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Wickbom A, Fengsrud E, Alfredsson J, Engdahl J, Kalm T, Ahlsson A. Atrial fibrillation incidence after coronary artery bypass graft surgery and percutaneous coronary intervention: the prospective AFAF cohort study. SCAND CARDIOVASC J 2024; 58:2347297. [PMID: 38695238 DOI: 10.1080/14017431.2024.2347297] [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: 10/02/2023] [Accepted: 04/20/2024] [Indexed: 05/12/2024]
Abstract
Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p < .001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p < .001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1-354.9, p < .001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge.
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Affiliation(s)
- Anders Wickbom
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Espen Fengsrud
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Johan Engdahl
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Torbjörn Kalm
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Anders Ahlsson
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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2
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Kemberi M, Urgesi E, Ng JY, Patel K, Khanji MY, Awad WI. Outcomes of Patients Presenting With Non-ST Elevation Myocardial Infarction Who Underwent Surgical Revascularization. Am J Cardiol 2024; 223:165-173. [PMID: 38777209 DOI: 10.1016/j.amjcard.2024.05.022] [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: 02/09/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
Non-ST-segment elevation myocardial infarction (NSTEMI) is a leading cause of emergency hospitalization across Europe. This study evaluates the in-hospital and mid-term outcomes of patients who underwent coronary artery bypass graft (CABG) after NSTEMI. A retrospective analysis of all cases who underwent isolated CABG after NSTEMI from September 2017 to September 2022 at our center. Patients were stratified according to in-hospital survival. Patient characteristics, operative details, and procedural complications were compared between those who survived and those who did not. Predictors of in-hospital and mid-term mortality were evaluated using logistic and Cox regression modeling. Kaplan-Meier analysis was used to generate a survival curve for all alive patients at the time of discharge. Among 1,011 patients (median age 64 [56 to 72] years, 852 [84.3%] male), 735 (72.7%) underwent urgent, 239 (23.6%) elective, and 37 (3.7%) emergency CABG. The in-hospital mortality was 1.5% (15/1,011 patients). Those who died were more likely to be New York Heart Association class III/IV, have left ventricular ejection fraction <21%, severe renal impairment, peripheral vascular disease (PVD), or poor mobility. Emergency procedures, preoperative ventilation, inotropic support, and intra-aortic balloon pump (IABP) use were also more prevalent among those who died. Logistic regression modeling revealed new postoperative stroke (odds ratio 22.0, 95% confidence interval 3.6 to 135.5, p = 0.001), preoperative IABP use (11.4; 2.4 to 53.7, p = 0.002), new hemodialysis (9.6; 2.7 to 34.7, p <0.001), PVD (5.6; 1.6 to 20.0, p = 0.008), and poor mobility (odds ratio 4.8, 95% confidence interval 1.3 to 18.2, p = 0.022) as independent predictors of in-hospital mortality. In conclusion, new postoperative stroke, preoperative IABP use, new hemodialysis, PVD, and poor mobility are independent predictors of mortality in patients with NSTEMI who underwent isolated CABG.
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Affiliation(s)
- Marsioleda Kemberi
- Department of Cardiothoracic Surgery, Barts and the London Medical School, London, United Kingdom
| | - Eduardo Urgesi
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Jing Yong Ng
- Department of Cardiothoracic Surgery, Barts and the London Medical School, London, United Kingdom
| | - Kush Patel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | - Wael I Awad
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; William Harvey Research Institute, QMUL, London, United Kingdom.
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Yamamoto K, Shiomi H, Morimoto T, Miyazawa A, Nakamura S, Suwa S, Fujita T, Kurita T, Sugawara S, Fujii K, Suematsu N, Isawa T, Matsuo H, Tanaka H, Shirota K, Hibi K, Kadota K, Ando K, Ono K, Kimura T. Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease and Diabetes. Am J Cardiol 2024; 223:18-28. [PMID: 38740165 DOI: 10.1016/j.amjcard.2024.04.054] [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: 03/17/2024] [Revised: 04/14/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and diabetes. The Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention study multivessel cohort was a prospective, multicenter, single-arm trial enrolling 1,021 patients who underwent multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between those patients with and without diabetes. The primary end point was a composite of death, myocardial infarction, stroke, or any coronary revascularization. There were 560 patients (54.8%) with diabetes and 461 patients (45.2%) without diabetes. The mean age was not different between the 2 groups (70.9 ± 9.7 vs 71.7 ± 10.4 years, p = 0.17). Patients with diabetes more often had chronic kidney disease and complex coronary artery disease, as indicated by the greater total number of stents and longer total stent length. The rate of meeting the OPTIVUS criteria was not different between the 2 groups (61.2% vs 60.7%, p = 0.83). The cumulative 1-year incidence of the primary end point was not different between the 2 groups (10.8% vs 9.8%, log-rank p = 0.65). After adjusting for confounders, the risk of diabetes relative to nondiabetes remained insignificant for the primary end point (hazard ratio 0.97, 95% confidence interval 0.65 to 1.44, p = 0.88). In conclusion, in patients who underwent multivessel IVUS-guided PCI and were managed with contemporary clinical practice, patients with diabetes had similar 1-year outcomes to patients without diabetes.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Takanari Fujita
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeo Sugawara
- Department of Cardiology, Nihonkai General Hospital, Yamagata Japan
| | - Kenji Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuhiro Suematsu
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tsuyoshi Isawa
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | | | - Hiroyuki Tanaka
- Department of Cariology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Kinya Shirota
- Division of Cardiology, Matsue Red Cross Hospital, Matsue, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan.
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4
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Elsheikh AN, Elsaeid A, Sharafeldin S, Elshedoudy S, ElGendy E. Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention. Egypt Heart J 2024; 76:81. [PMID: 38955907 DOI: 10.1186/s43044-024-00502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Bifurcation lesions are prevalent amongst patients with symptomatic coronary artery disease subjected to percutaneous coronary intervention (PCI). Recent consensus commends a conservative (provisional) approach when managing the side branch. Here, the aim was to explore the immediate impact of different bifurcation techniques (one stent and two stent strategies) on left ventricular LV) myocardial functions using speckle tracking echocardiography in patients subjected to elective PCI. Sixty two consecutive patients diagnosed with coronary bifurcation lesion (CBL) were enrolled. Patients were categorized into: one-stent strategy (Provisional group, n = 44) and a two-stent strategy (TAP, DK crush, or Culotte technique, n = 18), based on the coronary bifurcation site, angle, side branch diameter and Medina classification. LVEF%, regional and global longitudinal strain (GLS), and E/E' were measured before and within 24 h post PCI. RESULTS In both provisional and 2- stent technique, the mitral inflow velocities and mitral annular velocities showed improvement with significant reduction in E/e' (P < 0.03 and P < 0.001) respectively while LVEF% did not change. There were no significant changes in any other echo parameters post PCI. In provisional group, there were significant improvements in LAD (P < 0.001), RCA (P < 0.01) territories and GLS (P < 0.01). Δ LAD was expressively higher (34.5%) compared with Δ LCX (9.6%) and ΔRCA (25.4%), P < 0.001, P < 0.01 respectively. In the 2-stent technique group, there were significant improvements in peak longitudinal strain of LAD territory (P < 0.01), RCA territory (P < 0.01) and GLS (P < 0.01) respectively. Δ LAD territory was significantly higher in provisional group in comparison with the 2- stent technique group. Δ GLS was correlated inversely to Gensini score in provisional group and to the number of vessel diseased in 2-stent technique group. CONCLUSION PCI of the bifurcation lesion positively impact myocardial function. Both bifurcation techniques improve LV mechanical properties using 2D strain imaging while LV EF% remains unchanged.
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Affiliation(s)
- Amr Nasser Elsheikh
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt.
| | - Ayman Elsaeid
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Samia Sharafeldin
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Sahar Elshedoudy
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Ehab ElGendy
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
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5
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Elbasha K, Alotaibi S, Heyer H, Mankerious N, Toelg R, Geist V, Richardt G, Allali A. Predictors of long-term adverse outcomes after successful chronic total occlusion intervention: physiology or morphology? Clin Res Cardiol 2024; 113:977-986. [PMID: 37542021 DOI: 10.1007/s00392-023-02279-0] [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: 02/25/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and target-vessel SYNTAX score (tvSS) are novel indices used to assess lesion physiology and morphology in percutaneous coronary intervention (PCI). Their prognostic implication after successful recanalization of coronary chronic total occlusion (CTO) is unknown. OBJECTIVES To investigate the prognostic value of QFR measured immediately after successful CTO-recanalization in predicting vessel-oriented adverse events, and to compare it with the pre-procedural morphological tvSS. METHODS QFR was measured offline after successful CTO-PCIs in a single center. We grouped the patients according to a cut-off value of post-PCI QFR (0.91). The primary outcome was target-vessel failure (TVF) at 2 years. RESULTS Among 470 CTO lesions performed during the study period, 324 were eligible for QFR analysis (258 with QFR ≥ 0.91 and 66 with QFR < 0.91). The mean age of the study population was 68.3 ± 10.7 years. The low QFR group had a lower left ventricular ejection fraction (45.8 ± 13.9% vs. 49.8 ± 12.4%, p = 0.025) and a higher rate of atrial fibrillation (19.7% vs. 11.2%, p = 0.020). The mean tvSS was 12.8 ± 4.8, and it showed no significant difference in both groups (13.6 ± 5.1 vs. 12.6 ± 4.6, p = 0.122). Patients with low post-CTO QFR had a trend to develop more TVF at 2 years (21.2% vs. 12.4%, HR 1.74; 95% CI 0.93-3.25, p = 0.086). Low post-CTO QFR failed to predict 2-year TVF (aHR 1.67; 95% CI 0.85-3.29, p = 0.136), while pre-procedural tvSS was an independent predictor for 2-year TVF (aHR 1.06; 95% CI 1.01-1.13, p = 0.030). CONCLUSION We found a limited prognostic value of immediate physiological assessment using QFR after successful CTO intervention. Pre-procedure morphological characteristics of CTO lesions using tvSS can play a role in predicting long-term adverse events.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Sultan Alotaibi
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hajo Heyer
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
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6
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Gonzalez PE, Hebbe A, Hussain Y, Khera R, Banerjee S, Plomondon ME, Waldo SW, Pfau SE, Curtis JP, Shah SM. Real-World Experience and Outcomes With Percutaneous Coronary Intervention for Protected Versus Unprotected Left Main Coronary Artery Disease: Insights from the Veteran Affairs Clinical Assessment Reporting and Tracking Program. Am J Cardiol 2024; 222:39-50. [PMID: 38677666 DOI: 10.1016/j.amjcard.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/22/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
The practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary US clinical practice. Data were collected from all Veteran Affairs catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients who underwent left main PCI, of whom 1,306 pairs of PLM and ULM PCI were included in a propensity-matched cohort. Selected temporal trends were also assessed. The primary outcome was major adverse cardiovascular event (MACE) outcomes at 1 year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke, or urgent revascularization. Patients who underwent ULM PCI compared with patients who underwent PLM PCI were older (age 71.5 vs 69.2 years, p <0.001), more clinically complex, and more likely to present with acute coronary syndrome. In the propensity-matched cohort, radial access was used more often for ULM PCI (21% [273] vs 14% [185], p <0.001) and ULM PCI was more likely to involve the left main bifurcation (22% vs 14%, p = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17], p <0.001). The 1-year MACEs occurred more frequently with ULM PCI than PLM PCI (22% [289] vs 16% [215], p ≤0.001) and all-cause mortality was also higher (16% [213] vs 10% [125], p ≤0.001). In the matched cohort, there was a low incidence of rehospitalization for MI (4% [48] ULM vs 4% [48] PLM, p = 1.000) or revascularization (7% [94] ULM vs 6% [84] PLM, p = 0.485). In this real-world experience, patients who underwent PLM PCI had better 1-year outcomes than those who underwent ULM PCI; however, in both groups, there was a high rate of mortality and MACEs at 1 year despite a relatively low rate of MI or revascularization.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Annika Hebbe
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia
| | - Yasin Hussain
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia
| | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven E Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
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Bay B, Sharma R, Roumeliotis A, Power D, Sartori S, Murphy J, Vogel B, Smith KF, Oliva A, Hooda A, Sweeny J, Dangas G, Kini A, Krishnan P, Sharma SK, Mehran R. Impact of Polyvascular Disease in Patients Undergoing Unprotected Left Main Percutaneous Coronary Intervention. Am J Cardiol 2024; 222:113-120. [PMID: 38697455 DOI: 10.1016/j.amjcard.2024.04.037] [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: 02/20/2024] [Revised: 03/25/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024]
Abstract
Percutaneous coronary intervention (PCI) has demonstrated its safety and efficacy in treating left main (LM) coronary artery disease (CAD) in select patients. Polyvascular disease (PolyVD) is associated with adverse events in all-comers with CAD. However, there is little data examining the interplay between PolyVD and LM-PCI, which we sought to investigate in a retrospective single-center study. We included patients who underwent unprotected LM-PCI at a tertiary center from 2012 to 2019. The study population was stratified based on the presence or absence of PolyVD (i.e., medical history of cerebrovascular and/or peripheral artery disease in addition to LM-CAD). The primary outcome was major adverse cardiovascular events (MACE) combining all-cause mortality and spontaneous myocardial infarction within 1 year after index PCI. Overall, 869 patients were included, and 23.8% of the population had PolyVD. Subjects with PolyVD were older and had a greater burden of co-morbidities. After 1-year follow-up, PolyVD patients exhibited significantly higher rates of both MACE (22.8% vs 9.4%, p <0.001) and bleeding events compared with those without PolyVD. MACE was primarily driven by an increase in all-cause mortality (18.3% vs 7.1%, p <0.001). Results persisted after adjusting for confounders. In conclusion, in patients who underwent LM-PCI, the presence of PolyVD is linked to an increased risk of MACE and bleeding after 1 year of follow-up, which highlights the vulnerability of this population.
