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Dong H, Liu Z, Chen H, Ba J, Shi R, Jin Q, Shao X, Tian T, Yin J, Chang L, Deng Y. Association between glycemia and multi-vessel lesion in participants undergoing coronary angiography: a cross-sectional study. Front Cardiovasc Med 2024; 11:1435246. [PMID: 39087073 PMCID: PMC11288860 DOI: 10.3389/fcvm.2024.1435246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Background This study aims to elucidate the association between glycemia and the occurrence of multi-vessel lesions in participants undergoing coronary angiography. Methods We analyzed 2,533 patients with coronary artery disease who underwent coronary angiography. Of these, 1,973 patients, identified by the endpoint of multi-vessel lesions, were examined using univariate and multivariate logistic regression analyses to determine the relationship between glycemia levels and multi-vessel lesion occurrence. Results The analysis included 1,973 participants, among whom 474 patients were identified with coronary multi-vessel lesions. Univariate logistic regression analysis demonstrated a positive correlation between glycemia and the occurrence of coronary multi-vessel lesions (OR 1.04; 95% CI 1.01-1.08; p = 0.02). The adjusted model indicated that for each unit increase in glycemia, the risk of developing coronary multi-vessel lesions increased by 4%, showing a significant correlation (p < 0.05). Subgroup analyses revealed that the impact of glycemia on multi-vessel lesions in patients with PCI varied according to gender, age, and smoking status, with the effect being more pronounced in men, older patients, and smokers. Conclusion Our findings establish a significant association between glycemia and the incidence of multi-vessel lesions, particularly pronounced in male patients, individuals over 45, and smokers.
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Affiliation(s)
- Hezeng Dong
- College of Traditional Chinese Medicine, Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Zhaozheng Liu
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Hao Chen
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Jin Ba
- College of Traditional Chinese Medicine, Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Rui Shi
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Qu Jin
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Xiao Shao
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Tenghui Tian
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Jinzhu Yin
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Liping Chang
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Yue Deng
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
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Kim MC, Ahn JH, Hyun DY, Lim Y, Lee SH, Oh S, Cho KH, Sim DS, Hong YJ, Kim JH, Jeong MH, Cho JH, Lee SR, Kang DO, Hwang JY, Youn YJ, Jeong YH, Park Y, Kim DB, Choo EH, Kim CJ, Kim W, Rhew JY, Lee JH, Yoo SY, Ahn Y. Timing of fractional flow reserve-guided complete revascularization in patients with ST-segment elevation myocardial infarction with multivessel disease: Rationale and design of the OPTION-STEMI trial. Am Heart J 2024; 273:35-43. [PMID: 38641031 DOI: 10.1016/j.ahj.2024.03.017] [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: 02/16/2024] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Current guidelines recommend complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). With regard to the timing of percutaneous coronary intervention (PCI) for non-infarct-related artery (non-IRA), recent randomized clinical trials have revealed that immediate CR was non-inferior to staged CR. However, the optimal timing of CR remains uncertain. The OPTION-STEMI trial compared immediate CR and in-hospital staged CR guided by fractional flow reserve (FFR) for intermediate stenosis of the non-IRA. METHODS The OPTION-STEMI is a multicenter, investigator-initiated, prospective, open-label, non-inferiority randomized clinical trial. The study included patients with at least 1 non-IRA lesion with ≥50% stenosis by visual estimation. Patients fulfilling the inclusion criteria were randomized into 2 groups at a 1:1 ratio: immediate CR (i.e., PCI for the non-IRA performed during primary angioplasty) or in-hospital staged CR. In the in-hospital staged CR group, PCI for non-IRA lesions was performed on another day during the index hospitalization. Non-IRA lesions with 50%-69% stenosis by visual estimation were evaluated by FFR, whereas those with ≥70% stenosis was revascularized without FFR. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, and all unplanned revascularization at 1 year after randomization. Enrolment began in December 2019 and was completed in January 2024. The follow-up for the primary endpoint will be completed in January 2025, and primary results will be available in the middle of 2025. CONCLUSIONS The OPTION-STEMI is a multicenter, non-inferiority, randomized trial that evaluated the timing of in-hospital CR with the aid of FFR in patients with STEMI and MVD. TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT04626882; and URL: https://cris.nih.go.kr. Unique identifier: KCT0004457.
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Affiliation(s)
- Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Joon Ho Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yongwhan Lim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Seok Oh
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | | | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
| | - Dong Oh Kang
- Cardiovascular Center, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea and Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yongwhi Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | | | - Jung-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea and Division of Cardiology, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Sang-Yong Yoo
- Good Morning Hospital, Pyeongtaek, Korea and Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
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Jain C, Dash PK, Iyer VR, Deshmukh R. Culprit vessel only versus complete revascularization following thrombolysis in patients with ST elevation myocardial infraction and multivessel coronary artery disease - A prospective study. Indian Heart J 2023; 75:274-278. [PMID: 37402433 PMCID: PMC10421984 DOI: 10.1016/j.ihj.2023.06.010] [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: 12/01/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE The present study compares the treatment outcomes of only culprit vessel PCI and complete revascularization in patients with STEMI and multivessel disease (MVD) following thrombolysis. METHODS This was a single-center, prospective randomized study including a total of 108 patients presenting at a tertiary care center within 3-24 h post-thrombolysis and undergoing pharmacoinvasive PCI, and randomized into two groups: complete revascularization PCI group and culprit only PCI group. The primary outcomes were evaluated by cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina. The secondary outcomes include repeat revascularization and safety outcomes namely contrast induced nephropathy (CIN), cerebrovascular accident (CVA) and major bleeding were compared among both the groups at one year follow-up. RESULTS Complete revascularization PCI group and culprit only PCI group had 54 patients in each group. Left ventricular ejection fraction did not show significant difference at discharge (p = 1) but was significantly improved in complete revascularization PCI group (p = 0.001) at one year follow-up. Reduced number of outcomes with a significant difference in both the groups were seen for primary outcomes such as cardiac mortality (p = 0.01), repeat MI/ACS (p = 0.01) and refractory angina (p = 0.038) along with repeat revascularization (p = 0.001) at one year follow-up. Complete revascularization did not show any statistically significant difference for CIN (p = 0.567), CVA (p = 0.153) and major bleeding (p = 0.322) then culprit only revascularization group. CONCLUSION In patients with STEMI and MVD, complete revascularization was found more favourable in terms of primary and secondary outcomes compared to culprit only revascularization.
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Affiliation(s)
- Chetan Jain
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
| | - P K Dash
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
| | - V R Iyer
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Rizwan Deshmukh
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
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Justo FA, de Deus Herrera B, Soares PR, Scudeler TL. Plato's allegory of the cave and the paradigm of complete revascularization in STEMI. Clin Cardiol 2022; 46:232-233. [PMID: 36541034 PMCID: PMC9933109 DOI: 10.1002/clc.23946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/16/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fernanda A. Justo
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Bruna de Deus Herrera
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Paulo R. Soares
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Thiago L. Scudeler
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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Zheng W, Huang X, Zhao X, Gong W, Wang X, Nie S. Impact of Stress Hyperglycemia on the Timing of Complete Revascularization in Non-diabetes Patients with ST Elevation Myocardial Infarction and Multivessel Disease. Angiology 2022; 74:587-595. [PMID: 35854437 DOI: 10.1177/00033197221115555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Stress hyperglycemia (SHG) is related to an increased risk of mortality in diabetic patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). However, data are limited in non-diabetic patients especially in patients with multivessel disease (MVD). Methods and Results: In this retrospective study, 742 non-diabetic patients with STEMI and MVD were divided into SHG group and non-SHG group. The overall incidence of SHG was 24.9%. The incidence of no-reflow (NR) phenomenon (18.4% vs 11.8%; P = .024) and in-hospital mortality (1.6% vs .2%; P = .020) in SHG group were significantly higher than those in non-SHG group. SHG was associated with 30-day MACE (hazard ratio, 4.265; 95% confidence interval (CI), 1.354-13.439; P = .013), but not 1-year. Multivariate logistic analysis showed that SHG (odds ratio: 1.691, 95% CI: 1.072-2.667, P = .024) was an independent predictor of NR. If complete revascularization (CR) was performed during PPCI, the incidence of NR would be significantly higher. Conclusion: In non-diabetic patients with STEMI and MVD, SHG is associated with increased SF-NR and short-term adverse events, and CR during PPCI further increases the risk of NR.
