help to improve the long-term adverse outcomes in these patients following non-emergent PCI.
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Affiliation(s)
- Dmitriy N Feldman
- Greenberg Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
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Mazhar F, Tariq SR, Bashir F. Age- and gender-based studies of trace metal levels and various enzymes associated with myocardial infarction. Biol Trace Elem Res 2011; 140:139-50. [PMID: 20396994 DOI: 10.1007/s12011-010-8693-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Abstract
The present investigation deals with the determination of various serum enzymes known to be elevated during myocardial infarction (MI) and estimation of selected metals like Cu, Cr, Co, Fe, Pb, and Mg by flame atomic absorption spectrophotometry. The data obtained thereby were processed for the determination of correlation coefficient matrix among the cardiac enzymes and the serum metals. The study evidenced the accumulation of Pb during MI and reduction in the level of Fe. A significant negative correlation was observed between Cu and creatine kinase-MB. The data were also segregated into various groups to study the influence of age and gender on the levels of selected parameters. In both the genders, the age of the patients was found to be correlated significantly with various cardiac enzymes. In case of male patients, the most significant correlation was observed between age and blood sugar at random. The other significant correlations among the male patients included Cr-CPK, Cr-creatine kinase-MB, Fe-age, and others. In female patients, the pairs of studied parameters that exhibited significant correlations included age-lactic dehydrogenase, creatine phosphokinase isoenzyme-aspartate aminotransferase, lactic dehydrogenase-creatine phosphokinase isoenzymes, Pb-Fe, and Cu-Co in addition to others.
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Affiliation(s)
- Farhana Mazhar
- Central Research Lab., Lahore College for Women University, Pakistan
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44
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Affiliation(s)
- Abhiram Prasad
- Department of Internal Medicine and the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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45
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Dangas G, Erwin P. Angiographic complications and post-PCI myocardial enzyme elevation: brave new world revisited. Catheter Cardiovasc Interv 2010; 76:967-8. [PMID: 21108373 DOI: 10.1002/ccd.22893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Babu GG, Walker JM, Yellon DM, Hausenloy DJ. Peri-procedural myocardial injury during percutaneous coronary intervention: an important target for cardioprotection. Eur Heart J 2010; 32:23-31. [PMID: 21037252 DOI: 10.1093/eurheartj/ehq393] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Percutaneous coronary intervention (PCI) has become the predominant procedure for coronary revascularization in patients with both stable and unstable coronary artery disease (CAD). Over the past two decades, technical advances in PCI have resulted in a better and safer therapeutic procedure with minimal procedural complications. However, about 30% of patients undergoing elective PCI sustain myocardial injury arising from the procedure itself, the extent of which is significant enough to carry prognostic importance. The peri-procedural injury which accompanies PCI might therefore reduce some of the beneficial effects of coronary revascularization. The availability of more sensitive serum biomarkers of myocardial injury such as creatine phosphokinase MB isoenzyme (CK-MB), Troponin T, and Troponin I has enabled the quantification of previously undetectable myocardial injury. Peri-procedural myocardial injury (PMI) can also be visualized by cardiac magnetic resonance imaging, a technique which allows the detection and quantification of myocardial necrosis following PCI. The identification of CAD patients at greatest risk of sustaining PMI during PCI would allow targeted treatment with novel therapies capable of limiting the extent of PMI or reducing the number of patients experiencing PMI.