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Affiliation(s)
- Benjamin Bay
- Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raman Sharma
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - David Power
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Angelo Oliva
- Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Amit Hooda
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Sweeny
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Samin K Sharma
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York.
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8
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Zhang L, Richter LR, Wang Y, Ostropolets A, Elhadad N, Blei DM, Hripcsak G. Causal fairness assessment of treatment allocation with electronic health records. J Biomed Inform 2024; 155:104656. [PMID: 38782170 PMCID: PMC11180553 DOI: 10.1016/j.jbi.2024.104656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/31/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Healthcare continues to grapple with the persistent issue of treatment disparities, sparking concerns regarding the equitable allocation of treatments in clinical practice. While various fairness metrics have emerged to assess fairness in decision-making processes, a growing focus has been on causality-based fairness concepts due to their capacity to mitigate confounding effects and reason about bias. However, the application of causal fairness notions in evaluating the fairness of clinical decision-making with electronic health record (EHR) data remains an understudied domain. This study aims to address the methodological gap in assessing causal fairness of treatment allocation with electronic health records data. In addition, we investigate the impact of social determinants of health on the assessment of causal fairness of treatment allocation. METHODS We propose a causal fairness algorithm to assess fairness in clinical decision-making. Our algorithm accounts for the heterogeneity of patient populations and identifies potential unfairness in treatment allocation by conditioning on patients who have the same likelihood to benefit from the treatment. We apply this framework to a patient cohort with coronary artery disease derived from an EHR database to evaluate the fairness of treatment decisions. RESULTS Our analysis reveals notable disparities in coronary artery bypass grafting (CABG) allocation among different patient groups. Women were found to be 4.4%-7.7% less likely to receive CABG than men in two out of four treatment response strata. Similarly, Black or African American patients were 5.4%-8.7% less likely to receive CABG than others in three out of four response strata. These results were similar when social determinants of health (insurance and area deprivation index) were dropped from the algorithm. These findings highlight the presence of disparities in treatment allocation among similar patients, suggesting potential unfairness in the clinical decision-making process. CONCLUSION This study introduces a novel approach for assessing the fairness of treatment allocation in healthcare. By incorporating responses to treatment into fairness framework, our method explores the potential of quantifying fairness from a causal perspective using EHR data. Our research advances the methodological development of fairness assessment in healthcare and highlight the importance of causality in determining treatment fairness.
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Affiliation(s)
- Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren R Richter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Yixin Wang
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; Department of Computer Science, Columbia University, New York, NY, USA
| | - David M Blei
- Department of Statistics, Columbia University, New York, NY, USA; Department of Computer Science, Columbia University, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.
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9
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Holfeld J, Nägele F, Pölzl L, Engler C, Graber M, Hirsch J, Schmidt S, Mayr A, Troger F, Pamminger M, Theurl M, Schreinlechner M, Sappler N, Ruttmann-Ulmer E, Schaden W, Cooke JP, Ulmer H, Bauer A, Gollmann-Tepeköylü C, Grimm M. Cardiac shockwave therapy in addition to coronary bypass surgery improves myocardial function in ischaemic heart failure: the CAST-HF trial. Eur Heart J 2024:ehae341. [PMID: 38898573 DOI: 10.1093/eurheartj/ehae341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/02/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND AIMS In chronic ischaemic heart failure, revascularisation strategies control symptoms but are less effective in improving left ventricular ejection fraction (LVEF). The aim of this trial is to investigate the safety of cardiac shockwave therapy (SWT) as a novel treatment option and its efficacy in increasing cardiac function by inducing angiogenesis and regeneration in hibernating myocardium. METHODS In this single-blind, parallel-group, sham-controlled trial (cardiac shockwave therapy for ischemic heart failure, CAST-HF; NCT03859466) patients with LVEF ≤40% requiring surgical revascularisation were enrolled. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to coronary bypass surgery. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days. RESULTS Overall, 63 patients were randomized, out of which 30 patients of the SWT group and 28 patients of the Sham group attained 1-year follow-up of the primary endpoint. Greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3%, SD 8.8; Sham 6.3%, SD 7.4, P = .0146). Secondary endpoints included the 6-minute walking test, where patients randomized in the SWT group showed a greater Δ from baseline to 360 days (127.5 m, SD 110.6) than patients in the Sham group (43.6 m, SD 172.1) (P = .028) and Minnesota Living with Heart Failure Questionnaire score on day 360, which was 11.0 points (SD 19.1) for the SWT group and 17.3 points (SD 15.1) for the Sham group (P = .15). Two patients in the treatment group died for non-device-related reasons. CONCLUSIONS In conclusion, the CAST-HF trial indicates that direct cardiac SWT, in addition to coronary bypass surgery improves LVEF and physical capacity in patients with ischaemic heart failure.
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Affiliation(s)
- Johannes Holfeld
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Felix Nägele
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Leo Pölzl
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Clemens Engler
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael Graber
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Jakob Hirsch
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Sophia Schmidt
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Troger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathias Pamminger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Theurl
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Schreinlechner
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolay Sappler
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Elfriede Ruttmann-Ulmer
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Wolfgang Schaden
- The Research Center in Cooperation with AUVA, Ludwig Boltzmann Institute for Traumatology, Vienna, Austria
- International Medical Director of SoftWave Tissue Regeneration Technologies, Kennesaw, GA, USA
| | - John P Cooke
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Can Gollmann-Tepeköylü
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael Grimm
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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10
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Yang X, Zhang F, Zhan Y, Liu Z, Wang W, Shi J. Association between estimated plasma volume status and acute kidney injury in patients who underwent coronary revascularization: A retrospective cohort study from the MIMIC-IV database. PLoS One 2024; 19:e0300656. [PMID: 38865385 PMCID: PMC11168641 DOI: 10.1371/journal.pone.0300656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) remains a common complication of coronary revascularization and increases poor outcomes in critically ill surgical patients. Compared to the plasma volume status (PVS), estimated plasma volume status (ePVS) has the advantages of being noninvasive and simple and has been shown to be associated with worse prognosis in patients undergoing coronary revascularization. This study was to evaluate the association of ePVS with the risk of AKI in patients who underwent coronary revascularization. METHODS In this retrospective cohort study, data of patients who underwent coronary revascularization were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008-2019). The outcome was the occurrence of AKI after ICU admission. The covariates were screened via the LASSO regression method. Univariate and multivariate Logistic regression models were performed to assess the association of ePVS and PVS and the odds of AKI in patients who underwent coronary revascularization, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, surgery, and anticoagulation agents and sequential organ failure assessment (SOFA) score were performed to further explore the association of ePVS with AKI. RESULTS A total of 3,961 patients who underwent coronary revascularization were included in this study, of whom 2,863 (72.28%) had AKI. The high ePVS was associated with the higher odds of AKI in patients who received coronary revascularization (OR = 1.06, 95%CI: 1.02-1.10), after adjusting for the covariates such as age, race, SAPS-II score, SOFA score, CCI, weight, heart rate, WBC, RDW-CV, PT, BUN, glucose, calcium, PH, PaO2, mechanical ventilation, vasopressors, and diuretic. Similar results were found in patients who underwent the CABG (OR = 1.07, 95%CI: 1.02-1.11), without anticoagulation agents use (OR = 1.07, 95%CI: 1.03-1.12) and with high SOFA score (OR = 1.10, 95%CI: 1.04-1.17). No relationship was found between PVS and the odds of AKI in patients who underwent the coronary revascularization. CONCLUSION The ePVS may be a promising parameter to evaluate the risk of AKI in patients undergoing coronary revascularization, which provides a certain reference for the risk stratification management of ICU patients who underwent coronary revascularization.
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Affiliation(s)
- Xinping Yang
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fan Zhang
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yongqiang Zhan
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhiheng Liu
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Wenjing Wang
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jiahua Shi
- Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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11
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Koshy AN, Stone GW, Sartori S, Dhulipala V, Giustino G, Spirito A, Farhan S, Smith KF, Feng Y, Vinayak M, Salehi N, Tanner R, Hooda A, Krishnamoorthy P, Sweeny JM, Khera S, Dangas G, Filsoufi F, Mehran R, Kini AS, Fuster V, Sharma SK. Outcomes Following Percutaneous Coronary Intervention in Patients With Multivessel Disease Who Were Recommended for But Declined Coronary Artery Bypass Graft Surgery. J Am Heart Assoc 2024; 13:e033931. [PMID: 38818962 DOI: 10.1161/jaha.123.033931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Patients may prefer percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery, despite heart team recommendations. The outcomes in such patients have not been examined. We sought to examine the results of PCI in patients who were recommended for but declined CABG. METHODS AND RESULTS Consecutive patients with stable ischemic heart disease and unprotected left main or 3-vessel disease or Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score >22 who underwent PCI after heart team review between 2013 and 2020 were included. Patients were categorized into 3 groups according to heart team recommendations on the basis of appropriate use criteria: (1) PCI-recommended; (2) CABG-eligible but refused CABG (CABG-refusal); and (3) CABG-ineligible. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. The study included 3687 patients undergoing PCI (PCI-recommended, n=1718 [46.6%]), CABG-refusal (n=1595 [43.3%]), and CABG-ineligible (n=374 [10.1%]). Clinical and procedural risk increased across the 3 groups, with the highest comorbidity burden in CABG-ineligible patients. Composite events within 1 year after PCI occurred in 55 (4.1%), 91 (7.0%), and 41 (14.8%) of patients in the PCI-recommended, CABG-refusal, and CABG-ineligible groups, respectively. After multivariable adjustment, the risk of the primary composite outcome was significantly higher in the CABG-refusal (hazard ratio [HR], 1.67 [95% CI, 1.08-3.56]; P=0.02) and CABG-ineligible patients (HR, 3.26 [95% CI, 1.28-3.65]; P=0.004) groups compared with the reference PCI-recommended group, driven by increased death and stroke. CONCLUSIONS Cardiovascular event rates after PCI were significantly higher in patients with multivessel disease who declined or were ineligible for CABG. Our findings provide real-world data to inform shared decision-making discussions.
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Affiliation(s)
- Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
- Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Cardiology and The University of Melbourne Austin Health Melbourne Victoria Australia
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Kenneth F Smith
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Yihan Feng
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Negar Salehi
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Richard Tanner
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Farzan Filsoufi
- Department of Cardiac Surgery Icahn School of Medicine at Mount Sinai New York NY
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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12
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Shah T, Nathan A. Considering Initial "PCI Turndown" as a Risk Factor for Subsequent PCI. J Am Heart Assoc 2024; 13:e035891. [PMID: 38818930 DOI: 10.1161/jaha.124.035891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Tayyab Shah
- Hospital of the University of Pennsylvania Philadelphia PA USA
| | - Ashwin Nathan
- Hospital of the University of Pennsylvania Philadelphia PA USA
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13
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Wu HP, Yang FC, Lin HD, Cai CZ, Chuang MJ, Chiang KF, Lin MJ. Association between statin therapy and long-term clinical outcomes in patients with stable coronary disease undergoing percutaneous coronary intervention. Sci Rep 2024; 14:12674. [PMID: 38830964 PMCID: PMC11148088 DOI: 10.1038/s41598-024-63598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
This longitudinal cohort study examined the long-term effect of statin therapy on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). A total of 1760 patients with stable coronary artery disease (CAD) were divided by receipt of statin therapy or not after index PCI. Baseline clinical characteristics, risk factors, angiographic findings, and medications after interventional procedure were assessed to compare long-term clinical outcomes between groups. Predictors for all-cause death and major adverse cardiovascular events (MACE), including myocardial infarction (MI), cardiovascular death, and repeated PCI procedures, were also analyzed. The statin therapy group had higher average serum cholesterol and more elevated low-density lipoprotein cholesterol (LDL-C) than the non-statin therapy group (189.0 ± 47.9 vs 169.3 ± 37.00 mg/dl, 117.2 ± 42.6 vs 98.7 ± 31.8 mg/dl, respectively, both P < 0.001). The non-statin group had higher rates of all-cause death and cardiovascular death compared to statin group (both P < 0.001). After adjustment for age, diabetes, and chronic kidney disease, Cox proportion hazard analysis revealed statin use significantly reduced all-cause death and repeated PCI procedure (hazard ratio: 0.53 and 0.69, respectively). Statin use seemed not reduce the hazard of cardiovascular death or MI in patients with stable CAD after PCI; however, statin therapy still was associated with reduced rates of all-cause death and repeat PCI procedure.