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Affiliation(s)
- Wen Zheng
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Huang
- Department of Cardiology, 117968Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xuedong Zhao
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Gong
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hu MJ, Tan JS, Jiang WY, Gao XJ, Yang YJ. The optimal percutaneous coronary intervention strategy for patients with ST-segment elevation myocardial infarction and multivessel disease: a pairwise and network meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221078088. [PMID: 35295615 PMCID: PMC8918769 DOI: 10.1177/20406223221078088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the optimal percutaneous coronary intervention (PCI) strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. Methods: Trials that randomized patients with STEMI and multivessel coronary artery disease to immediate multivessel PCI, staged multivessel PCI, or culprit-only PCI and prospective observational studies that investigated all-cause death were included. Random effect risk ratio (RR) and 95% confidence interval (CI) were calculated. Results: A total of 13 randomized trials with 7627 patients and 21 prospective observational studies with 60311 patients were included. In the pairwise and network meta-analysis based on randomized trials, immediate or staged multivessel PCI was associated with a lower risk of long-term major adverse cardiac events (MACE; RR: 0.58; 95% CI: 0.45 to 0.74) than culprit-only PCI, which was mainly due to lower risks of myocardial infarction (RR: 0.67; 95% CI: 0.51 to 0.88) and revascularization (RR: 0.38; 95% CI: 0.28 to 0.51), without any significant difference in all-cause death (RR: 0.85; 95% CI: 0.69 to 1.04; I2 = 0.0%). However, short-term outcomes were deficient in randomized trials. The results from real-world prospective observational studies suggested that staged multivessel PCI reduced long-term all-cause death (RR: 0.53; 95% CI: 0.39 to 0.71; I2 = 15.6%), whereas immediate multivessel PCI increased short-term all-cause death (RR: 1.58; 95% CI: 1.22 to 2.05; I2 = 43.8%) relative to culprit-only PCI. Conclusion: For patients in randomized trials, multivessel PCI in an immediate or staged procedure was preferred due to improvements in long-term outcomes. As a supplement, the results in real-world patients derived from prospective observational studies suggested that staged multivessel PCI was superior to immediate multivessel PCI. Therefore, staged multivessel PCI may be the optimal PCI strategy for patients with STEMI and multivessel coronary artery disease.
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Affiliation(s)
- Meng-Jin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang-Shan Tan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Yang Jiang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Jin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Gao J, Wang Y, Yang YN, Wu XY, Cui Y, Zou ZH, Cui Z, Liu Y. Impact of Metabolic Syndrome and Its Components on Clinical Severity and Long-Term Prognosis in Patients With Premature Myocardial Infarction. Front Endocrinol (Lausanne) 2022; 13:920470. [PMID: 35846283 PMCID: PMC9279730 DOI: 10.3389/fendo.2022.920470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects of metabolic syndrome (MS) on premature myocardial infarction (PMI) are not clear to date. This study aimed to investigate the impact of MS and its components on clinical severity and long-term prognosis in patients with PMI. METHODS We enrolled 772 patients aged ≤45 years old who were diagnosed with acute myocardial infarction (AMI) at our hospital consecutively between 2015 and 2020. The patients were divided into an MS group and non-MS group. The parameters of clinical severity were compared using regression analysis. Patients were followed for median of 42 months for major adverse cardiovascular events (MACE). RESULTS Hyperglycemia was associated with multi-vessel disease [odds ratio(OR)=1.700, 95% confidence interval (CI)=1.172-2.464, P=0.005] and Syntax score ≥33 (OR=2.736, 95% CI=1.241-6.032, P=0.013). Increased MACE were observed in the MS group(17.9% vs 10.3%, P=0.004).The Kaplan-Meier curve also showed significant differences (P< 0.001). MS was an independent risk factor for MACE. Of each component of MS, BMI ≥28 kg/m2 (hazard ratio [HR]=2.022, 95% CI =1.213-3.369, P=0.007] and hyperglycemia (HR=2.904, 95% CI=1.847-4.567, P<0.001) were independent risk factors for MACE. CONCLUSIONS In patients with PMI, 1) hyperglycemia usually indicates more severe lesions; 2) MS as a whole was an independent risk factor for MACE; 3) BMI ≥28.0 kg/m2 and hyperglycemia were associated with MACE.
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Affiliation(s)
- Jing Gao
- Chest Hospital, Tianjin University, Tianjin, China
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Yuan Wang
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Ya-Nan Yang
- Cancer Department, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Yuan Wu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Yan Cui
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Zhong-He Zou
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
- *Correspondence: Zhuang Cui, ; Yin Liu,
| | - Yin Liu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
- *Correspondence: Zhuang Cui, ; Yin Liu,
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Fernández AI, Bermejo J, Yotti R, Martínez-Gonzalez MÁ, Mira A, Gophna U, Karlsson R, Al-Daccak R, Martín-Demiguel I, Gutiérrez-Ibanes E, Charron D, Fernández-Avilés F. The impact of Mediterranean diet on coronary plaque vulnerability, microvascular function, inflammation and microbiome after an acute coronary syndrome: study protocol for the MEDIMACS randomized, controlled, mechanistic clinical trial. Trials 2021; 22:795. [PMID: 34772433 PMCID: PMC8588729 DOI: 10.1186/s13063-021-05746-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background Primary prevention trials have demonstrated that the traditional Mediterranean diet is associated with a reduction in cardiovascular mortality and morbidity. However, this benefit has not been proven for secondary prevention after an acute coronary syndrome (ACS). We hypothesized that a high-intensity Mediterranean diet intervention after an ACS decreases the vulnerability of atherosclerotic plaques by complex interactions between anti-inflammatory effects, microbiota changes and modulation of gene expression. Methods The MEDIMACS project is an academically funded, prospective, randomized, controlled and mechanistic clinical trial designed to address the effects of an active randomized intervention with the Mediterranean diet on atherosclerotic plaque vulnerability, coronary endothelial dysfunction and other mechanistic endpoints. One hundred patients with ACS are randomized 1:1 to a monitored high-intensity Mediterranean diet intervention or to a standard-of-care arm. Adherence to diet is assessed in both arms using food frequency questionnaires and biomarkers of compliance. The primary endpoint is the change (from baseline to 12 months) in the thickness of the fibrous cap of a non-significant atherosclerotic plaque in a non-culprit vessel, as assessed by repeated optical coherence tomography intracoronary imaging. Indices of coronary vascular physiology and changes in gastrointestinal microbiota, immunological status and protein and metabolite profiles will be evaluated as secondary endpoints. Discussion The results of this trial will address the key effects of dietary habits on atherosclerotic risk and will provide initial data on the complex interplay of immunological, microbiome-, proteome- and metabolome-related mechanisms by which non-pharmacological factors may impact the progression of coronary atherosclerosis after an ACS. Trial registration ClinicalTrials.govNCT03842319. Registered on 13 May 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05746-z.
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Affiliation(s)
- Ana I Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain.
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Miguel Ángel Martínez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, CIBEROBN, Pamplona, Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - Alex Mira
- Department of Health and Genomics, Center for Advanced Research in Public Health, CSISP-FISABIO, and CIBERESP, Valencia, Spain
| | - Uri Gophna
- Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Roger Karlsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy of the University of Gothenburg; Sweden Nanoxis Consulting AB; Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Reem Al-Daccak
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS-97f, Université Paris-Diderot, HLA et Médecine, Labex Transplantex, Hôpital Saint-Louis, Paris, France
| | - Irene Martín-Demiguel
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Enrique Gutiérrez-Ibanes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Dominique Charron
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS-97f, Université Paris-Diderot, HLA et Médecine, Labex Transplantex, Hôpital Saint-Louis, Paris, France
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
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Xu B, Xu Z, Chen Y, Lu N, Shu Z, Tan X. Genetic and epigenetic associations of ANRIL with coronary artery disease and risk factors. BMC Med Genomics 2021; 14:240. [PMID: 34615528 PMCID: PMC8496081 DOI: 10.1186/s12920-021-01094-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/30/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Both DNA genotype and methylation of antisense non-coding RNA in the INK4 locus (ANRIL) have been robustly associated with coronary artery disease (CAD), but the interdependent mechanisms of genotype and methylation remain unclear. METHODS Eighteen tag single nucleotide polymorphisms (SNPs) of ANRIL were genotyped in a matched case-control study (cases 503 and controls 503). DNA methylation of ANRIL and the INK4/ARF locus (p14ARF, p15INK4b and p16INK4a) was measured using pyrosequencing in the same set of samples (cases 100 and controls 100). RESULTS Polymorphisms of ANRIL (rs1004638, rs1333048 and rs1333050) were significantly associated with CAD (p < 0.05). The incidence of CAD, multi-vessel disease, and modified Gensini scores demonstrated a strong, direct association with ANRIL gene dosage (p < 0.05). There was no significant association between ANRIL polymorphisms and myocardial infarction/acute coronary syndrome (MI/ACS) (p > 0.05). Methylation levels of ANRIL were similar between the two studied groups (p > 0.05), but were different in the rs1004638 genotype, with AA and AT genotype having a higher level of ANRIL methylation (pos4, p = 0.006; pos8, p = 0.019). Further Spearman analyses indicated that methylation levels of ANRIL were positively associated with systolic blood pressure (pos6, r = 0.248, p = 0.013), diastolic blood pressure (pos3, r = 0.213, p = 0.034; pos6, r = 0.220, p = 0.028), and triglyceride (pos4, r = 0.253, p = 0.013), and negatively associated with high-density lipoprotein cholesterol (pos2, r = - 0.243, p = 0.017). Additionally, we identified 12 transcription factor binding sites (TFBS) within the methylated ANRIL region, and functional annotation indicated these TFBS were associated with basal transcription. Methylation at the INK4/ARF locus was not associated with ANRIL genotype. CONCLUSIONS These results indicate that ANRIL genotype (tag SNPs rs1004638, rs1333048 and rs1333050) mainly affects coronary atherosclerosis, but not MI/ACS. There may be allele-related DNA methylation and allele-related binding of transcription factors within the ANRIL promoter.
