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Sykes R, Hanna R, Berry C. Prognostic Importance of Fractional Flow Reserve and Left Ventricular Systolic Dysfunction After Percutaneous Coronary Intervention. JACC. ASIA 2024; 4:241-243. [PMID: 38463675 PMCID: PMC10920047 DOI: 10.1016/j.jacasi.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Rebecca Hanna
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom
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2
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Ayoub M, Tajti P, Akin I, Behnes M, Schupp T, Forner J, Omran H, Westermann D, Rudolph V, Mashayekhi K. Safety and Long-Term Outcomes of Rotablation in Patients with Reduced (<50%) Left Ventricular Ejection Fraction (rEF) (The Rota-REF Study). J Clin Med 2023; 12:5640. [PMID: 37685706 PMCID: PMC10488397 DOI: 10.3390/jcm12175640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Clinical outcomes in patients with reduced left ventricular systolic function undergoing rotational atherectomy (RA) for percutaneous coronary intervention (PCI) remain understudied. Our study sought to evaluate the impact of RA-PCI in patients with LV systolic dysfunction on long-term outcomes. Between 2015 and 2019, 4941 patients with reduced LV function (rEF) undergoing PCI (with or without RA) were included in the hospital database. The primary endpoint was in-hospital major adverse cardiovascular and cerebral events (MACCE). The secondary endpoint was 3-year MACCE. In-hospital MACCE rates were significantly higher in RA-PCI compared to standard PCI without RA (PCI) (7.6% vs. 3.9%, p = 0.0009). However, 3-years MACCE rates were similar in RA-PCI and PCI (26.40% vs. 26.6%, p = 0.948). In conclusion, RA-PCI in patients with rEF is feasible, safe, and shows similar long-term results to PCI.
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Affiliation(s)
- Mohamed Ayoub
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, 1096 Budapest, Hungary
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Hazem Omran
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
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Protty MB, Valenzuela T, Sharaf A, Shome J, Hasan S, Chase A, UlHaq Z, Ionescu A, Khurana A, Jenkins G, Obaid DR, Choudhury A, Hailan A. Predictors of 1- and 12-month mortality in bifurcation coronary intervention: a contemporary perspective. Future Cardiol 2023; 19:353-361. [PMID: 37449460 DOI: 10.2217/fca-2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Aim: Bifurcation-PCI is performed frequently, although without extensive evidence to back up a definitive solution for its complexity. We set out to identify factors associated with 1- and 12-month mortality after bifurcation-PCI between 2017 and 2021 in our tertiary center in Wales, UK. Results: Of 732 bifurcation PCI cases (mean age 69; 25% female), 67% were in ACS, 42% were left main PCI and 25.3% involved two-stent strategy. 30-day and 12-month mortality were 1.9 and 8.2%, respectively. Age, diabetes, smoking and renal failure are associated with mortality after bifurcation-PCI, while the choice between provisional and 2-stent strategies did not impact mortality/TLR. Conclusion: Awareness of 'real-world' outcomes of bifurcation-PCI should be used for appropriate patient selection, technique planning and procedural consent.
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Affiliation(s)
- Majd B Protty
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - Tom Valenzuela
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Ahmed Sharaf
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Joy Shome
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Saad Hasan
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Alexander Chase
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Zia UlHaq
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Ayush Khurana
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Geraint Jenkins
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Daniel R Obaid
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Anirban Choudhury
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Ahmed Hailan
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
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4
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Al-Rashid F, Van Mieghem NM, Bonello L, Oreglia J, Romagnoli E. Standardized pre-procedural clinical workup for protected percutaneous coronary intervention. Eur Heart J Suppl 2022; 24:J11-J16. [PMCID: PMC9730791 DOI: 10.1093/eurheartjsupp/suac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
In addition to appropriate patient screening, pre-procedural preparation is essential to optimize both technical success and patient outcome for protected percutaneous coronary intervention (PCI). A critical component of optimization is the identification and preparation of a suitable femoral access site. Here, we describe several options for both imaging and image-guided access to optimize the approach.