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Affiliation(s)
- Han-Ping Wu
- Department of Pediatrics, Chang-Gung Memorial Hospital, Chiayi County, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Ching Yang
- Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Hau-De Lin
- Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chuan-Zhong Cai
- Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ming-Jen Chuang
- Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Kuo Feng Chiang
- Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Mao-Jen Lin
- Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.
- Division of Cardiology, Department of Medicine, Buddhist Taichung Tzu Chi Hospital, 88, Section 1, Fong-Sing Rd, Tanzi District, Taichung City, Taiwan.
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14
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Phuong Le DC, The Bui H, Duy Vo Q. Percutaneous Coronary Intervention of Left Main Disease: Outcome After 1-year Follow-up at a Tertiary Hospital in Vietnam. Interv Cardiol 2024; 19:e08. [PMID: 38915851 PMCID: PMC11194779 DOI: 10.15420/icr.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/15/2024] [Indexed: 06/26/2024] Open
Abstract
Background Left main (LM) coronary artery disease (CAD) is a severe condition that can lead to severe outcomes. Treatment options include medication, coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI). Recent advancements in PCI techniques position it as a viable alternative to CABG for LM revascularisation. Methods This prospective observational study evaluated outcomes after PCI for LM CAD, encompassing in-hospital and post-discharge mortality, in a single-centre registry in Vietnam. Results Our research involved 59 patients who underwent PCI for LM lesions, with an average age of 66.7 ±1.5 years, who were divided into two groups based on presentation diagnosis - acute coronary syndrome or chronic coronary syndrome. After PCI, one individual was diagnosed with contrast-induced nephropathy and one with cardiac shock. There were two cases of in-hospital mortality in the acute coronary syndrome group and one in the chronic coronary syndrome group giving a rate of major adverse cardiac and cerebrovascular events (MACCE) of 5.1%. After a 12-month follow-up, the MACCE rate increased to 18.6%. Triple vessel coronary artery disease and troponin I elevation exhibited significant associations with adverse in-hospital outcomes (p<0.05). Conclusion PCI for LM coronary artery disease is considered a safe treatment option, demonstrating relatively favourable in-hospital and mid-term outcomes. It presents a viable alternative for patients in need of revascularisation, particularly in cases where CABG is not the preferred choice. Clinical indicators, such as triple vessel coronary artery disease and elevated troponin I levels, may serve as predictors of adverse outcomes during hospitalisation.
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Affiliation(s)
- Duy Cao Phuong Le
- Department of Cardiovascular Intervention, Nguyen Tri Phuong Hospital Ho Chi Minh City, Vietnam
- Faculty of Medicine, Nguyen Tat Thanh University Ho Chi Minh City, Vietnam
| | - Hoa The Bui
- Department of Cardiovascular Intervention, Nguyen Tri Phuong Hospital Ho Chi Minh City, Vietnam
| | - Quan Duy Vo
- Department of Cardiovascular Intervention, Nguyen Tri Phuong Hospital Ho Chi Minh City, Vietnam
- Faculty of Medicine, Nguyen Tat Thanh University Ho Chi Minh City, Vietnam
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15
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Yigitdol I, Gulumsek E, Demirtas D, Ardic ML, Baylan FA, Ozturk HA, Arici FN, Seker T, Sumbul HE. The role of serum asprosin levels in predicting the severity of coronary artery disease in patients with diabetes mellitus. Ir J Med Sci 2024; 193:1239-1247. [PMID: 38300461 DOI: 10.1007/s11845-024-03616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Asprosin is an emerging biomarker that plays a role in metabolic diseases. This study investigates asprosin as a predictive marker for coronary artery disease (CAD) severity in diabetic patients. METHODS Diabetic patients (n = 181) and healthy controls (n = 60) were analyzed. CAD severity was assessed using SYNTAX score. Diabetic patients were divided into 3 groups. Group 1 = patients without CAD, group 2 = patients with low SYNTAX score, and group 3 = patients with moderate-high SYNTAX score. Asprosin levels were measured for all participants using an enzyme-linked immunosorbent assay (ELISA). RESULTS Asprosin levels were significantly higher in patient group compared to control group (p < 0.001). Asprosin levels were significantly higher in group 3 compared to group 1 and group 2 (p = 0.002). In logistic regression analysis, asprosin levels independently predicted patients with moderate-high SYNTAX scores. According to this analysis, 1 ng/mL increase in asprosin level was found to increase the risk of having moderate-high SYNTAX score by 14.1%. When the threshold value of asprosin level was set as 22.17 ng/mL, it predicted patients with moderate-high SYNTAX score with 63.6% sensitivity and 62.6% specificity. In multivariate regression analysis, SYNTAX score independently correlated with asprosin level. CONCLUSION This is the first study in the literature to demonstrate a positive correlation between asprosin levels and SYNTAX scores in diabetic patients with CAD. More comprehensive studies with larger groups are needed.
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Affiliation(s)
- Ismail Yigitdol
- Department of Internal Medicine, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey.
| | - Erdinc Gulumsek
- Department of Internal Medicine, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey
| | - Derya Demirtas
- Department of Hematology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Lutfullah Ardic
- Department of Cardiology, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey
| | - Filiz Alkan Baylan
- Department of Biochemistry, University of Sutcu Imam, Kahramanmaras, Turkey
| | - Huseyin Ali Ozturk
- Department of Internal Medicine, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey
| | - Fatih Necip Arici
- Department of Internal Medicine, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey
| | - Taner Seker
- Department of Cardiology, Medical Park Hospital, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey
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16
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El-Dosouky II, Ammar AS, Ahmed Abdelmaaboud A, Elkot MA. Validity of the Triglyceride-Glucose Indices for Predicting the Severity of Coronary Artery Disease in Patients With Nondiabetic Chronic Coronary Syndrome. Crit Pathw Cardiol 2024; 23:89-94. [PMID: 38358780 DOI: 10.1097/hpc.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND The triglyceride-glucose (TyG) index was shown to be an independent predictor of coronary artery disease (CAD) progression and prognosis. However, whether the TyG index can predict the severity of CAD in nondiabetic patients with chronic coronary syndrome remains unclear. METHODS A total of 118 individuals who underwent elective coronary angiography were classified into group A (59 with coronary lesions) and group B (59 with normal coronary arteries; as a control group) after coronary angiography and laboratory tests for fasting and the postprandial (PP) TyG index. The complexity of CAD was determined by the Synergy Between Percutaneous Coronary Intervention (SYNTAX) score (SYNTAX score >22 indicated moderate-high risk), and patients diagnosed with diabetes or prediabetes were excluded. RESULTS The TyG index was not related to the SYNTAX score in groups A and B; however, in the CAD group with an low-density lipoprotein (LDL) concentration <70 mg/dL (group A1), a fasting TyG index ≥8.25 and a PP TyG index ≥11 could predict moderate-high SYNTAX risk score; in addition, the odds ratio (OR) was 4.3× higher and the relative risk (RR) was 1.8× greater (OR = 4.3, RR = 1.8, 95% confidence interval = 1.4-13.5, P < 0.05) for individuals with a higher fasting TyG index ≥8.25 to have a moderate-high SYNTAX risk score. Individuals with a higher PP TyG index ≥11 had OR of 2.6× higher and a RR of 1.4× greater to have moderate-high SYNTAX risk score. CONCLUSIONS Both fasting and PP TyG levels were associated with greater coronary anatomical complexity (SYNTAX score >22) in nondiabetic chronic coronary patients with LDL <70 mg/dL. Fasting and the PP TyG indices can serve as noninvasive predictors of CAD complexity in nondiabetic patients with LDL <70 mg/dL and could change the management and therapeutic approaches.
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Affiliation(s)
- Ibtesam I El-Dosouky
- From the Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed S Ammar
- From the Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Moataz A Elkot
- From the Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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17
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Adhami M, Picco CJ, Detamornrat U, Anjani QK, Cornelius VA, Robles-Martinez P, Margariti A, Donnelly RF, Domínguez-Robles J, Larrañeta E. Clopidogrel-loaded vascular grafts prepared using digital light processing 3D printing. Drug Deliv Transl Res 2024; 14:1693-1707. [PMID: 38051475 PMCID: PMC11052781 DOI: 10.1007/s13346-023-01484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
The leading cause of death worldwide and a significant factor in decreased quality of life are the cardiovascular diseases. Endovascular operations like angioplasty, stent placement, or atherectomy are often used in vascular surgery to either dilate a narrowed blood artery or remove a blockage. As an alternative, a vascular transplant may be utilised to replace or bypass a dysfunctional or blocked blood vessel. Despite the advancements in endovascular surgery and its popularisation over the past few decades, vascular bypass grafting remains prevalent and is considered the best option for patients in need of long-term revascularisation treatments. Consequently, the demand for synthetic vascular grafts composed of biocompatible materials persists. To address this need, biodegradable clopidogrel (CLOP)-loaded vascular grafts have been fabricated using the digital light processing (DLP) 3D printing technique. A mixture of polylactic acid-polyurethane acrylate (PLA-PUA), low molecular weight polycaprolactone (L-PCL), and CLOP was used to achieve the required mechanical and biological properties for vascular grafts. The 3D printing technology provides precise detail in terms of shape and size, which lead to the fabrication of customised vascular grafts. The fabricated vascular grafts were fully characterised using different techniques, and finally, the drug release was evaluated. Results suggested that the performed 3D-printed small-diameter vascular grafts containing the highest CLOP cargo (20% w/w) were able to provide a sustained drug release for up to 27 days. Furthermore, all the CLOP-loaded 3D-printed materials resulted in a substantial reduction of the platelet deposition across their surface compared to the blank materials containing no drug. Haemolysis percentage for all the 3D-printed samples was lower than 5%. Moreover, 3D-printed materials were able to provide a supportive environment for cellular attachment, viability, and growth. A substantial increase in cell growth was detected between the blank and drug-loaded grafts.
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Affiliation(s)
- Masoud Adhami
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Camila J Picco
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Usanee Detamornrat
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Qonita K Anjani
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Victoria A Cornelius
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, BT9 7BL, UK
| | | | - Andriana Margariti
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK.
- Department of Pharmacy and Pharmaceutical Technology, University of Seville, Seville, Spain.
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK.
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18
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Yu S, Chaney MA. Combined Coronary and Carotid Artery Disease: What to Operate on First? Or Both at the Same Time? J Cardiothorac Vasc Anesth 2024; 38:1417-1422. [PMID: 37839940 DOI: 10.1053/j.jvca.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Sherman Yu
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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19
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Zhang H, Liu H, Jiao Y, Zhang J, Covassin N, Wang M, Lin Y, Xie J. Association between sleep apnea-specific hypoxic burden and severity of coronary artery disease. Sleep Breath 2024; 28:1293-1301. [PMID: 38386249 PMCID: PMC11196324 DOI: 10.1007/s11325-024-03008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Sleep apnea-specific hypoxic burden (SASHB) is a polysomnographic metric that comprehensively measures the degree of nocturnal desaturation caused by obstructive sleep apnea. This research was conducted to elucidate the relationship between SASHB and coronary artery disease (CAD) severity. METHODS We carried out a prospective study of hospitalized patients with CAD of unstable angina who were expected to undergo invasive coronary angiography at Beijing Anzhen Hospital from February to September 2023. SASHB values were calculated using a self-programmed C + + program. Multivariable logistic regression analysis was applied to identify the association between SASHB and the prevalence of severe CAD, documented by the Gensini Score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) Score. RESULTS This study enrolled 137 patients with a median age of 59 years, 96 (70.1%) of whom were male. A total of 125 (91.2%) patients had coronary stenosis of ≥ 50% in at least one location. Patients with a high SASHB of ≥ 18% min/h had a significantly higher Gensini Score (32.0 vs. 18.5, P = 0.002) and SYNTAX Score (14.0 vs. 7.0, P = 0.002) than those with a low SASHB. After adjusting for multiple covariates, a high SASHB was significantly associated with the prevalence of severe CAD, determined by a Gensini Score ≥ 21 (OR 2.67, P = 0.008) or a SYNTAX Score > 22 (OR 4.03, P = 0.016). CONCLUSION Our findings revealed a robust and independent association between SASHB and CAD severity in patients with unstable angina, highlighting the potential value of SASHB as a predictor of risk and a target for interventions aimed at preventing cardiovascular diseases. TRIAL REGISTRATION Chinese Clinical Trial Registry No. ChiCTR2300067991 on February 2, 2023.