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Affiliation(s)
- Bayi Xu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhixia Xu
- Department of Medical Service, Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yequn Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Nan Lu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhouwu Shu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China.
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Zhao B, Li GP, Peng JJ, Ren LH, Lei LC, Ye HM, Wang ZY, Zhao S. Pitavastatin Combined with Ezetimibe Treatment was an Effective Approach to Non-IRA Lesion of ST-segment Elevation Myocardial Infarction Patients with Primary Percutaneous Coronary Intervention. Curr Pharm Biotechnol 2021; 22:549-556. [PMID: 32598255 DOI: 10.2174/1389201021666200629153421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE ST-Segment Elevation Myocardial Infarction (STEMI) patients with the multivessel disease have distinctive plaque characteristics in non-IRA lesions. Intensive statin therapy was a potential approach to treat STEMI patients with the non-IRA disease. However, there is still poor evidence about the therapeutic effect. In this study, we have evaluated the detailed therapeutic effect of statin plus ezetimibe intensive therapy. METHODS For STEMI patients with non-IRA disease undergoing primary Percutaneous Coronary Intervention (PCI), 183 control STEMI patients without non-IRA disease undergoing primary PCI, and 200 STEMI patients with non-IRA disease undergoing primary PCI were introduced into this study. 200 STEMI patients with non-IRA disease undergoing primary PCI were divided into Normal group, Intensive group, Normal & Combined group, and Intensive & Combined group. The baseline information for each participant was recorded. Meanwhile, the physiological and biochemical indicators of each member with different treatments were collected after one-year follow-up. RESULTS For STEMI patients with non-IRA disease undergoing primary PCI, no differences could be detected in multiple indexes such as OCT examination results, age, stroke, etc. However, diabetes mellitus, smoking, and coronary Gensini score were different between different groups (P<0.05). After one year follow-up, cholesterol, low-density lipoprotein, coronary Gensini score, thin-cap fibroatheroma, length of non-infarcted arterial lesions, non-infarct artery lesion range, myocardial infarction again, and revascularization again were significantly different between different groups (P<0.05). CONCLUSION The results mentioned above suggested that pitavastatin combined with ezetimibe was an effective approach for STEMI patients with non-IRA disease undergoing primary PCI. The results obtained in this study have provided a novel method for the treatment of STEMI patients with non-IRA disease undergoing primary PCI.
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Affiliation(s)
- Bo Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Guang-Ping Li
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Jian-Jun Peng
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Li-Hui Ren
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Li-Cheng Lei
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Hui-Ming Ye
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zuo-Yan Wang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Sheng Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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11
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Changes in non-culprit lesion severity on follow-up coronary angiography after primary percutaneous coronary ıntervention. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.851281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Primary Percoutaneous Coronary Intervention on Unprotected Left Main Coronary Artery with Staged Complex Bifurcational Treatment: A Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2018-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
We present the case of patient with ST elevation myocardial infarction in cardiogenic shock with primary percutaneous coronary intervention of Left anterior descending coronary artery and Left main coronary artery with staged complex procedure on Left anterior descending/Diagonal branch bifurcation in Culotte manner. This case shows that “the simpler, the better” approach of only infarct related artery revascularization may be applied in acute patients with cardiogenic shock and optimal clinical and hemodynamic response on revascularization and intra-aortic balloon pump. But, complete revascularization should be done in staged procedure and later, a control coronary angiography with intravascular ultrasound assistance is mandatory.
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13
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Kim MC, Bae S, Ahn Y, Sim DS, Hong YJ, Kim JH, Jeong MH, Kim HS, Chae SC, Cha KS. Benefit of a staged in-hospital revascularization strategy in hemodynamically stable patients with ST-segment elevation myocardial infarction and multivessel disease: Analyses by risk stratification. Catheter Cardiovasc Interv 2021; 97:1151-1159. [PMID: 32569397 DOI: 10.1002/ccd.29062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 05/24/2020] [Indexed: 11/11/2022]
Abstract
AIMS The proper timing and indication of revascularization for a non-culprit artery in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) without cardiogenic shock remains controversial. METHODS AND RESULTS This multicenter study included patients with STEMI and MVD without cardiogenic shock. Data were analyzed at 3 years according to the percutaneous coronary intervention (PCI) strategy: immediate multivessel revascularization (MVR) (n = 351), stepwise MVR (n = 510), and culprit-only PCI (n = 1,142). The primary outcome was all-cause mortality. The stepwise MVR group had a lower risk of all-cause death. The results were consistent after multivariate regression, propensity-score matching, inverse probability weighting, and Bayesian proportional hazards modeling. In subgroup analyses stratified by the Global Registry of Acute Coronary Events score, stepwise MVR also lowered the risk of all-cause death compared to culprit-only PCI and immediate MVR in high risk patients but not in patients at low to intermediate risk. CONCLUSIONS In patients with STEMI and MVD without cardiogenic shock, in-hospital stepwise MVR was associated with a lower risk of all-cause death than culprit-only PCI or immediate MVR, particularly in the high-risk subgroup.
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Affiliation(s)
- Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - SungA Bae
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyo-Soo Kim
- Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Department of Cardiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Republic of Korea
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14
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Puymirat E, Nakache A, Saint Etienne C, Marcollet P, Fichaux O, Decomis MP, Chassaing S, Commeau P, Danchin N, Cayla G, Montalescot G, Benamer H, Koning R, Motreff P, Rangé G. Is coronary multivessel disease in acute myocardial infarction patients still associated with worse clinical outcomes at 1-year? Clin Cardiol 2021; 44:429-437. [PMID: 33586188 PMCID: PMC7943894 DOI: 10.1002/clc.23567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background ST‐elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention. Hypothesis We hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced. Methods All consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1‐year were analyzed according to coronary status (one‐, two‐, and three‐VD). Results A total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three‐VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all‐cause death, stroke or re‐MI) was 10%, 12%, and 12% in one‐, two, and three‐VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two‐ and three‐VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76–1.56 for two‐VD; HR, 0.74; 95%CI 0.48–1.14 for three‐VD). Conclusions MVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1‐year compared with one‐VD patients in a modern reperfusion area and secondary medication prevention.
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Affiliation(s)
- Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, Paris, France
| | - Ariel Nakache
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, Paris, France
| | | | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier de Bourges, Bourges, France
| | - Olivier Fichaux
- Cardiology Department, Centre Hospitalo-régional d'Orléans, Orléans, France
| | | | | | - Philippe Commeau
- Cardiology Department, Polyclinique les Fleurs, Ollioules, France
| | - Nicolas Danchin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, Paris, France
| | - Guillaume Cayla
- Cardiology Department, CHU Nîmes, Université Montpellier, Nîmes, France
| | - Gilles Montalescot
- Cardiology Department, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie; ICPS Massy Ramsay group, Paris 13, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, Rouen, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont Ferrand, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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15
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Puymirat E, Simon T, de Bruyne B, Montalescot G, Steg G, Cayla G, Durand-Zaleski I, Blanchard D, Danchin N, Chatellier G. Rationale and design of the Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction (FLOWER-MI) trial. Am Heart J 2020; 222:1-7. [PMID: 32000067 DOI: 10.1016/j.ahj.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI) patients presenting with multivessel disease (MVD), recent studies have demonstrated the superiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-culprit lesions compared to culprit lesion treatment-only therapy. FFR- and angio-guided PCI have however never been compared in STEMI patients. TRIAL DESIGN FLOWER-MI is an open-label multicenter national randomized clinical trial. The aim is to investigate FFR-guided complete revascularization in comparison to angio-guided complete revascularization in STEMI patients with successful PCI of the culprit lesion and ≥50% stenosis in at least one additional non-culprit lesion requiring PCI. Eligible patients will be randomized after successful primary PCI in a 1:1 fashion to either FFR-guided or angio-guided complete revascularization during the index procedure or a staged procedure before discharge (≤5 days). Patients assigned to FFR guidance first have FFR measured in each non-culprit vessel and only undergo PCI if FFR is ≤0.80. The primary end point of the study is a composite of major adverse cardiac events, including all-cause death, non-fatal MI, and unplanned hospitalization leading to urgent revascularization at 1 year. Secondary end points will include the individual adverse events, cost-effectiveness, quality of life, and 30-day, 6-month, and 3-year outcomes. Based on estimated event rates, a sample size of 1170 patients is needed to show superiority of the FFR-guided revascularization with 80% power. CONCLUSION The aim of FLOWER-MI trial is to assess whether FFR-guided complete revascularization in the acute setting is superior angio-guided complete revascularization.