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Affiliation(s)
- Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen , Essen , Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter , Rotterdam , The Netherlands
| | - Laurent Bonello
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University , Marseille , France
| | - Jacopo Oreglia
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
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The Prognostic Value of Echocardiographic Wall Motion Score Index in ST-Segment Elevation Myocardial Infarction. Crit Care Res Pract 2022; 2022:8343785. [PMID: 36405398 PMCID: PMC9671736 DOI: 10.1155/2022/8343785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background When compared to left ventricular ejection fraction (LVEF), previous studies have suggested the superiority of wall motion score index (WMSI) in predicting cardiac events in patients who have suffered acute myocardial infarction. However, there are limited studies assessing WMSI and mortality in ST-segment elevation myocardial infarction (STEMI). We aimed to compare the prognostic value of WMSI in a cohort of STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods A comparison of WMSI, LVEF, and all-cause mortality in STEMI patients treated with primary PCI between January 2008 and December 2020 was performed. The prognostic value of WMSI, LVEF, and traditional risk scores (TIMI, GRACE) were compared using multivariable logistic regression modelling. Results Among 1181 patients, 27 died within 30-days (2.3%) and 49 died within 12 months (4.2%). WMSI ≥1.8 was associated with poorer survival at 12-months (9.2% vs 1.5%; p < 0.001). When used as the only classifier for predicting 12-month mortality, the discriminatory ability of WMSI (area under the curve (AUC): 0.77; 95% CI: 0.68–0.84) was significantly better than LVEF (AUC: 0.71; 95% CI: 0.61–0.79; p=0.034). After multivariable modelling, the AUC was comparable between models with either WMSI (AUC: 0.89; 95% CI: 0.85–0.94) or LVEF (AUC: 0.87; 95% CI: 0.83–0.92; p < 0.08) yet performed significantly better than TIMI (AUC: 0.71; 95% CI: 0.62–0.79; p < 0.001), or GRACE (AUC: 0.63; 95% CI: 0.54–0.71; p < 0.001) risk scores. Conclusions When examined individually, WMSI is a superior predictor of 12-month mortality over LVEF in STEMI patients treated with primary PCI. When examined in multivariable predictive models, WMSI and LVEF perform very well at predicting 12-month mortality, especially when compared to existing STEMI risk scores.
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Tayal R, Kalra S, Seth A, Chandra P, Sohal S, Punamiya K, Rao R, Rastogi V, Kapardhi PLN, Sharma S, Kumar P, Arneja J, Mathew R, Kumar D, Mahesh NK, Trehan V. Clinical expert consensus document on the use of percutaneous left ventricular assist devices during complex high-risk PCI in India using a standardised algorithm. ASIAINTERVENTION 2022; 8:75-85. [PMID: 36483283 PMCID: PMC9706744 DOI: 10.4244/aij-d-22-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/12/2022] [Indexed: 06/17/2023]
Abstract
Over the past decade, percutaneous left ventricular assist devices (pLVAD), such as the Impella microaxial flow pump (Abiomed), have been increasingly used to provide haemodynamic support during complex and high-risk revascularisation procedures to reduce the risk of intraprocedural haemodynamic compromise and to facilitate complete and optimal revascularisation. A global consensus on patient selection for the use of pLVADs, however, is currently lacking. Access to these devices is different across the world, thus, individual health care environments need to create and refine patient selection paradigms to optimise the use of these devices. The Impella pLVAD has recently been introduced in India and is being used in several centres in the management of high-risk percutaneous coronary intervention (PCI) and cardiogenic shock. With this increasing utilisation, there is a need for a standardised evaluation protocol to guide Impella use that factors in the unique economic and infrastructural characteristics of India's health care system to ensure that the needs of patients are optimally managed. In this consensus document, we present an algorithm to guide Impella use in Indian patients: to establish a standardised patient selection and usage paradigm that will allow both optimal patient outcomes and ongoing data collection.
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Affiliation(s)
- Rajiv Tayal
- Interventional Cardiology Unit, The Valley Hospital, Ridgewood, NJ, USA
| | - Sanjog Kalra
- Interventional Cardiology Unit, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
| | - Ashok Seth
- Interventional Cardiology Unit, Fortis Escorts Heart Institute, New Delhi, India
| | - Praveen Chandra
- Interventional Cardiology Unit, Medanta Heart Institute, Gurgaon, India
| | - Sumit Sohal
- Interventional Cardiology Unit, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Kirti Punamiya
- Interventional Cardiology Unit, Breach Candy Hospital, Mumbai, India
| | - Ravinder Rao
- Interventional Cardiology Unit, Rajasthan Hospital, Jaipur, India
| | - Vishal Rastogi
- Interventional Cardiology Unit, Fortis Escorts Heart Institute, New Delhi, India
| | - P L N Kapardhi
- Interventional Cardiology Unit, CARE Hospitals, Hyderabad, India
| | - Sanjeev Sharma
- Interventional Cardiology Unit, Eternal Hospital, Jaipur, India
| | - Prathap Kumar
- Interventional Cardiology Unit, Meditrina Group of Hospitals, Kollam, India