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Affiliation(s)
- Hehe Zhang
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, #2 An Zhen Road, Beijing, 100029, China
- Beijing Anzhen Hospital Centre for Sleep Medicine and Science, Capital Medical University, Beijing, 100029, China
| | - Honghong Liu
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, #2 An Zhen Road, Beijing, 100029, China
| | - Yuanni Jiao
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, #2 An Zhen Road, Beijing, 100029, China
- Beijing Anzhen Hospital Centre for Sleep Medicine and Science, Capital Medical University, Beijing, 100029, China
| | - Jing Zhang
- Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55902, USA
| | - Mu Wang
- School of Aerospace Engineering, Tsinghua University, Beijing, 100084, China
| | - Yun Lin
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, #2 An Zhen Road, Beijing, 100029, China.
| | - Jiang Xie
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, #2 An Zhen Road, Beijing, 100029, China.
- Beijing Anzhen Hospital Centre for Sleep Medicine and Science, Capital Medical University, Beijing, 100029, China.
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20
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Guissé PM, Sall SAB, Niang T, Doucouré TS, Mboup MC, Ngaïdé AA, Mbaye A. [Acute coronary syndromes in diabetes mellitus : A comparative study between diabetics and non-diabetics patients in Senegalese urban environment]. Ann Cardiol Angeiol (Paris) 2024; 73:101767. [PMID: 38723316 DOI: 10.1016/j.ancard.2024.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Diabetes Mellitus is a strong cardiovascular risk factor in which acute coronary syndromes (ACS) are thought to have a particular feature. We aimed to determine the characteristics of acute coronary syndromes in diabetics compared with non-diabetics patients. PATIENTS AND METHODS We carried out a prospective, descriptive and analytical study comparing diabetic and non-diabetic patients admitted for acute coronary syndrome to the cardiology department of Idrissa Pouye general hospital over a period of one year by studying socio-demographic, clinical, paraclinical, therapeutic and evolutionary parameters. We performed a multivariable logistic regression analysis to identify factors associated with chest pain and triple vessels disease. RESULTS Our study included 139 patients, 61 with diabetes (44%) and 78 without diabetes (56%). Among diabetics, there was a predominance of women (p = 0.0001) in contrast to non-diabetics. The mean age was 62.7 ± 10.8 years in diabetics and 56.9 ± 13.5 years in non-diabetics (p = 0.006). Chest pain was found in 88.5% of diabetics and 97.4% of non-diabetics (p = 0.03). The mean HbA1c in diabetics was 9.4 ± 3.3%. ST elevation acute coronary syndrome was predominant in both groups. The mean GRACE score was 147 ± 29 in diabetics and 132 ± 28 in non-diabetics (p = 0.003). In multivariable analysis, only diabetes was associated with triple vessels disease (aOR (IC à 95%): 2,60 (1.29-6.83); p = 0.042). A total of 31% of diabetics and 43% of nondiabetics undergoes cardiac revascularization. There was no difference between the two groups in terms of complications. The mortality was 6.6% and 3.8% respectively among diabetics and non-diabetics (p = 0.49). CONCLUSION According to our study, diabetes is frequently encountered during acute coronary syndromes. It also shows that diabetics are more likely to be female and older, with more atypical symptoms and more severe coronary disease.
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Qiao Z, Bian X, Song C, Zhang R, Yuan S, Lin Z, Zhu C, Liu Q, Ma W, Dou K. High stress hyperglycemia ratio predicts adverse clinical outcome in patients with coronary three-vessel disease: a large-scale cohort study. Cardiovasc Diabetol 2024; 23:190. [PMID: 38824608 PMCID: PMC11144339 DOI: 10.1186/s12933-024-02286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Coronary three-vessel disease (CTVD) accounts for one-third of the overall incidence of coronary artery disease, with heightened mortality rates compared to single-vessel lesions, including common trunk lesions. Dysregulated glucose metabolism exacerbates atherosclerosis and increases cardiovascular risk. The stress hyperglycemia ratio (SHR) is proposed as an indicator of glucose metabolism status but its association with cardiovascular outcomes in CTVD patients undergoing percutaneous coronary intervention (PCI) remains unclear. METHODS 10,532 CTVD patients undergoing PCI were consecutively enrolled. SHR was calculated using the formula: admission blood glucose (mmol/L)/[1.59×HbA1c (%)-2.59]. Patients were divided into two groups (SHR Low and SHR High) according to the optimal cutoff value of SHR. Multivariable Cox regression models were used to assess the relationship between SHR and long-term prognosis. The primary endpoint was cardiovascular (CV) events, composing of cardiac death and non-fatal myocardial infarction (MI). RESULTS During the median follow-up time of 3 years, a total of 279 cases (2.6%) of CV events were recorded. Multivariable Cox analyses showed that high SHR was associated with a significantly higher risk of CV events [Hazard Ratio (HR) 1.99, 95% Confidence interval (CI) 1.58-2.52, P < 0.001). This association remained consistent in patients with (HR 1.50, 95% CI 1.08-2.10, P = 0.016) and without diabetes (HR 1.97, 95% CI 1.42-2.72, P < 0.001). Additionally, adding SHR to the base model of traditional risk factors led to a significant improvement in the C-index, net reclassification and integrated discrimination. CONCLUSIONS SHR was a significant predictor for adverse CV outcomes in CTVD patients with or without diabetes, which suggested that it could aid in the risk stratification in this particular population regardless of glucose metabolism status.
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Affiliation(s)
- Zheng Qiao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaohui Bian
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chenxi Song
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Rui Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Sheng Yuan
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhangyu Lin
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chenggang Zhu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qianqian Liu
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wenjun Ma
- Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China.
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China.
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22
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Conte MS, Azene E, Doros G, Gasper WJ, Hamza T, Kashyap VS, Guzman R, Mena-Hurtado C, Menard MT, Rosenfield K, Rowe VL, Strong M, Farber A. Secondary interventions following open vs endovascular revascularization for chronic limb threatening ischemia in the BEST-CLI trial. J Vasc Surg 2024; 79:1428-1437.e4. [PMID: 38368997 DOI: 10.1016/j.jvs.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Patients undergoing revascularization for chronic limb-threatening ischemia experience a high burden of target limb reinterventions. We analyzed data from the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) randomized trial comparing initial open bypass (OPEN) and endovascular (ENDO) treatment strategies, with a focus on reintervention-related study endpoints. METHODS In a planned secondary analysis, we examined the rates of major reintervention, any reintervention, and the composite of any reintervention, amputation, or death by intention-to-treat assignment in both trial cohorts (cohort 1 with suitable single-segment great saphenous vein [SSGSV], n = 1434; cohort 2 lacking suitable SSGSV, n = 396). We also compared the cumulative number of major and all index limb reinterventions over time. Comparisons between treatment arms within each cohort were made using univariable and multivariable Cox regression models. RESULTS In cohort 1, assignment to OPEN was associated with a significantly reduced hazard of a major limb reintervention (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.28-0.49; P < .001), any reintervention (HR, 0.63; 95% CI, 0.53-0.75; P < .001), or any reintervention, amputation, or death (HR, 0.68; 95% CI, 0.60-0.78; P < .001). Findings were similar in cohort 2 for major reintervention (HR, 0.53; 95% CI, 0.33-0.84; P = .007) or any reintervention (HR, 0.71; 95% CI, 0.52-0.98; P = .04). In both cohorts, early (30-day) limb reinterventions were notably higher for patients assigned to ENDO as compared with OPEN (14.7% vs 4.5% of cohort 1 subjects; 16.6% vs 5.6% of cohort 2 subjects). The mean number of major (mean events per subject ratio [MR], 0.45; 95% CI, 0.34-0.58; P < .001) or any target limb reinterventions (MR, 0.67; 95% CI, 0.57-0.80; P < .001) per year was significantly less in the OPEN arm of cohort 1. The mean number of reinterventions per limb salvaged per year was lower in the OPEN arm of cohort 1 (MR, 0.45; 95% CI, 0.35-0.57; P < .001 and MR, 0.66; 95% CI, 0.55-0.79; P < .001 for major and all, respectively). The majority of index limb reinterventions occurred during the first year following randomization, but events continued to accumulate over the duration of follow-up in the trial. CONCLUSIONS Reintervention is common following revascularization for chronic limb-threatening ischemia. Among patients deemed suitable for either approach, initial treatment with open bypass, particularly in patients with available SSGSV conduit, is associated with a significantly lower number of major and minor target limb reinterventions.
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Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA.
| | - Ezana Azene
- Department of Interventional Radiology, Gundersen Health System, La Crosse, WI
| | | | - Warren J Gasper
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Vikram S Kashyap
- Frederik Meijer Heart and Vascular Institute, Corewell Health, Grand Rapids, MI
| | - Randy Guzman
- Section of Vascular Surgery, Hospital St. Boniface, Winnipeg, Manitoba, Canada
| | | | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Vincent L Rowe
- Division of Vascular Surgery and Endovascular Therapy, University of California, Los Angeles, CA
| | - Michael Strong
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
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23
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Nasso G, Vignaroli W, Amodeo V, Bartolomucci F, Larosa C, Contegiacomo G, Demola MA, Girasoli C, Valenzano A, Fiore F, Bonifazi R, Triggiani V, Vitobello V, Errico G, Lamanna A, Hila D, Loizzo T, Franchino R, Sechi S, Valenti G, Diaferia G, Brigiani MS, Arima S, Angelelli M, Curcio A, Greco F, Greco E, Speziale G, Santarpino G. Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results. J Clin Med 2024; 13:2987. [PMID: 38792527 PMCID: PMC11121999 DOI: 10.3390/jcm13102987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment (p-value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16-5.43]; p-value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Vincenzo Amodeo
- Department of Cardiology, “Santa Maria degli Ungheresi” Hospital, 89024 Polistena, Italy;
| | - Francesco Bartolomucci
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Claudio Larosa
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Cataldo Girasoli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Antongiulio Valenzano
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Raffaele Bonifazi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Vera Triggiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Vincenza Vitobello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Giacomo Errico
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Angela Lamanna
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Dritan Hila
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Tommaso Loizzo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Rosalba Franchino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Stefano Sechi
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Giovanni Valenti
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Giuseppe Diaferia
- Department of Cardiology, “M. Di Miccoli” Hospital, 70051 Barletta, Italy;
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Serena Arima
- Department of Human and Social Sciences Unisalento, University of Salento, 73100 Lecce, Italy; (S.A.); (M.A.)
| | - Mario Angelelli
- Department of Human and Social Sciences Unisalento, University of Salento, 73100 Lecce, Italy; (S.A.); (M.A.)
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy;
| | - Francesco Greco
- Department of Cardiology, “Santissima Annunziata” Hospital, 87100 Cosenza, Italy;
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany
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Nogueira-Garcia B, Vilela M, Oliveira C, Caldeira D, Martins AM, Nobre Menezes M. A Narrative Review of Revascularization in Chronic Coronary Syndrome/Disease: Concepts and Misconceptions. J Pers Med 2024; 14:506. [PMID: 38793088 PMCID: PMC11122013 DOI: 10.3390/jpm14050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Ischemic heart disease represents a significant global burden of morbidity and mortality. While revascularization strategies are well defined in acute settings, there are uncertainties regarding chronic coronary artery disease treatment. Recent trials have raised doubts about the necessity of revascularization for "stable", chronic coronary syndromes or disease, leading to a shift towards a more conservative approach. However, the issue remains far from settled. In this narrative review, we offer a summary of the most pertinent evidence regarding revascularization for chronic coronary disease, while reflecting on less-often-discussed details of major clinical trials. The cumulative evidence available indicates that there can be a prognostic benefit from revascularization in chronic coronary syndrome patients, provided there is significant ischemia, as demonstrated by either imaging or coronary physiology. Trials that have effectively met this criterion consistently demonstrate a reduction in rates of spontaneous myocardial infarction, which holds both prognostic and clinical significance. The prognostic benefit of revascularization in patients with heart failure with reduced ejection fraction remains especially problematic, with a single contemporary trial favouring surgical revascularization. The very recent publication of a trial focused on revascularizing non-flow-limiting "vulnerable" plaques adds further complexity to the field. The ongoing debates surrounding revascularization in chronic coronary syndromes emphasize the importance of personalized strategies. Revascularization, added to the foundational pillar of medical therapy, should be considered, taking into account symptoms, patient preferences, coronary anatomy and physiology, ischemia tests and intra-coronary imaging.