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16
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Figini F, Chen SL, Sheiban I. ST-elevation Myocardial Infarction and Multivessel Coronary Artery Disease – A Critical Review of Current Practice, Evidence and Meta-analyses. Heart Int 2020; 14:80-85. [DOI: 10.17925/hi.2020.14.2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023] Open
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Impact of Multivessel Coronary Artery Disease on Long Term Prognosis in Patients with ST-segment Elevation Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: A significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVD), and they are at high risk for recurrent cardiac events. The aim of the present study was to analyze the impact of MVD on long-term cardiovascular mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Method: This study included 3,115 consecutive STEMI patients hospitalized in the Coronary Care Unit of the Clinical Centre of Serbia, between November 2005 and January 2012. Patients were divided in two groups: MVD and no MVD. MVD disease was defined as stenosis greater than 50% by visual assessment in more than one major coronary artery. Primary PCI was limited to the infarct-related artery (IRA). Cardiovascular mortality was defined as any death from cardiovascular reason (myocardial reinfarction, low-output heart failure, and sudden death). Patients presenting with cardiogenic shock were excluded. Patients were followed-up for 6 years after enrollment. Results: Among 3,115 analyzed patients, 1,352 (43.4%) patients had no MVD and 1,763 (56.6%) had MVD; among patients with MVD, 926 (52.6%) had two-vessel disease and 837 (47.4%) had three-vessel disease. Compared with patients with single-vessel disease, patients with MVD were older, had longer pain duration, and presented more often with heart failure; they were more likely to have previous coronary artery disease, diabetes, hypertension, and chronic kidney disease; post-procedural flow TIMI <3 was more frequently observed in patients with MVD than in patients with no MVD (5.9% vs. 3.1%, p <0.001). Patients with MVD had lower left ventricular ejection fraction than patients with single-vessel disease: 45% (interquartile range [IQR] 40¬–55%) vs. 50% (IQR 43–55%), p <0.001. Revascularization of non-IRA lesions was performed at index hospitalization in 1,075 (61%) patients, and in 602 (34.1%) patients revascularization was performed in the first few months after pPCI (median 1.5 months, IQR 1–2.5 months); coronary artery bypass grafting was performed in 291 (18.4%) patients and PCI (with stent implantation) in 1,368 (81.6%) patients. Six-year cardiovascular mortality was significantly higher in patients with MVD than in patients with single-vessel disease (10.4% vs. 4.6%, p <0.001). In multivariate Cox regression analysis, MVD remained an independent predictor for 6-year cardiovascular mortality (HR 1.55, 95% CI 1.11–2.06, p = 0.041). Conclusion: In STEMI patients treated with pPCI, the presence of MVD remained an independent predictor for higher long-term cardiovascular mortality despite early revascularization of the remaining stenosis in non-IRA.
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Omori T, Kurita T, Dohi K, Takasaki A, Nakata T, Nakamori S, Fujimoto N, Kitagawa K, Hoshino K, Tanigawa T, Sakuma H, Ito M. Prognostic impact of unrecognized myocardial scar in the non-culprit territories by cardiac magnetic resonance imaging in patients with acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2018; 19:108-116. [PMID: 28950314 DOI: 10.1093/ehjci/jex194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/10/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Unrecognized myocardial scar by late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is strongly associated with cardiac event in patients with stable coronary artery disease. The purpose of this study was to evaluate the prognostic impact of unrecognized non-infarct-related LGE (non-IR-LGE) in patients with acute myocardial infarction (AMI). Methods and results We studied 269 patients with a first clinical episode of AMI underwent cardiac MRI within 6 weeks after onset (209 men; age, 66 ± 12 years). LGE, cine MRI and T2-weighted imaging were obtained to evaluate the presence and extent of LGE and to evaluate cardiac function. Major adverse cardiac events (MACE) were defined as cardiovascular death, non-fatal AMI, unstable angina requiring revascularization, fatal arrhythmia, and heart failure. Unrecognized non-IR LGE was observed in 13.0% of patients. During follow-up periods (median, 22 months; range, 3-95 months), 8.9% of patients experienced MACE in this study. In addition, 22.9% of patients with unrecognized non-IR LGE and 6.8% of patients without unrecognized non-IR-LGE experienced MACE (P < 0.01). The presence of unrecognized non-IR LGE predicted MACE with a hazard ratio of 3.45 (95% confidential interval, 1.03-11.47; P < 0.01). In addition, unrecognized non-IR LGE was the strongest independent predictors of MACE with a hazard ratio of 3.30 by the Cox proportional hazards model (P < 0.01). In contrast, angiography-proven multi-vessel disease and transmural extent of infarct-related LGE were not independently associated with MACE. Conclusion Among patients with a first clinical episode of AMI, unrecognized non-IR myocardial scar provides incremental prognostic value for predicting MACE beyond that of common clinical, angiographic and functional variables.
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Affiliation(s)
- Taku Omori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Akihiro Takasaki
- Department of Cardiology, Matsusaka Central Hospital, 102 Kawai, Matsusaka 515-8566, Japan
| | - Tomoyuki Nakata
- Department of Cardiology, Nagai Hospital, 29-29 Nishimarunouchi, Tsu 514-8508, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu 514-8507, Japan
| | - Kozo Hoshino
- Department of Cardiology, Nagai Hospital, 29-29 Nishimarunouchi, Tsu 514-8508, Japan
| | - Takashi Tanigawa
- Department of Cardiology, Matsusaka Central Hospital, 102 Kawai, Matsusaka 515-8566, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu 514-8507, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
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Hypertension Is an Independent Predictor of Multivessel Coronary Artery Disease in Young Adults with Acute Coronary Syndrome. Int J Hypertens 2018; 2018:7623639. [PMID: 30538861 PMCID: PMC6260551 DOI: 10.1155/2018/7623639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/18/2018] [Accepted: 11/01/2018] [Indexed: 12/26/2022] Open
Abstract
Background Risk factors of multivessel coronary artery disease (CAD) among young acute coronary syndrome (ACS) patients remain elusive now. Methods This retrospective study analyzed data from 187 consecutive young (age ≤45 years) ACS patients (75 STEMI, 30 NSTEMI, and 72 unstable angina) hospitalized in our hospital from January 2012 to December 2016. Thirty-six young male patients with normal coronary angiography (CAG) findings (no-CAD), who underwent CAG due to suspected chest pain in this period, served as control group. There were 83 patients with single-vessel disease (SVD) and 104 patients with multiple-vessel disease (MVD) among ACS patients. Patients were followed up for a mean of 267±124 days by clinical visit or telephone calls. Results All included patients were male. Prevalence of hypertension (57.2% vs. 30.6%, p=0.002) and smoking (70.6% vs. 52.8%, p=0.049) was significantly higher in ACS patients than in no-CAD patients. Prevalence of hypertension (72.1% vs. 38.6%, p<0.001) and body mass index (BMI) were significantly higher in MVD group than in SVD group. Multivariable analysis revealed that hypertension was an independent risk factor for MVD after adjustment for age, gender, BMI, smoking, family history of premature CAD, hyperlipidemia, left ventricular ejection fraction, and brain natriuretic peptide (odds ratio=3.71, 95% confidence interval=1.84-7.46, p<0.001). Rate of major adverse cardiovascular events (MACE) during follow-up (20.2% vs. 4.8%) was significantly higher in MVD group compared with SVD group. Conclusions Hypertension is an independent predictor of MVD and MVD is associated with increased MACE rate compared to SVD in young ACS patients during the short-term follow-up.