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Affiliation(s)
- Girish Ganesha Babu
- Division of Medicine, The Hatter Cardiovascular Institute, University College Medical School, 67 Chenies Mews, London, UK
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Hong YJ, Jeong MH, Kim SW, Choi YH, Ma EH, Ko JS, Lee MG, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Relation between plaque components and plaque prolapse after drug-eluting stent implantation--virtual histology-intravascular ultrasound. Circ J 2010; 74:1142-51. [PMID: 20453386 DOI: 10.1253/circj.cj-09-0781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is not well known which plaque components are associated with the development of plaque prolapse (PP) and what are the major components in prolapsed plaque. The relationship between pre-stenting plaque components and post-stenting PP was assessed and the plaque components of prolapsed plaque were evaluated in patients who underwent drug-eluting stent (DES) implantation using virtual histology-intravascular ultrasound (VH-IVUS). METHODS AND RESULTS The study group consisted of 132 patients who underwent DES implantation and pre- and post-stenting VH-IVUS. Of these patients, 68 patients had 76 PP lesions and 64 patients had 76 non-PP lesions. Intra-stent PP volume was 3.6+/-1.5 mm(3). Plaque volume was significantly greater and absolute fibrotic (FT) and necrotic core (NC) volumes were significantly greater in PP lesions compared with non-PP lesions. On multivariate analysis, absolute NC (odds ratios [OR]=1.14, P<0.001) and FT volume (OR =1.09, P<0.001) were independently associated with the development of PP. In intra-stent prolapsed plaque the FT component was greatest, but the NC component was also large, and %NC volume correlated positively with Deltacreatine kinase-MB (r=0.489, P<0.001) and Deltatroponin-I (r=0.679, P<0.001), and %FT volume correlated negatively with DeltaCK-MB (r=-0.539, P<0.001) and Deltatroponin-I. CONCLUSIONS NC and FT components were associated with development of PP; and NC and FT components in prolapsed plaque were associated with cardiac enzyme elevation after DES implantation.
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Affiliation(s)
- Young Joon Hong
- Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
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Differences in intravascular ultrasound findings in culprit lesions in infarct-related arteries between ST segment elevation myocardial infarction and non-ST segment elevation myocardial infarction. J Cardiol 2010; 56:15-22. [PMID: 20350520 DOI: 10.1016/j.jjcc.2010.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 12/22/2009] [Accepted: 01/19/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI). We used intravascular ultrasound (IVUS) to assess coronary culprit lesions in ST segment elevation MI (STEMI) vs. in non-ST segment elevation MI (NSTEMI). METHODS Patient population comprised 125 STEMI and 185 NSTEMI patients. IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), lipid-pool like image (a pooling of hypoechoic or echolucent material covered with a hyperechoic layer), thrombus (discrete intraluminal filling defects), and plaque prolapse (tissue extrusion through the stent strut at post-stenting). RESULTS Culprit lesions had larger external elastic membrane area (13.5+/-4.9mm(2) vs. 11.9+/-4.3mm(2), p=0.002), larger plaque plus media area (10.8+/-4.4mm(2) vs. 9.1+/-4.1mm(2), p=0.001), and greater plaque burden (78.7+/-10.1% vs. 74.8+/-12.0%, p=0.002), and smaller culprit lesion site calcium arc (96+/-90 degrees vs. 153+/-114 degrees , p=0.002) in patients with STEMI than in those with NSTEMI. Culprit lesion plaque ruptures, lipid-pool like images, and thrombus were observed more frequently in patients with STEMI than in those with NSTEMI (46% vs. 29%, p=0.002; 39% vs. 25%, p=0.010; and 34% vs. 21%, p=0.006, respectively). Culprit lesions were more predominantly hypoechoic in patients with STEMI than in those with NSTEMI (62% vs. 40%, p<0.001). There was a trend that post-stenting plaque prolapse was observed more frequently in patients with STEMI than in those with NSTEMI (33% vs. 24%, p=0.081). CONCLUSIONS Culprit lesions in STEMI have more markers of plaque instability (more plaque rupture and thrombus, and larger plaque mass) compared with lesions in NSTEMI.
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Klein LW. Cardiac enzyme elevations after apparently successful percutaneous interventions are a marker of extensive coronary artery disease and complex stenoses. Catheter Cardiovasc Interv 2009; 74:823-5. [PMID: 19902503 DOI: 10.1002/ccd.22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2009; 54:477-86. [DOI: 10.1016/j.jacc.2009.03.063] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/19/2009] [Accepted: 03/24/2009] [Indexed: 11/23/2022]
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