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Affiliation(s)
- Beatriz Nogueira-Garcia
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - Marta Vilela
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
| | - Catarina Oliveira
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
| | - Daniel Caldeira
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
- Faculdade de Medicina, Centro de Estudos de Medicina Baseada na Evidência (CEMBE), 1649-028 Lisbon, Portugal
| | - Ana Margarida Martins
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
| | - Miguel Nobre Menezes
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
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25
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Masuda S, Revaiah PC, Kageyama S, Tsai TY, Miyashita K, Tobe A, Puskas JD, Teichgräber U, Schneider U, Doenst T, Tanaka K, De Mey J, La Meir M, Mushtaq S, Bartorelli AL, Pompilio G, Garg S, Andreini D, Onuma Y, Serruys PW. Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00108-4. [PMID: 38714459 DOI: 10.1016/j.jcct.2024.04.013] [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: 03/08/2024] [Revised: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUNDS The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown. OBJECTIVE This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA). METHODS This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opacification within the coronary occlusion, with corresponding ICA. RESULTS Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66-0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis. CONCLUSION In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis. NCT REGISTRATION NUMBER NCT04142021.
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Affiliation(s)
| | | | | | - Tsung-Ying Tsai
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Akihiro Tobe
- Department of Cardiology, University of Galway, Galway, Ireland
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Kaoru Tanaka
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Belgium
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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26
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Fezzi S, Ding D, Mahfoud F, Huang J, Lansky AJ, Tu S, Wijns W. Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention? Nat Rev Cardiol 2024:10.1038/s41569-024-01014-0. [PMID: 38710772 DOI: 10.1038/s41569-024-01014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
This Perspective article is a form of 'pastiche', inspired by the 1993 review by Lincoff and Topol entitled 'Illusion of reperfusion', and explores how their concept continues to apply to percutaneous revascularization in patients with coronary artery disease and ischaemia. Just as Lincoff and Topol argued that reperfusion of acute myocardial infarction was facing unresolved obstacles that hampered clinical success in 1993, we propose that challenging issues are similarly jeopardizing the potential benefits of stent-based angioplasty today. By analysing the appropriateness and efficacy of percutaneous coronary intervention (PCI), we emphasize the limitations of relying solely on visual angiographic guidance, which frequently leads to inappropriate stenting and overtreatment in up to one-third of patients and the associated increased risk of periprocedural myocardial infarction. The lack of optimal revascularization observed in half of patients undergoing PCI confers risks such as suboptimal physiology after PCI, residual angina and long-term stent-related events, leaving an estimated 76% of patients with an 'illusion of revascularization'. These outcomes highlight the need to refine our diagnostic tools by integrating physiological assessments with targeted intracoronary imaging and emerging strategies, such as co-registration systems and angiography-based computational methods enhanced by artificial intelligence, to achieve optimal revascularization outcomes.
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Affiliation(s)
- Simone Fezzi
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Felix Mahfoud
- Saarland University Hospital, Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Homburg/Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- University Heart Center Basel, Department of Cardiology, University Basel, Basel, Switzerland
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Alexandra J Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shengxian Tu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland.
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27
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Demir ÖF, Koca F. The relationship between triglyceride/high-density lipoprotein cholesterol ratio and the severity of coronary artery disease in patients presenting with acute coronary syndrome. Coron Artery Dis 2024:00019501-990000000-00225. [PMID: 38699854 DOI: 10.1097/mca.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND The SYNTAX score is a score that grades the severity and complexity of coronary lesions. In this study, we aimed to investigate the relationship between triglyceride/high-density lipoprotein cholesterol (triglyceride/HDL-C) ratio and SYNTAX scores in patients presenting with non-ST elevation myocardial infarction (NSTEMI). METHODS This prospective study included 258 patients who presented at our center with STEMI, and underwent coronary angiography (CAG). The triglyceride/HDL-C ratio was calculated, and the relationship of this ratio with the SYNTAX score was determined with univariate and multivariate linear regression analyses. RESULTS The patients were separated into two groups according to the triglyceride/HDL-C ratios as low (<3.88) and high (≥3.88). The SYNTAX scores of the group with a high triglyceride/HDL-C score were determined to be significantly high ( P < 0.001). When the SYNTAX scores were separated into two groups as low (≤22) and high (>23), a statistically significant correlation was determined between a high SYNTAX score and a high triglyceride/HDL-C ratio ( P < 0.001). Logistic regression analysis was performed for the SYNTAX score, and the BMI value [odds ratio (OR) = 0.91, 95% confidence interval (CI): 0.85-0.98] and the triglyceride/HDL-C ratio (OR = 6.86, 95% CI: 3.45-13.65) alone were determined to be independent determinants of the SYNTAX score. CONCLUSION The most important result obtained from this study was that the triglyceride/HDL-C ratio, which is an index that has recently started to be frequently used, was a marker of greater coronary anatomic complexity (SYNTAX score >22), independently of other parameters in patients who presented with NSTEMI and underwent CAG.
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Affiliation(s)
- Ömer Furkan Demir
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
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28
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Khorsandi M, Blumenthal RS, Blaha MJ, Kohli P. The ABCs of the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease. Clin Cardiol 2024; 47:e24284. [PMID: 38766996 PMCID: PMC11103637 DOI: 10.1002/clc.24284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/27/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The 2023 Multisociety Guideline for the Management of Chronic Coronary Disease (CCD) updates recommendations for CCD, formerly known as "stable ischemic heart disease." This condition encompasses a spectrum of coronary vascular pathologies from subclinical to clinical ischemic heart disease. HYPOTHESIS The new "ABC" mnemonic offers clinicians a streamlined framework for applying Class One Recommendations (COR1) and integrating recent updates into CCD management. METHODS A critical analysis of the 2023 CCD guidelines was conducted, with this review highlighting key elements. RESULTS The review outlines crucial changes, including novel recommendations supported by current clinical evidence. The focus is on these developments, clarifying their importance for day-to-day clinical practice. CONCLUSIONS The review encourages a synergistic approach between primary healthcare providers and cardiologists to develop comprehensive strategies for lifestyle modification and medication therapy in CCD care. Furthermore, it suggests that utilizing comprehensive risk assessment tools can refine medical decision-making, ultimately enhancing patient care and clinical outcomes.
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Affiliation(s)
- Michael Khorsandi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMarylandUSA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMarylandUSA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMarylandUSA
| | - Payal Kohli
- Cardiology Division, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
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29
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Bista R, Zghouzi M, Jasti M, Lichaa H, Kerrigan J, Haddad E, Alraies MC, Paul TK. Outcomes of Percutaneous Revascularization in Severe Ischemic Left Ventricular Dysfunction. Curr Cardiol Rep 2024; 26:435-442. [PMID: 38642298 PMCID: PMC11136825 DOI: 10.1007/s11886-024-02045-2] [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] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE OF REVIEW This article presents a comprehensive review of coronary revascularization versus optimal medical therapy (OMT) in patients with severe ischemic left ventricular dysfunction. RECENT FINDINGS The REVIVED-BCIS2 trial randomized 700 patients with extensive coronary artery disease and left ventricular (LV) ejection fraction (LVEF) ≤ 35% and viability in more than four dysfunctional myocardial segments to percutaneous coronary intervention (PCI) plus OMT versus OMT alone. Over a median duration of 41 months, there was no difference in the composite of all-cause mortality, heart failure hospitalization, or improvement in LVEF with PCI plus OMT versus OMT alone at 6 and 12 months, quality of life scores at 24 months, or fatal ventricular arrhythmia. The STICH randomized trial was conducted between 2002 and 2007, involving patients with LV dysfunction and coronary artery disease. The patients were assigned to either CABG plus medical therapy or medical therapy alone. At the 5-year follow-up, the trial showed that CABG plus medical therapy reduced cardiovascular disease-related deaths and hospitalizations but no reduction in all-cause mortality. However, a 10-year follow-up showed a significant decrease in all-cause mortality with CABG. The currently available evidence showed no apparent benefit of PCI in severe ischemic cardiomyopathy as compared to OMT, but that CABG improves outcomes in this patient population. The paucity of data on the advantages of PCI in this patient population underscores the critical need for optimization of medical therapy for better survival and quality of life until further evidence from RCTs is available.
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Affiliation(s)
- Roshan Bista
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Mohamed Zghouzi
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Manasa Jasti
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Hady Lichaa
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Jimmy Kerrigan
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - Elias Haddad
- University of Tennessee Health Science Center, Nashville, TN, USA
- Ascension St., Thomas Hospital, Nashville, TN, USA
| | - M Chadi Alraies
- Detroit Medical Center, Cardiovascular Institute, Heart Hospital, Detroit, MI, USA
| | - Timir K Paul
- University of Tennessee Health Science Center, Nashville, TN, USA.
- Ascension St., Thomas Hospital, Nashville, TN, USA.
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30
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Cheng AM, Doll JA. When to Consider Coronary Revascularization for Stable Coronary Artery Disease. Med Clin North Am 2024; 108:517-538. [PMID: 38548461 DOI: 10.1016/j.mcna.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Revascularization is an effective adjunct to medical therapy for some patients with chronic coronary disease. Despite numerous randomized trials, there remains significant uncertainty regarding if and how to revascularize many patients. Coronary artery bypass grafting is a class I indication for patients with significant left main stenosis or multivessel disease with ejection fraction ≤ 35%. For other patients, clinicians must carefully consider the potential benefits of symptom improvement and reduction of future myocardial infarction or CV death against the risk and cost of revascularization. Although guidelines provide a framework for these decisions, each individual patient will have distinct coronary anatomy, clinical factors, and preferences.
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Affiliation(s)
- Andrew M Cheng
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Section of Cardiology, VA Puget Sound Health Care System, 1660 South Columbian Way S111-CARDIO, Seattle, WA 98108, USA
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Section of Cardiology, VA Puget Sound Health Care System, 1660 South Columbian Way S111-CARDIO, Seattle, WA 98108, USA.
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31
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Gaba P, Sabik JF, Murphy SA, Bellavia A, O'Gara PT, Smith PK, Serruys PW, Kappetein AP, Park SJ, Park DW, Christiansen EH, Holm NR, Nielsen PH, Sabatine MS, Stone GW, Bergmark BA. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation 2024; 149:1328-1338. [PMID: 38465592 DOI: 10.1161/circulationaha.123.065571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Diabetes may be associated with differential outcomes in patients undergoing left main coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The aim of this study was to investigate outcomes in patients with left main disease with and without diabetes randomized to PCI versus CABG. METHODS Individual patient data were pooled from 4 trials (SYNTAX [Synergy Between PCI With Taxus and Cardiac Surgery], PRECOMBAT [Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease], NOBLE [Nordic-Baltic-British Left Main Revascularisation Study], and EXCEL [Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization]) that randomized patients with left main disease to PCI or CABG. Patients were considered suitable for either approach. Patients were categorized by diabetes status. Kaplan-Meier event rates, Cox model hazard ratios, and interactions were assessed. RESULTS Among 4393 patients, 1104 (25.1%) had diabetes. Patients with diabetes experienced higher rates of 5-year death (158/1104 [Kaplan-Meier rate, 14.7%] versus 297/3289 [9.3%]; P<0.001), spontaneous myocardial infarction (MI; 67/1104 [6.7%] versus 114/3289 [3.7%]; P<0.001), and repeat revascularization (189/1104 [18.5%] versus 410/3289 [13.2%]; P<0.001). Rates of all-cause mortality did not differ after PCI versus CABG in those with (84/563 [15.3%] versus 74/541 [14.1%]; hazard ratio, 1.11 [95% CI, 0.82-1.52]) or without (155/1634 [9.7%] versus 142/1655 [8.9%]; hazard ratio, 1.08 [95% CI, 0.86-1.36; PintHR=0.87) diabetes. Rates of stroke within 1 year were lower with PCI versus CABG in the entire population, with no heterogeneity based on diabetes status (PintHR=0.51). The 5-year rates of spontaneous MI and repeat coronary revascularization were higher after PCI regardless of diabetes status (spontaneous MI: 45/563 [8.9%] versus 22/541 [4.4%] in diabetes and 82/1634 [5.3%] versus 32/1655 [2.1%] in no diabetes, PintHR=0.47; repeat revascularization: 127/563 [24.5%] versus 62/541 [12.4%] in diabetes and 254/1634 [16.3%] versus 156/1655 [10.1%] in no diabetes, PintHR=0.18). For spontaneous MI and repeat revascularization, there were greater absolute risk differences beyond 1 year in patients with diabetes (4.9% and 9.9%) compared with those without (2.1% and 4.3%; PintARD=0.047 and 0.016). CONCLUSIONS In patients with left main disease considered equally suitable for PCI or CABG and with largely low to intermediate SYNTAX scores, diabetes was associated with higher rates of death and cardiovascular events through 5 years. Compared with CABG, PCI resulted in no difference in the risk of death and a lower risk of early stroke regardless of diabetes status, and a higher risk of spontaneous MI and repeat coronary revascularization, with larger late absolute excess risks in patients with diabetes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01205776, NCT0146651, NCT00422968, and NCT00114972.
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Affiliation(s)
- Prakriti Gaba
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, OH (J.F.S.)
| | - Sabina A Murphy
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Andrea Bellavia
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Patrick T O'Gara
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Peter K Smith
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC (P.K.S)
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, UK (P.W.S.)
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands (A.P.K.)