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20
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Immediate complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease treated by primary percutaneous coronary intervention: Insights from the ORBI registry. Arch Cardiovasc Dis 2018; 111:656-665. [DOI: 10.1016/j.acvd.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/02/2017] [Accepted: 08/28/2017] [Indexed: 11/24/2022]
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Ahn MJ, Kim MC, Ahn Y, Sim DS, Hong YJ, Kim JH, Jeong MH, Cho JG, Park JC. Impact of Complete Revascularization on Six-Year Clinical Outcomes and Incidence of Acute Decompensated Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. Am J Cardiol 2018; 121:544-551. [PMID: 29325904 DOI: 10.1016/j.amjcard.2017.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 12/13/2022]
Abstract
It remains unclear whether complete revascularization (CR) reduces the incidences of acute decompensated heart failure (ADHF) and adverse cardiac outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). A total of 453 hemodynamically stable patients with STEMI and MVD were retrospectively evaluated; the patients were divided into 2 groups according to interventional strategy: CR (n = 240) and incomplete revascularization (IR) (n = 213). We analyzed the incidences of ADHF and major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction, and any revascularization) over a long follow-up period (median 6.3 years). MACE developed in 158 patients (34.9%), and 40 patients (8.8%) were re-admitted because of ADHF developing during follow-up. Results after propensity matching showed that CR did not reduce the incidence of ADHF (hazard ratio [HR] for IR 1.63, 95% confidence interval [CI] 0.63 to 4.22, p = 0.311). However, IR increased the risk of MACE (HR 1.73, 95% CI 1.09 to 2.74, p = 0.021), attributable principally to an increased risk of nontarget vessel revascularization (HR 3.12, 95% CI 1.23 to 7.92, p = 0.039). Although CR did not reduce the incidence of ADHF, CR might reduce repeat revascularization to treat non-infarct-related arteries in hemodynamically stable patients with STEMI and MVD.
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Affiliation(s)
- Min Joo Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
| | - Doo Sun Sim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Young Joon Hong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Jong Chun Park
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea
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Polito MV, Asparago S, Galasso G, Farina R, Panza A, Iesu S, Piscione F. Early myocardial surgical revascularization after ST-segment elevation myocardial infarction in multivessel coronary disease: bridge therapy is the solution? J Cardiovasc Med (Hagerstown) 2018; 19:120-125. [PMID: 29389817 DOI: 10.2459/jcm.0000000000000621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many ST-segment elevation myocardial infarction (STEMI) patients have a multivessel disease that initially require percutaneous coronary intervention (PCI) of the culprit vessel but subsequently may require coronary artery bypass graft (CABG) of nonculprit vessels. Evidence supports staged revascularization, but the identification of optimal strategies (percutaneous or surgical), the timing and the management of antiplatelet therapy after recent PCI with stenting are matters of great controversies. METHODS In our retrospective registry, we have enrolled 21 patients presenting with STEMI and multivessel disease, who underwent PCI of the culprit vessel only and then CABG of nonculprit vessels. Demographic, clinical, echocardiographic, angiographic findings, preoperative score, surgical data and postoperative complications were collected. At 21.6 ± 15.6 months follow-up death, reinfarction and/or cardiovascular and noncardiovascular events were recorded. RESULTS Patients were 62 ± 9 years old and had in the most cases a good ejection fraction. At angiography, the culprit lesion was right coronary artery in 16 patients (76%). Angiographic characteristics excluded a staged PCI (SYNTAX score = 31.6 ± 7.4) and European System for Cardiac Operative Risk Evaluation II resulted low (1.46 ± 1.01). Following the indication to cardiac surgery after Heart Team discussion, the withdrawal of oral P2Y12 inhibitor was planned and tirofiban intravenous was started. Off-pump CABG was performed after 7.2 ± 3.2 days. No death, reinfarction and/or cardiovascular and noncardiovascular events occurred at follow-up. CONCLUSION We can conclude that a careful preoperative selection is mandatory for a good postoperative course and long-term survival and that early-staged CABG can, however, be performed using bridge therapy, also after STEMI.
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Affiliation(s)
- Maria V Polito
- Department of Medicine and Surgery, University of Salerno
| | | | | | | | - Antonio Panza
- Cardiac Surgery, Heart Department, A.O.U. 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Severino Iesu
- Cardiac Surgery, Heart Department, A.O.U. 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
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23
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Özcan C, Deleskog A, Schjerning Olsen AM, Nordahl Christensen H, Lock Hansen M, Hilmar Gislason G. Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 4:25-35. [PMID: 28444162 PMCID: PMC5843132 DOI: 10.1093/ehjcvp/pvx009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 11/13/2022]
Abstract
Aim Long-term prognostic impact of coronary artery disease (CAD) severity in stable post-myocardial infarction (MI) patients is not well known. We examined the impact of CAD severity and co-morbidity on the long-term (1 year and beyond) risk of cardiovascular events post-MI. Methods and results From nationwide administrative and clinical registers, we identified 55 747 MI patients, during 2004-2010, who had not experienced subsequent MI, stroke, or death within 7 days post-discharge. The risk for primary composite endpoint (MI, stroke, or cardiovascular death) was estimated for the first 365 days after MI (index MI) and from day 366 to study completion (stable post-MI population), corresponding to a mean follow-up of 3.6 (2.2) years. Risk was assessed using cumulative incidence, multivariable adjusted logistic regression and Cox proportional-hazards models. The 1-year cumulative incidence for primary endpoint was 20.0% [95% confidence interval (CI), (19.6-20.3)]. Correspondingly, the 4-year cumulative incidence for primary endpoint was 21.0% (95% CI, 20.6-21.4) in patients without events on the first year. In multivariable models with no significant stenosis as reference, CAD severity was the most important risk factor for cardiovascular events the first 365 days [left main stenosis (LMS): odds ratio and 95% CI, 4.37, 3.69-5.17; 3-vessel disease (VD), 4.18, 3.66-4.77; 2-VD, 3.23, 2.81-3.72; 1-VD, 2.12,-1.85-2.43] and remained from day 366 to study completion [LMS: hazard ratio and 95% CI, 1.91, 1.64-2.22; 3-VD, 1.85,1.65-2.07; 2-VD, 1.55, 1.38-1.74; 1-VD, 1.30, 1.16-1.45]. Conclusion Despite contemporary treatment at baseline, stable post-MI patients' 4-year outcome was similar to 1-year outcome after MI, and CAD severity remained a critical risk factor the first year and thereafter.
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Affiliation(s)
- Cengiz Özcan
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | | | | | | | - Morten Lock Hansen
- Department of Cardiology, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
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Ganyukov VI, Tarasov RS. Current Concept of Revascularization in STEMI Patients with Multivessel Coronary Artery Disease: Evidence Base and Our Own Randomized Trial Results. Interv Cardiol 2017. [DOI: 10.5772/67884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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25
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Krishnan SK, Riley RF, Hira RS, Lombardi WL. Multivessel Revascularization in Shock and High-Risk Percutaneous Coronary Intervention. Interv Cardiol Clin 2017; 6:407-416. [PMID: 28600093 DOI: 10.1016/j.iccl.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review explores the usefulness of multivessel revascularization with percutaneous coronary intervention in patients with multivessel obstructive coronary artery disease (CAD) presenting with and without cardiogenic shock. We also evaluate the literature regarding complete versus incomplete revascularization for patients with cardiogenic shock, acute coronary syndromes, and stable coronary artery disease.
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Affiliation(s)
- Sandeep K Krishnan
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Robert F Riley
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Ravi S Hira
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - William L Lombardi
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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Kim I, Kim MC, Jeong HC, Park KH, Sim DS, Hong YJ, Kim JH, Jeong MH, Cho JG, Park JC, Seung KB, Chang K, Ahn Y. Optimal Timing of Percutaneous Coronary Intervention for Nonculprit Vessel in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease. Korean Circ J 2017; 47:36-43. [PMID: 28154589 PMCID: PMC5287185 DOI: 10.4070/kcj.2015.0358] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/19/2016] [Accepted: 06/30/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the optimal timing of staged percutaneous coronary intervention (PCI) remains unclear. SUBJECTS AND METHODS This study was a retrospective analysis of 753 STEMI patients with MVD who were treated by multivessel PCI in the Convergent Registry of Catholic and Chonnam University for Acute myocardial infarction (MI). Patients were divided into 3 groups according to the time from initial to staged PCI: group 1 (n=316, multivessel PCI performed during the index procedure), group 2 (n=360, staged PCI within 1 week), and group 3 (n=77, staged PCI after 1 week). The endpoint was major adverse cardiac events (MACEs), including all-cause mortality, non-fatal MI, and repeat PCI during 3.4 years follow-up. RESULTS The incidence of composite MACEs was higher in group 3 than in group 1 (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.06 to 3.18, p=0.031). However, the risk of MACEs in groups 1 and 2 was comparable (OR: 1.01, 95% CI: 0.70 to 1.46, p=0.950). In multivariate logistic regression, independent predictors of 3-year MACEs were high Killip class (OR: 2.72, 95% CI: 1.38 to 5.37, p=0.004), left ventricular ejection fraction <45% (OR: 1.57, 95% CI: 1.06 to 2.32, p=0.024), and group 3 (OR: 1.83, 95% CI: 1.06 to 3.18, p=0.009). CONCLUSION Deferred staged PCI after one week index PCI was associated with the highest MACE, as compared to both simultaneous multivessel PCI and early staged PCI <1 week.