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, Seoul, South Korea (S.-J.P., D.-W.P.,)
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, Seoul, South Korea (S.-J.P., D.-W.P.,)
| | - Evald H Christiansen
- Department of Cardiology, Aarhus, Aarhus University Hospital, Denmark (E.H.C., N.R.H., P.H.N.)
| | - Niels R Holm
- Department of Cardiology, Aarhus, Aarhus University Hospital, Denmark (E.H.C., N.R.H., P.H.N.)
| | - Per H Nielsen
- Department of Cardiology, Aarhus, Aarhus University Hospital, Denmark (E.H.C., N.R.H., P.H.N.)
| | - Marc S Sabatine
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | - Brian A Bergmark
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
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Ozuynuk-Ertugrul AS, Kirsan CB, Erkan AF, Ekici B, Komurcu-Bayrak E, Coban N. Genetic variants of ANRIL and coronary artery disease: Insights from a Turkish study population. Gene 2024; 917:148475. [PMID: 38631653 DOI: 10.1016/j.gene.2024.148475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIM Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally despite advancements in treatment. Long non-coding RNAs (lncRNAs) play crucial roles in the atherosclerotic process, with ANRIL being one such lncRNA. This study explored the association between ANRIL polymorphisms (rs1333049:C > G, rs564398:T > C, and rs10757274:A > G) and CAD along with CAD risk factors in a Turkish patient group. METHODS The study included 1285 participants, consisting of 736 patients diagnosed with CAD (mean age = 63.3 ± 10.5 years) and 549 non-CAD controls (mean age = 57.52 ± 11.01 years). Genotypes for rs1333049, rs564398, and rs10757274 were determined using qRT-PCR. RESULTS G allele carriage of both rs1333049 and rs10757274 polymorphisms were associated with higher Gensini score, SYNTAX score, total cholesterol, and triglyceride levels in female CAD patients and non-CAD males. Females with rs564398 CC genotype were more susceptible to CAD (p = 0.02) and severe CAD (p = 0.05). Moreover, the G and T alleles of rs10757274 and rs564398 were more prevalent among hypertensive males. Also, carrying the C allele for rs564398 was associated with a decreased risk for type 2 diabetes mellitus (T2DM) (p = 0.02). Besides, carriers of the rs1333049 C allele for decreased risk for T2DM (p = 0.03) and CAD complexed with T2DM (p = 0.04) in logistic regression analyses. CONCLUSIONS In conclusion, selected ANRIL polymorphisms were associated with CAD presence/severity and CAD risk factors, T2DM, and hypertension. Notably, this study, the largest sample-sized study examining the effects of selected polymorphisms on CAD and its risk factors among Turkish individuals, supported the findings of previous studies conducted on different ethnicities.
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Affiliation(s)
- Aybike Sena Ozuynuk-Ertugrul
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey; Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey
| | - Cemre Buse Kirsan
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey; Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey
| | - Aycan Fahri Erkan
- Ufuk University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Berkay Ekici
- Ufuk University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Evrim Komurcu-Bayrak
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, Turkey
| | - Neslihan Coban
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey.
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da Silveira Maia A, Dos Santos MA. 2023 ACC/AHA Chronic Coronary Disease Guideline - An opportunity to reestablish coronary artery bypass recommendations. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00172-6. [PMID: 38631937 DOI: 10.1016/j.carrev.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
Coronary artery bypass (CABG) has evolved over the decades, supported by scientific evidence from robust studies. The downgrade of the recommendation for CABG in patients with multivessel coronary artery disease proposed by the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization and the 2023 ACC/AHA Chronic Coronary Disease Guidelines has brought this discussion to the fore, with prestigious cardiothoracic surgery societies such as AATS and STS not supporting these recommendations. The purpose of this article is to broaden this discussion in light of published studies.
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D'Angelo O, Menard MT, Farber A. Common Criticisms and Rebuttals of the Best Endovascular Versus Best Surgical Therapy in Patients with Chronic Limb-Threatening Ischemia (BEST-CLI) Trial. Ann Vasc Surg 2024:S0890-5096(24)00149-3. [PMID: 38599479 DOI: 10.1016/j.avsg.2023.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 04/12/2024]
Abstract
The Best Endovascular Versus Best Surgical Therapy in Patients With Chronic Limb-Threatening Ischemia trial was a landmark trial which provides high-quality data for the decision-making regarding the treatment of chronic-limb threatening ischemia. Overall, the trial suggests that in patients with adequate greater saphenous vein conduit, bypass surgery should be offered as a first line treatment given superior outcomes. In this article, we outline the common critiques of the trial, followed by responses to provide a deeper understanding of the strengths and limitations of this important trial.
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Affiliation(s)
- Olivia D'Angelo
- Division of Vascular & Endovascular Surgery, Boston University School of Medicine, Boston, MA.
| | - Matthew T Menard
- Division of Vascular Surgery, Brigham and Women's Hospital, Boston, MA
| | - Alik Farber
- Division of Vascular & Endovascular Surgery, Boston University School of Medicine, Boston, MA
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Fan T, Li Y, Li M, Zhu N, Zhang C, Wang X. The correlation between subendocardial viability ratio and the degree of coronary artery stenosis in patients with coronary heart disease and its predictive value for the incidence of short-term cardiovascular events. Coron Artery Dis 2024:00019501-990000000-00213. [PMID: 38595165 DOI: 10.1097/mca.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study aimed to analyze the ability of subendocardial viability ratio (SEVR) to predict the degree of coronary artery stenosis and the relationship between SEVR and the incidence of short-term cardiovascular endpoint events. METHOD The indexes of 243 patients with chest pain were collected.. Binary logistic regression analyses were performed using the dichotomous outcome of high and non-high SYNTAX scores. Receiver operating characteristic curves were employed to comparatively analyze the diagnostic efficiencies of the indices and models. A survival analysis combined with the Cox regression analysis was performed using the Kaplan-Meier method to understand the relationship between the SEVR and the incidence of cardiovascular events within 1 year in patients with coronary heart disease (CHD). RESULTS SEVR was significantly lower (P < 0.05) in the high-stenosis group than control and low-stenosis groups. The diagnostic efficacy of SEVR [area under the curve (AUC) = 0.861] was better than those of age (AUC = 0.745), ABI (AUC = 0.739), and AIx@HR75 (AUC = 0.659). The cutoff SEVR was 1.105. In patients with confirmed CHD who had been discharged from the hospital for 1 year, only SEVR affected survival outcomes (hazard ratio = 0.010; 95% confidence interval: 0.001-0.418; P = 0.016). CONCLUSION A significant decrease in SEVR predicted severe coronary artery stenosis, with a cutoff value of 1.105 and an accuracy of 0.861. In patients with CHD, the lower the SEVR, the higher was the rate of cardiovascular events at 1 year after hospital discharge.
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Affiliation(s)
- Tingting Fan
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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36
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Cader FA, Arshad N, Tremmel JA. Highlights From the Society for Cardiovascular Angiography & Interventions (SCAI) Scientific Sessions 2023. J Am Heart Assoc 2024; 13:e031067. [PMID: 38533981 PMCID: PMC11179763 DOI: 10.1161/jaha.123.031067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
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37
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Rogers RK, Herold J, Govsyeyev N, Iezzi R, Morrison J, Hogan SE, Nehler M, Bricker R, Andring B, Bergmark B, Cavender M, Malgor E, Jacobs D, Young MN, Capell W, Yčas JW, Anand SS, Berkowitz SD, Debus ES, Haskell LP, Muehlhofer E, Patel MR, Hess CN, Bauersachs RM, Anderson V, Bonaca MP. Methods, design, and initial results of an angiographic core lab from VOYAGER-PAD. Vasc Med 2024; 29:143-152. [PMID: 38493348 PMCID: PMC11010567 DOI: 10.1177/1358863x241228542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Background: Anatomy is critical in risk stratification and therapeutic decision making in coronary disease. The relationship between anatomy and outcomes is not well described in PAD. We sought to develop an angiographic core lab within the VOYAGER-PAD trial. The current report describes the methods of creating this core lab, its study population, and baseline anatomic variables. Methods: Patients undergoing lower-extremity revascularization for symptomatic PAD were randomized in VOYAGER-PAD. The median follow up was 2.25 years. Events were adjudicated by a blinded Clinical Endpoint Committee. Angiograms were collected from study participants; those with available angiograms formed this core lab cohort. Angiograms were scored for anatomic and flow characteristics by trained reviewers blinded to treatment. Ten percent of angiograms were evaluated independently by two reviewers; inter-rater agreement was assessed. Clinical characteristics and the treatment effect of rivaroxaban were compared between the core lab cohort and noncore lab participants. Anatomic data by segment were analyzed. Results: Of 6564 participants randomized in VOYAGER-PAD, catheter-based angiograms from 1666 patients were obtained for this core lab. Anatomic and flow characteristics were collected across 16 anatomic segments by 15 reviewers. Concordance between reviewers for anatomic and flow variables across segments was 90.5% (24,417/26,968). Clinical characteristics were similar between patients in the core lab and those not included. The effect of rivaroxaban on the primary efficacy and safety outcomes was also similar. Conclusions: The VOYAGER-PAD angiographic core lab provides an opportunity to correlate PAD anatomy with independently adjudicated outcomes and provide insights into therapy for PAD. (ClinicalTrials.gov Identifier: NCT02504216).
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Affiliation(s)
- R Kevin Rogers
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Joerg Herold
- Department of Angiology, Darmstadt Hospital, Darmstadt, Germany
| | - Nicholas Govsyeyev
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Roberto Iezzi
- Department of Radiology, Agostino Gemelli University Hospital, IRCCS, Catholic University, Rome, Italy
| | - Justin Morrison
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shea E Hogan
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Mark Nehler
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Rory Bricker
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Brian Bergmark
- Thrombolysis in Myocardial Infarction Study Group, Brigham and Women’s Hospital, Boston, MA, USA
| | - Matt Cavender
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Emily Malgor
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Donald Jacobs
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael N Young
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Warren Capell
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | - Sonia S Anand
- Vascular Medicine, McMaster University, Hamilton, ON, Canada
| | - Scott D Berkowitz
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | | | | | - Manesh R Patel
- Division of Cardiology, Duke Medical Center, Durham, NC, USA
| | - Connie N Hess
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | | | - Marc P Bonaca
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- CPC Clinical Research, Aurora, CO, USA
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Seto AH, Yau P. Does ejection fraction matter in choosing between percutaneous coronary intervention and coronary artery bypass surgery? Catheter Cardiovasc Interv 2024; 103:826-827. [PMID: 38494669 DOI: 10.1002/ccd.31014] [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: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Key points
Left ventricular systolic dysfunction has traditionally been used as a risk factor favoring coronary artery bypass surgery over percutaneous coronary intervention (PCI), but recent data have challenged this.
Retrospective data from the BIOFLOW trials show no difference between normal and moderately abnormal LVEF (30%–50%) in acute complications or target vessel failure.
Abnormal LVEF may be a marker for comorbidities but no longer a relative contraindication to PCI.
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Affiliation(s)
- Arnold H Seto
- Charles R Drew University School of Medicine, Los Angeles, California, USA
- Long Beach VA Medical Center, Long Beach, California, USA
- Irvine Medical Center, University of California, Irvine, Irvine, California, USA
| | - Persephone Yau
- Irvine Medical Center, University of California, Irvine, Irvine, California, USA
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Asano T, Tanigaki T, Ikeda K, Ono M, Yokoi H, Kobayashi Y, Kozuma K, Tanaka N, Kawase Y, Matsuo H. Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2024; 39:109-125. [PMID: 38367157 PMCID: PMC10940478 DOI: 10.1007/s12928-024-00988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/19/2024]
Abstract
Invasive functional coronary angiography (FCA), an angiography-derived physiological index of the functional significance of coronary obstruction, is a novel physiological assessment tool for coronary obstruction that does not require the utilization of a pressure wire. This technology enables operators to rapidly evaluate the functional relevance of coronary stenoses during and even after angiography while reducing the burden of cost and complication risks related to the pressure wire. FCA can be used for treatment decision-making for revascularization, strategy planning for percutaneous coronary intervention, and procedure optimization. Currently, various software-computing FCAs are available worldwide, with unique features in their computation algorithms and functions. With the emerging application of this novel technology in various clinical scenarios, the Japanese Association of Cardiovascular Intervention and Therapeutics task force was created to outline expert consensus on the clinical use of FCA. This consensus document advocates optimal clinical applications of FCA according to currently available evidence while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software.
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Affiliation(s)
- Taku Asano
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, P.O. Box 104-8560, Tokyo, Japan.
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Kazumasa Ikeda
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masafumi Ono
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, P.O. Box 104-8560, Tokyo, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University, Chiba, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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Kedhi E, Rroku A, Hermanides RS, Dambrink JH, Singh S, Berg JT, van Ginkel DJ, Hudec M, Amoroso G, Amat-Santos IJ, Andreas M, Teles RC, Bonnet G, Van Belle E, Conradi L, van Garsse L, Wojakowski W, Voudris V, Sacha J, Cervinka P, Lipsic E, Somi S, Nombela-Franco L, Postma S, Piayda K, De Luca G, Malinofski K, Modine T. TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and multivessel or advanced coronary disease: The transcatheter valve and vessels trial (TCW trial): Design and rationale. Am Heart J 2024; 270:86-94. [PMID: 38309610 DOI: 10.1016/j.ahj.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) frequently present with concomitant obstructive coronary artery disease (CAD). In those, current guidelines recommend combined coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) as the preferred treatment option, although this surgical approach is associated with a high rate of clinical events. Combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) with or without FFR have evolved as a valid alternative for cardiac surgery in patients with AS and multivessel or advanced CAD. To date, no dedicated trial has prospectively evaluated the outcomes of a percutaneous versus surgical treatment for patients with both severe AS and CAD. AIMS To investigate whether fractional-flow reserve (FFR)-guided PCI and TAVI is noninferior to combined CABG and SAVR for the treatment of severe AS and multivessel or advanced CAD. METHODS The Transcatheter Valve and Vessels (TCW) trial (clinicaltrial.gov: NCT03424941) is a prospective, randomized, controlled, open label, international trial. Patients ≥ 70 years with severe AS and multivessel (≥ 2 vessels) or advanced CAD, deemed feasible by the heart team for both; a full percutaneous or surgical treatment, will be randomised in a 1:1 fashion to either FFR-guided PCI followed by TAVI (intervention arm) vs. CABG and SAVR (control arm). The primary endpoint is a patient-oriented composite of all-cause mortality, myocardial infarction, disabling stroke, unscheduled clinically-driven target vessel revascularization, valve reintervention, and life threatening or disabling bleeding at 1 year. The TCW trial is powered for noninferiority, and if met, superiority will be tested. Assuming a primary endpoint rate of 30% in the CABG-SAVR arm, with a significance level α of 5%, a noninferiority limit delta of 15% and a loss to follow-up of 2%, a total of 328 patients are needed to obtain a power of 90%. The primary endpoint analysis is performed on an intention-to-treat basis. SUMMARY The TCW Trial is the first prospective randomized trial that will study if a less invasive percutaneous treatment for severe AS and concomitant advanced CAD (i.e., FFR-guided PCI-TAVI) is noninferior to the guidelines recommended approach (CABG-SAVR).
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Affiliation(s)
- Elvin Kedhi
- McGill University Health Center, Montreal, Quebec, Canada; Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland.
| | - Andi Rroku
- Department of Cardiology, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Rik S Hermanides
- Isala Heart Center, Department of Cardiology, Zwolle, The Netherlands
| | - Jan Henk Dambrink
- Isala Heart Center, Department of Cardiology, Zwolle, The Netherlands
| | - Sandeep Singh
- Isala Heart Center, Department of Thoracic Surgery, Zwolle, The Netherlands
| | - Jurriën Ten Berg
- St.Antonius Ziekenhuis, Nieuwegein, The Netherlands and University Medical Center Maastricht, Maastricht, The Netherlands
| | - Dirk-Jan van Ginkel
- St.Antonius Ziekenhuis, Nieuwegein, The Netherlands and University Medical Center Maastricht, Maastricht, The Netherlands
| | | | - Giovanni Amoroso
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomdica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Guillaume Bonnet
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Eric Van Belle
- CHU Lille, Department of Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Puomon, Inserm, U1011, Institut Pasteur de Lille, EGIG, Université de Lille, Lille, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany
| | - Leen van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, The Netherlands
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Disease, Medical Univ. Silesia, Katowice, Poland
| | - Vasileious Voudris
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Jerzy Sacha
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland; Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Pavel Cervinka
- Department of Cardiology, Krajska Zdravotni A.S., Masaryk Hospital and UJEP Usti nad Labem, Czech Republic
| | - Erik Lipsic
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Samer Somi
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | | | | | - Kerstin Piayda
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, Giessen, Germany
| | - Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, University of Sassari, Sassari, Italy
| | - Krzysztof Malinofski
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kraków, Poland; Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Thomas Modine
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
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41
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Wang Y, Ma X, Yang Z, Li Q, Zhou Y, Gao F, Wang Z. Value of Absolute Eosinophil Count in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Int J Gen Med 2024; 17:1025-1038. [PMID: 38525068 PMCID: PMC10959244 DOI: 10.2147/ijgm.s451900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background and Aims Elevated eosinophils typically indicate hypersensitive inflammation; however, their involvement in cardiovascular events remains incompletely understood. We investigated the association between the absolute eosinophil count (AEC) and major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Additionally, we determine whether the integration of AEC with the SYNTAX II score could improve predictive ability. Methods and Results The AECs of 1711 patients with ACS undergoing PCI from June 2016 to November 2017 were analyzed on admission. All recruitments were splitted into three groups based on AEC tertiles and 101 participants underwent one or more noteworthy outcomings. The association between AEC and MACCEs (defined as a composite of cardiovascular death, myocardial infarction [MI], and stroke) was tested by Cox proportional-hazards regression analysis. After adjusting for confounders, AEC was independently associated with MACCEs (HR 11.555, 95% CI: 3.318-40.239). Patients in the lowest AEC tertile (T1) as a reference, those in the higher tertiles had an incrementally higher risk of MACCEs (T3: HR 1.848 95% CI: 1.157-2.952; P for trend=0.008). Inclusion of AEC enhanced the predictive accuracy of the SYNTAX II score for MACCEs (AUC: from 0.701 [95% CI: 0.646-0.756] to 0.728 [95% CI: 0.677-0.780]; DeLong's test, P = 0.020). Conclusion AEC is independently linked to MACCEs in ACS patients who underwent PCI, and adds incremental predictive information to the SYNTAX II score.
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Affiliation(s)
- Yufei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Zhiqiang Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qiuxuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
| | - Fei Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
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Alzahrani AH, Itagaki S, Egorova NN, Chikwe J. Choice of revascularization strategy for ischemic cardiomyopathy due to multivessel coronary disease. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00208-3. [PMID: 38492720 DOI: 10.1016/j.jtcvs.2024.03.007] [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: 11/24/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Limited comparative data guide the decision between coronary artery bypass grafting and percutaneous coronary intervention for multivessel revascularization in ischemic cardiomyopathy. The study objective was to compare the long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention for ischemic cardiomyopathy. METHODS Clinical registries from the New Jersey Department of Health linked to administrative databases were used to compare all-cause mortality, repeat revascularization, heart failure readmissions, myocardial infarction, and stroke using Cox proportional hazards and propensity matching with competing risk analysis in 5988 patients with ejection fraction 35% or less who underwent coronary artery bypass grafting (3673, 61.3%) or percutaneous coronary intervention (2315, 38.6%) for multivessel coronary disease between 2007 and 2018. Median follow-up time was 5.2 years (range, 0-13 years); the last follow-up date was December 31, 2020. RESULTS After controlling for completeness of revascularization, at 13 years, mortality was 57% (95% CI, 51-63) after percutaneous coronary intervention and 60% (95% CI, 53-66) after coronary artery bypass grafting (hazard ratio [HR], 1.10; 95% CI, 0.93-1.31; P = .28); risk of repeat revascularization was 18% for percutaneous coronary intervention versus 14% for coronary artery bypass grafting (HR, 1.62; 95% CI, 1.17-2.25; P = .003); risk of readmission for heart failure was 16% after percutaneous coronary intervention and coronary artery bypass grafting (HR, 1.13,95% CI, 0.84-1.51, weighted P = .10); risk of myocardial infarction was 10% versus 6%, respectively (HR, 1.91; 95% CI, 1.18-3.09; P = .007); and stroke risk was 3% versus 4%, respectively (HR, 0.79; 95% CI, 0.41-1.53; P = .52). Rate of complete revascularization was lower after percutaneous coronary intervention than after coronary artery bypass grafting and associated with higher mortality after percutaneous coronary intervention (HR, 1.35; 95% CI, 1.20-1.52; P < .001). CONCLUSIONS Coronary bypass was associated with similar mortality, stroke, and heart failure readmissions, and reduced repeat revascularization compared with percutaneous coronary intervention in patients with ischemic cardiomyopathy if similar rates of complete revascularization were achieved. These findings support consensus recommendations for coronary artery bypass grafting and medical therapy in patients with multivessel coronary disease and left ventricular dysfunction.
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Affiliation(s)
- Anas H Alzahrani
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
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Lin J, Li G, Ji Y, Xu Y, Liu S, Qu Z, Li P, You B. Comparing clinical outcomes of hybrid coronary revascularization with open coronary artery bypass in patients with multi-vessels lesions. Perfusion 2024:2676591241238871. [PMID: 38458155 DOI: 10.1177/02676591241238871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Hybrid coronary revascularization (HCR) involves the use of minimally invasive direct coronary artery bypass grafting (CABG) to treat the left anterior descending artery (LAD), and percutaneous coronary intervention to treat non-LAD vessels. We reported the results of a comparative analysis between HCR and off-pump CABG via sternotomy (OPCABG). METHODS Data were retrospectively collated from patients who underwent HCR or OPCABG for multivessel coronary artery disease between 2011 and 2022. Propensity score-based matching was performed to reduce the selection bias. The Comparisons of cardiac-related death, major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization were performed by Kaplan-Meier analysis or the Fine-Gray test. RESULTS After matching, the baseline characteristics were well-balanced between the two groups with 91 patients per group. There was no significant difference in operative mortality rate (1.1% for HCR vs2.2% for OPCABG, p = 1.000). However, patients undergoing HCR required a significantly lower rate of blood product transfusions (p < .001) and experienced significantly fewer pulmonary complications than OPCABG patients (p < .001). At 10 years, the incidences of cardiac-related death, MACCE and repeat revascularization did not differ significantly between the two groups (9.5% vs11.5%, p = .277; 4.7% vs12.3%, p = .361; 1.2% vs2.5%, p = .914, respectively). CONCLUSIONS For patients with multi-vessel lesions, HCR was comparable to OPCABG in long-term outcomes such as cardiac-related death, MACCE, and the durability of grafts. Additionally, HCR was better than OPCABG in perioperative outcomes. HCR may be an alternative therapy for OPCABG in patients with multi-vessel coronary artery disease.
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Affiliation(s)
- Ji Lin
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Guang Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yuan Ji
- Peking University Clinical Research Institute, Beijing, China
| | - Yi Xu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shuo Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zheng Qu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Ping Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Bin You
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Mangalesh S, Dudani S, Mahesh NK. Development of a Novel Inflammatory Index to Predict Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome. Angiology 2024; 75:231-239. [PMID: 36629740 DOI: 10.1177/00033197231151564] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) have previously demonstrated predictive value in coronary artery disease (CAD). We developed on an expanded, novel systemic immune-inflammation response index (SIIRI), calculated as peripheral neutrophil × monocyte × platelet ÷ lymphocyte count. We assessed 240 patients with an acute coronary syndrome that subsequently underwent percutaneous coronary intervention. CAD severity was measured using the SYNTAX score. Laboratory measurements, including cell counts, were obtained on admission. On multivariate analysis, the SIIRI was an independent predictor of severe CAD with an adjusted odds ratio (OR) of 1.666 [1.376-2.017] per 105-unit increase. The SIIRI had the highest area under the receiver operator curve of .771 [.709-.833] compared to the SII, SIRI neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio. The optimal cut-off for SIIRI was 4.3 × 105, with sensitivity = 69.9% and specificity = 75.8%. Increment in model performance resulting from adding SIIRI versus other inflammatory indices was assessed using discrimination, calibration, and goodness-of-fit measures. When added to a baseline model, the SIIRI resulted in a significant increase in the c-statistic and significant net reclassification index (.808, P < .0001) and integrated discrimination index (.129, P < .0001), and a decrease in Akaike and Bayesian information criteria.
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Affiliation(s)
- Sridhar Mangalesh
- Department of Medicine, Army College of Medical Sciences, New Delhi, India
| | - Sharmila Dudani
- Department of Pathology, Army College of Medical Sciences, New Delhi, India
| | - Nalin K Mahesh
- Department of Cardiology, Army College of Medical Sciences, New Delhi, India
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45
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Lawal OA, Awosoga OA, Santana MJ, Ayilara OF, Wang M, Graham MM, Norris CM, Wilton SB, James MT, Sajobi TT. Response shift in coronary artery disease. Qual Life Res 2024; 33:767-776. [PMID: 38133786 DOI: 10.1007/s11136-023-03564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Patients with coronary artery disease (CAD) experience significant angina symptoms and lifestyle changes. Revascularization procedures can result in better patient-reported outcomes (PROs) than optimal medical therapy (OMT) alone. This study evaluates the impact of response shift (RS) on changes in PROs of patients with CAD across treatment strategies. METHODS Data were from patients with CAD in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry who completed the 16-item Canadian version of the Seattle Angina Questionnaire at 2 weeks and 1 year following a coronary angiogram. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across treatment groups at week 2. Longitudinal MG-CFA was used to test for RS according to receipt of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical therapy (OMT) alone. RESULTS Of the 3116 patients included in the analysis, 443 (14.2%) received CABG, 2049(65.8%) PCI, and the remainder OMT alone. The MG-CFA revealed a partial-strong invariance across the treatment groups at 2 weeks (CFI = 0.98, RMSEA [90% CI] = 0.05 [0.03, 0.06]). Recalibration RS was detected on the Angina Symptoms and Burden subscale and its magnitude in the OMT, PCI, and CABG groups were 0.32, 0.28, and 0.53, respectively. After adjusting for RS effects, the estimated target changes were largest in the CABG group and negligible in the OMT group. CONCLUSION Adjusting for RS is recommended in studies that use SAQ-CAN to assess changes in patients with CAD who have received revascularization versus OMT alone.