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Affiliation(s)
- Inna Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Chang Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ki-Bae Seung
- Department of Cardiology, Cardiovascular Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kiyuk Chang
- Department of Cardiology, Cardiovascular Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
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Mariathas M, Olechowski B, Mahmoudi M, Curzen N. Does the evidence really suggest that we should completely revascularise bystander disease in patients with ST elevation myocardial infarction undergoing primary angioplasty? Why we still need more definitive trial data to change routine practice. Expert Rev Cardiovasc Ther 2016; 15:75-81. [PMID: 27983887 DOI: 10.1080/14779072.2017.1273770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There remains considerable heterogeneity in the management of significant lesions in non culprit coronary arteries in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Three recent randomised trials have shown clinical outcome benefit in a complete revascularisation approach when compared to PPCI of the culprit artery alone. By contrast, observational data suggest that an aggressive complete revascularisation may not confer clinical benefit and may, in some cases, be harmful. Areas covered: In this review we discuss the three recent randomised trials that have advocated a complete revasculariation approach in addition to data available from registries. Expert commentary: An adequately powered, randomised controlled trial is required to answer the question of whether complete revascularisation in STEMI patients is beneficial and, if so, whether it should be ischaemia directed and whether it should be at the index procedure or staged.
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Affiliation(s)
- Mark Mariathas
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Bartosz Olechowski
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Michael Mahmoudi
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Nick Curzen
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
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28
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Abstract
Approximately 50 % of hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and up to 80 % of patients with infarction-related cardiogenic shock have multivessel coronary artery disease. The optimal revascularization strategy in these patients has still not been defined. Following successful percutaneous coronary intervention (PCI) of the culprit lesion, immediate PCI of all additional lesions or staged PCI, after invasive or non-invasive proof of ischemia or conservative therapy can be considered. Randomized studies have demonstrated a clinical benefit of immediate or staged multivessel PCI compared to a conservative approach. So far there are no randomized studies available comparing immediate versus staged PCI. The data regarding the optimal strategy in patients with cardiogenic shock show low concordance. The currently running CULPRIT shock study will help to define the optimal strategy in shock patients. This manuscript summarizes the current knowledge and data and provides recommendations for the clinical practice.
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29
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Zeymer U, Werdan K, Schuler G, Zahn R, Neumann FJ, Fürnau G, de Waha S, Schneider S, Thiele H. Editor's Choice- Impact of immediate multivessel percutaneous coronary intervention versus culprit lesion intervention on 1-year outcome in patients with acute myocardial infarction complicated by cardiogenic shock: Results of the randomised IABP-SHOCK II trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:601-609. [PMID: 27655918 DOI: 10.1177/2048872616668977] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current guidelines recommend immediate multivessel percutaneous coronary intervention (PCI) in patients with cardiogenic shock, despite the lack of randomised trials. We sought to investigate the use and impact on outcome of multivessel PCI in comparison to culprit lesion only PCI in a retrospective analysis in patients with cardiogenic shock complicating acute myocardial infarction. METHODS AND RESULTS In the randomised IABP-SHOCK II trial, investigating the effect of intra-aortic balloon pump on outcome, 451 (75%) of the total of 600 patients had multivessel coronary artery disease and underwent PCI. Immediate multivessel PCI was performed in 167 (37%) patients. TIMI 3 patency after PCI in all treated vessels was observed in 83.2% versus 79.0% of patients after multivessel versus culprit lesion PCI, respectively. The 30-day (44.9% vs. 42.3%) and 12-month (54.8% vs. 52.7%) mortality rates did not significantly differ between the two groups. In the multivariate analysis multivessel PCI was not associated with an improved mortality after 12 months (odds ratio 0.92, 95% confidence intervals 0.69-1.21). CONCLUSION In this retrospective analysis of the largest randomised study in cardiogenic shock immediate multivessel PCI was used in approximately one third of patients with cardiogenic shock. There was no benefit with immediate multivessel PCI in comparison to culprit lesion only PCI. Therefore a randomised trial is needed to determine the definitive role of multivessel PCI in cardiogenic shock. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT00491036.
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Affiliation(s)
- Uwe Zeymer
- 1 Klinikum Ludwigshafen, Medizinische Klinik B, Germany.,2 Institut für Herzinfarktforschung Ludwigshafen, Germany
| | - Karl Werdan
- 3 Universitätsklinikum Halle, Klinik für Kardiologie, Germany
| | | | - Ralf Zahn
- 1 Klinikum Ludwigshafen, Medizinische Klinik B, Germany
| | | | - Georg Fürnau
- 4 Universität Leipzig, Herzzentrum, Kardiologie, Germany
| | | | | | - Holger Thiele
- 4 Universität Leipzig, Herzzentrum, Kardiologie, Germany.,7 Medical Clinic II, Universitäres Herzzentrum Lübeck University Hospital Schleswig-Holstein, Germany
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30
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Managing Multivessel Coronary Artery Disease in Patients With ST-Elevation Myocardial Infarction: A Comprehensive Review. Cardiol Rev 2016; 25:179-188. [PMID: 27124268 DOI: 10.1097/crd.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multivessel coronary artery disease (CAD) is found in up to 60% of the patients presenting with an ST-elevation myocardial infarction (STEMI) and worsens the prognosis proportional to the extent of CAD severity. However, the 2013 American College of Cardiology/American Heart Association STEMI guidelines, based on mostly observational data, had recommended against a routine noninfarct-related artery percutaneous coronary intervention (PCI). After these guidelines were published, a handful of randomized trials became available, and they suggested that PCI of significant lesions in a noninfarct-related artery at the time of primary PCI might result in improved patient outcomes. The incidence of major adverse cardiac events was significantly reduced by 55% at 1 year and 65% at 2 years in patients undergoing angiographically guided PCI of nonculprit vessels at the time of primary PCI, in 2 different randomized trials. Fractional flow reserve-guided PCI of nonculprit vessels in this setting has also been shown to reduce cardiac events by 44% at 1 year. Meta-analyses of both nonrandomized and randomized trials have also suggested that complete revascularization at the time of STEMI significantly improves outcomes, including long-term all-cause mortality. In view of the emerging data, a focused update on primary PCI was published in 2015 and suggested that PCI of noninfarct-related arteries might be considered in selected patients. This article is a comprehensive review of the literature on the treatment of multivessel CAD in patients with STEMI, which provides the reader a critical analysis of the available information to determine the best therapeutic approach.
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Toyota T, Shiomi H, Taniguchi T, Morimoto T, Furukawa Y, Nakagawa Y, Horie M, Kimura T. Culprit Vessel-Only vs. Staged Multivessel Percutaneous Coronary Intervention Strategies in Patients With Multivessel Coronary Artery Disease Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Circ J 2016; 80:371-8. [DOI: 10.1253/circj.cj-15-0493] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshiaki Toyota
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Minoru Horie
- Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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de Waha S, Eitel I, Desch S, Fuernau G, Pöss J, Schuler G, Thiele H. Impact of multivessel coronary artery disease on reperfusion success in patients with ST-elevation myocardial infarction: A substudy of the AIDA STEMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:592-600. [DOI: 10.1177/2048872615624240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Suzanne de Waha
- University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Ingo Eitel
- University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Steffen Desch
- University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Georg Fuernau
- University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Janine Pöss
- University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Gerhard Schuler
- Department of Internal Medicine – Cardiology, University of Leipzig – Heart Centre, Germany
| | - Holger Thiele
- University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Germany
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Bajaj NS, Kalra R, Aggarwal H, Ather S, Gaba S, Arora G, McGiffin DC, Ahmed M, Aslibekyan S, Arora P. Comparison of Approaches to Revascularization in Patients With Multivessel Coronary Artery Disease Presenting With ST-Segment Elevation Myocardial Infarction: Meta-analyses of Randomized Control Trials. J Am Heart Assoc 2015; 4:e002540. [PMID: 26667087 PMCID: PMC4845262 DOI: 10.1161/jaha.115.002540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/23/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Significant controversy exists regarding the best approach for nonculprit vessel revascularization in patients with multivessel coronary artery disease presenting with ST-segment elevation myocardial infarction. We conducted a systematic investigation to pool data from current randomized controlled trials (RCTs) to assess optimal treatment strategies in this patient population. METHODS AND RESULTS A comprehensive search of SCOPUS from inception through May 2015 was performed using predefined criteria. We compared efficacy and safety outcomes of different approaches by categorizing the studies into 3 groups: (1) complete revascularization (CR) versus culprit lesion revascularization (CL) at index hospitalization, (2) CR at index hospitalization versus staged revascularization (SR) of nonculprit vessels at a separate hospitalization, and (3) comparison of SR versus CL. Eight eligible RCTs met the inclusion criteria: (1) CR versus CL (6 RCTs, n=1727) (2) CR versus SR (3 RCTs, n=311), and (3) SR versus CL (1 RCT, n=149). We observed significantly lower rates of major adverse cardiovascular events, revascularization, and repeat percutaneous coronary interventions among patients treated with CR and SR compared with a CL approach (P<0.05). The rates of all-cause mortality, cause-specific mortality, major bleeding, reinfarction, stroke, and contrast-induced nephropathy did not differ in the CR arm compared with the CL arm. The rates of these outcomes were similar in the CR and SR arms. CONCLUSION Results suggest that CR and SR compared with CL reduce major adverse cardiovascular event and revascularization rates primarily by lowering repeated percutaneous coronary intervention rates. We did not observe any increase in the rate of adverse events while using a CR or SR strategy compared with a CL approach. Current guidelines discouraging CR need to be reevaluated, and clinical judgment should prevail in treating multivessel coronary artery disease patients with ST-segment elevation myocardial infarction as data from larger RCTs accumulate.
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Affiliation(s)
- Navkaranbir S. Bajaj
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
- Ryals School of Public HealthDepartment of EpidemiologyUniversity of Alabama at BirminghamAL
| | - Rajat Kalra
- Department of MedicineUniversity of Alabama at BirminghamAL
| | - Himanshu Aggarwal
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Sameer Ather
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Saurabh Gaba
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | - Garima Arora
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
| | | | - Mustafa Ahmed
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
- Division of CardiologyBaptist PrincetonBirminghamAL
| | - Stella Aslibekyan
- Ryals School of Public HealthDepartment of EpidemiologyUniversity of Alabama at BirminghamAL
| | - Pankaj Arora
- Division of CardiologyDepartment of MedicineUniversity of Alabama at BirminghamAL
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Quantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction. J Am Soc Echocardiogr 2015; 28:1379-89.e1. [DOI: 10.1016/j.echo.2015.07.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 11/20/2022]
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35
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Park JS, Cha KS, Lee DS, Shin D, Lee HW, Oh JH, Kim JS, Choi JH, Park YH, Lee HC, Kim JH, Chun KJ, Hong TJ, Jeong MH, Ahn Y, Chae SC, Kim YJ. Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock. Heart 2015; 101:1225-32. [DOI: 10.1136/heartjnl-2014-307220] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/18/2015] [Indexed: 11/04/2022] Open
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Dahal K, Rijal J, Panta R, Lee J, Azrin M, Lootens R. Multi-vessel versus culprit-vessel and staged percutaneous coronary intervention in STEMI patients with multivessel disease: a meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:408-13. [PMID: 25454258 DOI: 10.1016/j.carrev.2014.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/06/2014] [Accepted: 10/10/2014] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD. METHODS PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013. Random effects model was used to compute summary effects. RESULTS Four RCTs (840 patients) were identified. MV-PCI compared to CV-PCI significantly reduced the risks of major adverse cardiac events (MACE)-a composite of MI, revascularization and all-cause mortality (RR: 0.46, 95% CI: 0.35-0.60, P<0.00001) by reducing the risks of MI (0.35, 0.17-0.71, P=0.004) and revascularization (0.35, 0.24-0.52, P<0.00001). The risk of all-cause mortality was not different (0.69, 0.39-1.21, P=0.19). S-PCI and MV-PCI had similar risks of MACE (0.96, 0.59-1.57, P=0.87), MI (0.60, 0.20-1.78, P=0.36), revascularization (0.86, 0.47-1.54, P=0.60) and all-cause mortality (1.50, 0.44-5.07, P=0.57). CONCLUSIONS MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.
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Affiliation(s)
| | - Jharendra Rijal
- Department of Medicine, Miriam Hospital, Brown University, Providence, RI
| | - Raju Panta
- Department of Medicine, LRGHealthcare, Laconia, NH
| | - Juyong Lee
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT
| | - Michael Azrin
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT
| | - Robert Lootens
- Department of Medicine, LRGHealthcare, Laconia, NH; Concord Cardiac Associates, Dartmouth Hitchcock Medical Center, Concord, NH
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Bradshaw PJ, Trafalski S, Hung J, Briffa TG, Einarsdóttir K. Outcomes after first percutaneous coronary intervention for acute myocardial infarction according to patient funding source. BMC Health Serv Res 2014; 14:405. [PMID: 25231072 PMCID: PMC4261771 DOI: 10.1186/1472-6963-14-405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 09/15/2014] [Indexed: 11/24/2022] Open
Abstract
Background Disparities in the use of invasive coronary artery revascularisation procedures to manage acute myocardial infarction (AMI) have been found in several developed economies. Factors such as socio-economic status, income and funding source may influence the use of invasive procedures and have also been associated with ongoing care. The objectives of this study were to determine whether outcomes for patients at one and five years after AMI treated with first-ever percutaneous coronary intervention (PCI) were the same for public and privately funded patients. Methods Retrospective, population-based cohort study using linked data to identify 30-day survivors of AMI treated with PCI in the index admission between 1995 and 2008 in Western Australian hospitals. The main outcome measures were admission for another PCI, re-AMI, and all-cause and cardiac mortality at one and five years. Results At one year, private patients were at greater adjusted risk for another PCI (HR 1.62 [1.36 – 1.94]; p < 0.001) than public patients, and more likely to have an additional revascularisation procedure from 90 days to 5 years (HR 1.33 [1.11 – 1.58]; p < 0.001). They were at less risk for all-cause death within five years (HR 0.69 [0.62–0.91]; p = 0.01) with a trend to reduced risk for cardiac death and re-AMI. Conclusions Treatment as a private patient for AMI with first PCI is associated with an increased likelihood of additional coronary revascularisation procedure within 12 months and to five years, and a reduced risk for all-cause mortality to 5 years. While additional procedures were not associated with poorer outcomes, there was no clear relationship between better outcomes and additional procedures. Other lifestyle and health care factors may contribute to the significant reduction in all-cause mortality and the trends to reduced hazard for AMI and cardiac death among private patients.
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Affiliation(s)
- Pamela J Bradshaw
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia.
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de Paula JGR, de Godoy MF, dos Santos MA, Pivatelli FC, Osti AVG, Trindade LF, Novelli D, Nakazone MA. Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up. Braz J Cardiovasc Surg 2014; 29:177-85. [PMID: 25140467 PMCID: PMC4389456 DOI: 10.5935/1678-9741.20140051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/26/2014] [Indexed: 11/20/2022] Open
Abstract
Objective In the clinical scenario of ST-segment elevation acute myocardial infarction,
several patients with multivessel coronary atherosclerotic disease are discharged
without a defined strategy to monitor the residual atherosclerotic lesions. The
clinical endpoints evaluated were cardiovascular death, symptoms of angina
pectoris, rehospitalization for a new acute coronary syndrome, and the necessity
of reintervention during the two-year follow-up. Methods This observational, prospective, and historical study included multivessel
coronary atherosclerotic disease patients who were admitted to a tertiary care
university hospital with ST-segment elevation acute myocardial infarction and
underwent primary percutaneous coronary intervention with stent implantation only
at the culprit lesion site; these patients were monitored in the outpatient clinic
according to two treatments: the Clinical Group - CG (optimized pharmacological
therapy associated with counseling for a healthy diet and cardiac rehabilitation)
or the Intervention Group - IG (new staged percutaneous coronary intervention or
surgical coronary artery bypass graft surgery combined with the previously
prescribed treatment). Results Of 143 patients consecutively admitted with ST-segment elevation acute myocardial
infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the
clinical endpoints, the cardiovascular death rate did not differ between the CG
and IG. The symptom of angina pectoris and the rehospitalization rate for a new
episode of acute coronary syndrome were accentuated in the CG
(P=0.020 and P=0.049, respectively) mainly in
individuals with evidence of ischemia evidenced by myocardial scintigraphy
(P<0.001 and P=0.001, respectively) which
culminated in an even greater need for reintervention (P=0.001)
in this subgroup of patients. Conclusion The staged intervention was demonstrated to be safe and able to reduce angina
pectoris and rehospitalization for a new episode of acute coronary syndrome. In
addition, it decreases the likelihood of unplanned reinterventions of patients
without ischemia evidenced by myocardial scintigraphy.