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Affiliation(s)
- Oluwaseyi A Lawal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Olawale F Ayilara
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Meng Wang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michelle M Graham
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - Stephen B Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Matthew T James
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Szoke D, Bainbridge D. Contrast and Compare: New Imaging Modalities for Angiography. J Cardiothorac Vasc Anesth 2024; 38:601-603. [PMID: 38148264 DOI: 10.1053/j.jvca.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Daniel Szoke
- Department of Anesthesiology and Perioperative Medicine, Western University and London Health Sciences Center, London, ON, Canada.
| | - Daniel Bainbridge
- Department of Anesthesiology and Perioperative Medicine, Western University and London Health Sciences Center, London, ON, Canada
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Natsuaki M, Watanabe H, Morimoto T, Yamamoto K, Obayashi Y, Nishikawa R, Ando K, Domei T, Suwa S, Ogita M, Isawa T, Takenaka H, Yamamoto T, Ishikawa T, Hisauchi I, Wakabayashi K, Onishi Y, Hibi K, Kawai K, Yoshida R, Suzuki H, Nakazawa G, Kusuyama T, Morishima I, Ono K, Kimura T. An Aspirin-Free Versus Dual Antiplatelet Strategy for Coronary Stenting: STOPDAPT-3 Randomized Trial. Circulation 2024; 149:585-600. [PMID: 37994553 DOI: 10.1161/circulationaha.123.066720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Bleeding rates on dual antiplatelet therapy (DAPT) within 1 month after percutaneous coronary intervention (PCI) remain high in clinical practice, particularly in patients with acute coronary syndrome or high bleeding risk. Aspirin-free strategy might result in lower bleeding early after PCI without increasing cardiovascular events, but its efficacy and safety have not yet been proven in randomized trials. METHODS We randomly assigned 6002 patients with acute coronary syndrome or high bleeding risk just before PCI either to prasugrel (3.75 mg/day) monotherapy or to DAPT with aspirin (81-100 mg/day) and prasugrel (3.75 mg/day) after loading of 20 mg of prasugrel in both groups. The coprimary end points were major bleeding (Bleeding Academic Research Consortium 3 or 5) for superiority and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke) for noninferiority with a relative 50% margin. RESULTS The full analysis set population consisted of 5966 patients (no-aspirin group, 2984 patients; DAPT group, 2982 patients; age, 71.6±11.7 years; men, 76.6%; acute coronary syndrome, 75.0%). Within 7 days before randomization, aspirin alone, aspirin with P2Y12 inhibitor, oral anticoagulants, and intravenous heparin infusion were given in 21.3%, 6.4%, 8.9%, and 24.5%, respectively. Adherence to the protocol-specified antiplatelet therapy was 88% in both groups at 1 month. At 1 month, the no-aspirin group was not superior to the DAPT group for the coprimary bleeding end point (4.47% and 4.71%; hazard ratio, 0.95 [95% CI, 0.75-1.20]; Psuperiority=0.66). The no-aspirin group was noninferior to the DAPT group for the coprimary cardiovascular end point (4.12% and 3.69%; hazard ratio, 1.12 [95% CI, 0.87-1.45]; Pnoninferiority=0.01). There was no difference in net adverse clinical outcomes and each component of coprimary cardiovascular end point. There was an excess of any unplanned coronary revascularization (1.05% and 0.57%; hazard ratio, 1.83 [95%CI, 1.01-3.30]) and subacute definite or probable stent thrombosis (0.58% and 0.17%; hazard ratio, 3.40 [95% CI, 1.26-9.23]) in the no-aspirin group compared with the DAPT group. CONCLUSIONS The aspirin-free strategy using low-dose prasugrel compared with the DAPT strategy failed to attest superiority for major bleeding within 1 month after PCI but was noninferior for cardiovascular events within 1 month after PCI. However, the aspirin-free strategy was associated with a signal suggesting an excess of coronary events. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04609111.
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Affiliation(s)
- Masahiro Natsuaki
- Department of Cardiovascular Medicine, Saga University, Japan (M.N.)
| | - Hirotoshi Watanabe
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan (H.W., H.T., T.Y., T.K.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.)
| | - Ko Yamamoto
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan (K.Y., K.A., T.D.)
| | - Yuki Obayashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y. Obayashi, R.N., K.O.)
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y. Obayashi, R.N., K.O.)
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan (K.Y., K.A., T.D.)
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan (K.Y., K.A., T.D.)
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan (S.S., M.O.)
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan (S.S., M.O.)
| | - Tsuyoshi Isawa
- Department of Cardiology, Sendai Kousei Hospital, Japan (T. Isawa)
| | - Hiroyuki Takenaka
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan (H.W., H.T., T.Y., T.K.)
| | - Takashi Yamamoto
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan (H.W., H.T., T.Y., T.K.)
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan (T. Ishikawa, I.H.)
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan (T. Ishikawa, I.H.)
| | - Kohei Wakabayashi
- Department of Cardiology, Showa University Koto Toyosu Hospital, Tokyo, Japan (K.W.)
| | - Yuko Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital, Japan (Y. Onishi)
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H.)
| | - Kazuya Kawai
- Division of Cardiology, Chikamori Hospital, Kochi, Japan (K.K.)
| | - Ruka Yoshida
- Division of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (R.Y.)
| | - Hiroshi Suzuki
- Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan (H.S.)
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan (G.N.)
| | - Takanori Kusuyama
- Division of Cardiology, Tsukazaki Hospital, Himeji, Japan (T. Kusuvama)
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.)
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y. Obayashi, R.N., K.O.)
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan (H.W., H.T., T.Y., T.K.)
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Zeng Y, Xu J, Deng Y, Li X, Chen W, Tang Y. Drug-eluting stents for coronary artery disease in the perspective of bibliometric analysis. Front Cardiovasc Med 2024; 11:1288659. [PMID: 38440210 PMCID: PMC10910058 DOI: 10.3389/fcvm.2024.1288659] [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: 09/04/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Drug-eluting stents (DES) play a crucial role in treating coronary artery disease (CAD) by preventing restenosis. These stents are coated with drug carriers that release antiproliferative drugs within the vessel. Over the past two decades, DES have been employed in clinical practice using various materials, polymers, and drug types. Despite optimizations in their design and materials to enhance biocompatibility and antithrombotic properties, evaluating their long-term efficacy and safety necessitates improved clinical follow-up and monitoring. To delineate future research directions, this study employs a bibliometric analysis approach. We comprehensively surveyed two decades' worth of literature on DES for CAD using the Web of Science Core Collection (WOSCC). Out of 5,778 articles, we meticulously screened them based on predefined inclusion and exclusion criteria. Subsequently, we conducted an in-depth analysis encompassing annual publication trends, authorship affiliations, journal affiliations, keywords, and more. Employing tools such as Excel 2021, CiteSpace 6.2R3, VOSviewer 1.6.19, and Pajek 5.17, we harnessed bibliometric methods to derive insights from this corpus. Analysis of annual publication data indicates a recent stabilisation or even a downward trend in research output in this area. The United States emerged as the leading contributor, with Columbia University and CRF at the forefront in both publication output and citation impact. The most cited document pertained to standardized definitions for clinical endpoints in coronary stent trials. Our author analysis identifies Patrick W. Serruys as the most prolific contributor, underscoring a dynamic exchange of knowledge within the field.Moreover, the dual chart overlay illustrates a close interrelation between journals in the "Medicine," "Medical," and "Clinical" domains and those in "Health," "Nursing," and "Medicine." Frequently recurring keywords in this research landscape include DES coronary artery disease, percutaneous coronary intervention, implantation, and restenosis. This study presents a comprehensive panorama encompassing countries, research institutions, journals, keyword distributions, and contributions within the realm of DES therapy for CAD. By highlighting keywords exhibiting recent surges in frequency, we elucidate current research hotspots and frontiers, thereby furnishing novel insights to guide future researchers in this evolving field.
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Affiliation(s)
- Ying Zeng
- Jiangxi Medical College, Nanchang University, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jiawei Xu
- Jiangxi Medical College, Nanchang University, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yuxuan Deng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiaoxing Li
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wen Chen
- Jiangxi Cancer Hospital, Nanchang, China
| | - Yu Tang
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Jonik S, Kageyama S, Ninomiya K, Onuma Y, Kochman J, Grabowski M, Serruys PW, Mazurek T. Five-year outcomes in patients with multivessel coronary artery disease undergoing surgery or percutaneous intervention. Sci Rep 2024; 14:3218. [PMID: 38332036 PMCID: PMC10853195 DOI: 10.1038/s41598-024-53905-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
The outcomes from real-life clinical studies regarding the optimal revascularization strategy in patients with multivessel coronary artery disease (MVD) are still poorly investigated. In this retrospective study we assessed 5-year outcomes: primary, secondary endpoints and quality of life of 1035 individuals with severe coronary artery disease (CAD) treated either with coronary artery bypass grafting (CABG)-356 patients or percutaneous coronary intervention (PCI)-679 patients according to the recommendation of a local Heart Team (HT). At 5 years no significant difference in overall mortality and rates of myocardial infarctions (MI) were observed between CABG and PCI cohorts (11.0% vs. 13.4% for PCI, P = 0.27 and 9.6% vs. 12.8% for PCI, P = 0.12, respectively). The incidence of major adverse cardiac and cerebrovascular events (MACCE), mainly driven by increased rates of repeat revascularization (RR) were higher in PCI-cohort than in CABG-group (56.1% vs. 40.4%, P < 0.01 and 26.8% vs. 12.6%, P < 0.01, respectively), while CABG-patients experienced stroke more often (7.3% vs. 3.1% for PCI, P < 0.01). In real-life practice with long-term follow-up, none of the two revascularization modalities implemented following HT decisions showed overwhelming superiority: occurrence of death and MI were similar, rates of RR favoured CABG, while incidence of strokes advocated PCI.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland.
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, University Road Galway, Galway, H91 TK33, Ireland
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str, 01-267, Warsaw, Poland
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Alzahrani AH, Alabbadi S, Itagaki S, Egorova N. Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease. J Am Heart Assoc 2024; 13:e032212. [PMID: 38240212 PMCID: PMC11056153 DOI: 10.1161/jaha.123.032212] [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: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Current guidelines recommend revascularization in patients with ischemic cardiomyopathy (ICM). However, there is limited information about the trends and outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in ischemic cardiomyopathy patients with multivessel coronary artery disease. METHODS AND RESULTS Using New Jersey state mandatory registries, 8083 patients with ischemic cardiomyopathy with CABG or PCI revascularization for multivessel coronary artery disease from 2007 to 2018 were included in the analysis. Joinpoint regression and multivariable logistic regression analyses were performed to assess the annual percentage change in trends and predictors of the 30-day mortality rate, respectively. A decline in CABG procedures was observed from 2007 to 2011 (annual percentage change, -11.5%; P=0.003), followed by stabilization. The PCI trend remained unchanged from 2007 to 2010 and then increased significantly (annual percentage change, 3.2%; P=0.02). In the subsample of patients with proximal left anterior descending artery plus circumflex and right coronary artery, CABG was a predominant procedure until 2011, and the proportion of both procedures did not differ thereafter. In the subsample of patients with left anterior descending artery and any other artery stenosis, PCI remained dominant from 2007 to 2018, while in patients with left main and any other artery stenosis, CABG remained dominant from 2007 to 2018 (P<0.001). The 30-day risk-adjusted mortality rate was higher after PCI versus CABG for each year, but after adjustment for completeness of revascularization, there was no difference between groups. CONCLUSIONS The patterns of revascularization procedures for patients with ischemic cardiomyopathy with multivessel coronary artery disease have changed over the years, as evidenced by the changes in CABG and PCI trends. CABG and PCI had comparable 30-day risk-adjusted mortality risks.
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Affiliation(s)
- Anas H. Alzahrani
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
- Department of Surgery, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Sundos Alabbadi
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Shinobu Itagaki
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount Sinai, The Mount Sinai HospitalNew YorkNY
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Natalia Egorova
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
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