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Affiliation(s)
- José Guilherme Rodrigues de Paula
- Correspondence address: José Guilherme Rodrigues de Paula, Hospital de
Base de S. José do Rio Preto - Laboratório de Hemodinâmica e Cardiologia
Intervencionista, Av. Brigadeiro Faria Lima, 5544, São José do Rio Preto, SP, Brazil,
Zip code: 15090-000. E-mail:
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Cuisset T, Noc M. Multivessel PCI in STEMI: ready to be the recommended strategy? EUROINTERVENTION 2014; 10 Suppl T:T47-54. [DOI: 10.4244/eijv10sta9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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[ST segment elevation myocardial infarction: what is the best timing for revascularization of non-culprit lesions?]. Ann Cardiol Angeiol (Paris) 2014; 63:262-4. [PMID: 24834992 DOI: 10.1016/j.ancard.2014.04.003] [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: 07/11/2013] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
Approximately 50% of patients admitted for ST-elevation myocardial infarction (STEMI) have multi-vessel disease. Current guidelines recommend revascularization of the culprit lesion only during the initial procedure except in cardiogenic shock. Benefits of revascularization of associated functional lesions are not debate. However, timing of the procedure is not clear. This article is a review over timing of secondary revascularization in STEMI patients with multi-vessels disease.
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Kim MC, Jeong MH, Kim SH, Hong YJ, Kim JH, Ahn Y. Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. Korean Circ J 2014; 44:131-8. [PMID: 24876852 PMCID: PMC4037633 DOI: 10.4070/kcj.2014.44.3.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Primary percutaneous coronary intervention (PCI) is a standard interventional treatment modality for ST-segment elevation myocardial infarction (STEMI). Diagnostic coronary angiogram during PCI reveals multivessel coronary artery disease in about half of patients with STEMI, and it is difficult to make decision on the extent of intervention in these patients. Although revascularization for the infarct-related artery only is still effective for STEMI patients, several studies have reported the efficacy of multivessel revascularization during primary PCI, as well as in a staged PCI procedure. Clinicians should consider clinical aspects such as initial cardiogenic shock and myocardial viability when performing primary multivessel intervention, including the risks and benefits of multivessel revascularization in patients undergoing primary PCI. This review describes the current status of performing multivessel PCI in patients with STEMI and proposes an optimal revascularization strategy based on the previous literature.
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Affiliation(s)
- Min Chul Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Hyung Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
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Prodanov P, Widimsky P. Acute Revascularization in ST-Segment-Elevation Myocardial Infarction. Curr Atheroscler Rep 2014; 16:412. [DOI: 10.1007/s11883-014-0412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zhang D, Song X, Lv S, Yuan F, Xu F, Zhang M, Li W, Yan S. Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment elevation myocardial infarction and multivessel disease. PLoS One 2014; 9:e92316. [PMID: 24651489 PMCID: PMC3961318 DOI: 10.1371/journal.pone.0092316] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/21/2014] [Indexed: 11/18/2022] Open
Abstract
Background The best strategy for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD), who underwent primary percutaneous coronary intervention (PCI) in the acute phase, is not well established. Objectives Our goal was to conduct a meta-analysis comparing culprit vessel only percutaneous coronary intervention (culprit PCI) with multivessel percutaneous coronary intervention (MV-PCI) for treatment of patients with STEMI and MVD. Methods Pubmed, Elsevier, Embase, and China National Knowledge Infrastructure (CNKI) databases were systematically searched for randomized and nonrandomized studies comparing culprit PCI and MV-PCI strategies during the index procedure. A meta-analysis was performed using Review Manager 5.1 (Cochrane Center, Denmark). Results Four randomized and fourteen nonrandomized studies involving 39,390 patients were included. MV-PCI strategy is associated with an increased short-term mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p = 0.002), long-term mortality (OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001), and risk of renal dysfunction (OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03) compared with culprit PCI strategy, while it reduced the incidence of revascularization (OR: 2.65, 95% CI: 1.80 to 3.90, p<0.001). Conclusions This meta-analysis supports current guidelines which indicate that the non-culprit vessel should not be treated during the index procedure.
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Affiliation(s)
- Dongfeng Zhang
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
- * E-mail:
| | - Shuzheng Lv
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Fei Yuan
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Feng Xu
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Min Zhang
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Wei Li
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Shuai Yan
- Department of Cardiology, Capital Medical University affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
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de Sousa Almeida M. ["Unsuitable for PCI..." Multivessel primary PCI. But for whom?]. Rev Port Cardiol 2014; 33:75-7. [PMID: 24529893 DOI: 10.1016/j.repc.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022] Open
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de Sousa Almeida M. “Unsuitable for PCI…” Multivessel primary PCI. But for whom? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Pieter C Smits
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
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Birkmeier S, Thiele H, Dörr R. [Management of acute myocardial infarction with ST-segment elevation: Update 2013]. Herz 2013; 38:889-98; quiz 899. [PMID: 24068024 DOI: 10.1007/s00059-013-3941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article gives an update on the management of ST-segment elevation myocardial infarction (STEMI) according to guidelines released in 2012 by the European Society of Cardiology. To ensure a reliable diagnosis the updated universal definition of myocardial infarction will also be covered which is defined by myocardial necrosis. Criteria for diagnosis are a rise or fall of cardiac biomarkers, preferably troponin, in conjunction with symptoms of myocardial ischemia, new repolarisation disorders or left bundle branch block, development of pathological Q-waves, new hypokinesia/akinesia or loss in viability or the detection of intracoronary thrombi during cardiac catheterization or autopsy. The current recommendations for primary diagnosis and treatment by the first medical contact will also be discussed and contains decision-making for the optimal reperfusion strategy. Primary percutaneous coronary intervention remains the preferred reperfusion strategy; however, specifications with respect to time for diagnosis and reperfusion have been introduced. Furthermore, establishing a STEMI network has been emphasized in more detail. Special attention is paid to the new antiplatelet agents and anticoagulation therapy where prasugrel and ticagrelor are currently preferred over clopidogrel.
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Affiliation(s)
- S Birkmeier
- Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum, Strümpellstr. 39, 04289, Leipzig, Deutschland
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Kelly DJ, McCann GP, Blackman D, Curzen NP, Dalby M, Greenwood JP, Fairbrother K, Shipley L, Kelion A, Heatherington S, Khan JN, Nazir S, Alahmar A, Flather M, Swanton H, Schofield P, Gunning M, Hall R, Gershlick AH. Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design. EUROINTERVENTION 2013; 8:1190-8. [PMID: 23425543 DOI: 10.4244/eijv8i10a183] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Primary percutaneous coronary intervention (PPCI) is the preferred strategy for acute ST-segment elevation myocardial infarction (STEMI), with evidence of improved clinical outcomes compared to fibrinolytic therapy. However, there is no consensus on how best to manage multivessel coronary disease detected at the time of PPCI, with little robust data on best management of angiographically significant stenoses detected in non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the optimal management of N-IRA lesions detected during PPCI. METHODS AND RESULTS CVLPRIT (Complete Versus culprit-Lesion only PRimary PCI Trial) is an open-label, prospective, randomised, multicentre trial. STEMI patients undergo verbal "assent" on presentation. Patients are included when angiographic MVD has been detected, and randomised to culprit (IRA)-only PCI (n=150) or in-patient complete multivessel PCI (n=150). Cumulative major adverse cardiac events (MACE) - all-cause mortality, recurrent MI, heart failure, need for revascularisation (PCI or CABG) will be recorded at 12 months. Secondary endpoints include safety endpoints of confirmed ischaemic stroke, intracranial haemorrhage, major non-intracranial bleeding, and repair of vascular complications. A cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage index and microvascular obstruction. A cost efficacy analysis will be undertaken. CONCLUSIONS The management of multivessel coronary artery disease in the setting of PPCI for STEMI, including the timing of when to perform non-culprit-artery revascularisation if undertaken, remains unresolved. CVLPRIT will yield mechanistic insights into the myocardial consequence of N-IRA intervention undertaken during the peri-infarct period.
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Affiliation(s)
- Damian J Kelly
- Department of Cardiology, University Hospitals of Leicester, Leicester, United Kingdom
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Steg G, James SK, Atar D, Badano LP, Blomstrom Lundqvist C, A. Borger M, di Mario C, Dickstein K, Ducrocq G, Fernández-Avilés F, H. Gershlick A, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, J. Lenzen M, W. Mahaffey K, Valgimigli M, van’t Hof A, Widimsky P, Zahger D, J. Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Astin F, Astrom-Olsson K, Budaj A, Clemmensen P, Collet JP, Fox KA, Fuat A, Gustiene O, Hamm CW, Kala P, Lancellotti P, Pietro Maggioni A, Merkely B, Neumann FJ, Piepoli MF, Werf FVD, Verheugt F, Wallentin L. Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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