| | - Jaspal Arneja
- Interventional Cardiology Unit, Arneja Heart and Multispeciality Hospital, Nagpur, India
| | - Rony Mathew
- Interventional Cardiology Unit, Lisie Hospital, Ernakulam, India
| | - Dilip Kumar
- Interventional Cardiology Unit, Medica Superspecialty Hospital, Kolkata, India
| | - N K Mahesh
- Interventional Cardiology Unit, Apollo Adlux Hospital, Kochi, India
| | - Vijay Trehan
- Interventional Cardiology Unit, Govind Ballabh Pant Hospital, New Delhi, India
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Abusnina W, Mostafa MR, Al-Abdouh A, Radaideh Q, Ismayl M, Alam M, Shah J, Yousfi NE, Paul TK, Ben-Dor I, Dahal K. Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:946027. [PMID: 36204563 PMCID: PMC9530054 DOI: 10.3389/fcvm.2022.946027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSeverely calcified coronary lesions with reduced left ventricular (LV) function result in worse outcomes. Atherectomy is used in treating such lesions when technically feasible. However, there is limited data examining the safety and efficacy of atherectomy without hemodynamic support in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction (LVEF).ObjectiveTo evaluate the clinical outcomes of atherectomy in patient with reduced LVEF.MethodsWe searched PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 21, 2021) for studies evaluating the outcomes of atherectomy in patients with severe LV dysfunction. We used random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI). The endpoints were in-hospital and long term all-cause mortality, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).ResultsA total of 7 studies consisting of 2,238 unique patients were included in the analysis. The median follow-up duration was 22.4 months. The risk of in-hospital all-cause mortality using atherectomy in patients with severely reduced LVEF compared to the patients with moderate reduced or preserved LVEF was [2.4vs.0.5%; RR:5.28; 95%CI 1.65–16.84; P = 0.005], the risk of long term all-cause mortality was [21 vs. 8.8%; RR of 2.84; 95% CI 1.16–6.95; P = 0.02]. In-hospital TVR risk was 2.0 vs. 0.6% (RR: 4.15; 95% CI 4.15–15.67; P = 0.04) and long-term TVR was [6.0 vs. 9.9%; RR of 0.75; 95% CI 0.39–1.42; P = 0.37]. In-hospital MI was [7.1 vs. 5.4%; RR 1.63; 95% CI 0.91–2.93; P = 0.10], long-term MI was [7.5 vs. 5.7; RR 1.74; 95%CI 0.95–3.18; P = 0.07).ConclusionOur meta-analysis suggested that the patients with severely reduced LVEF when using atherectomy devices experienced higher risk of clinical outcomes in the terms of all-cause mortality and cardiac mortality. As we know that the patients with severely reduced LVEF are inherently at increased risk of adverse clinical outcomes, this information should be considered hypothesis generating and utilized while discussing the risks and benefits of atherectomy in such high risk patients. Future studies should focus on the comparison of outcomes of different atherectomy devices in such patients. Adjusting for the inherent mortality risk posed by left ventricular dysfunction may be a strategy while designing a study.
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Affiliation(s)
- Waiel Abusnina
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
| | - Mostafa Reda Mostafa
- Department of Medicine, Rochester Regional/Unity Hospital, Rochester, NY, United States
| | - Ahmad Al-Abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, United States
| | - Qais Radaideh
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
| | - Mahmoud Ismayl
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan
- *Correspondence: Jaffer Shah
| | | | - Timir K. Paul
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, United States
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Khagendra Dahal
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United States
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Gallone G, Kang J, Bruno F, Han JK, De Filippo O, Yang HM, Doronzo M, Park KW, Mittone G, Kang HJ, Parma R, Gwon HC, Cerrato E, Chun WJ, Smolka G, Hur SH, Helft G, Han SH, Muscoli S, Song YB, Figini F, Choi KH, Boccuzzi G, Hong SJ, Trabattoni D, Nam CW, Giammaria M, Kim HS, Conrotto F, Escaned J, Di Mario C, D'Ascenzo F, Koo BK, de Ferrari GM. Impact of Left Ventricular Ejection Fraction on Procedural and Long-Term Outcomes of Bifurcation Percutaneous Coronary Intervention. Am J Cardiol 2022; 172:18-25. [PMID: 35365291 DOI: 10.1016/j.amjcard.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 11/01/2022]
Abstract
The association of left ventricular ejection fraction (LVEF) with procedural and long-term outcomes after state-of-the-art percutaneous coronary intervention (PCI) of bifurcation lesions remains unsettled. A total of 5,333 patients who underwent contemporary coronary bifurcation PCI were included in the intercontinental retrospective combined insights from the unified RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) and COBIS (COronary BIfurcation Stenting) III bifurcation registries. Of 5,003 patients (93.8%) with known baseline LVEF, 244 (4.9%) had LVEF <40% (bifurcation with reduced ejection fraction [BIFrEF] group), 430 (8.6%) had LVEF 40% to 49% (bifurcation with mildly reduced ejection fraction [BIFmEF] group) and 4,329 (86.5%) had ejection fraction (EF) ≥50% (bifurcation with preserved ejection fraction [BIFpEF] group). The primary end point was the Kaplan-Meier estimate of major adverse cardiac events (MACEs) (a composite of all-cause death, myocardial infarction, and target vessel revascularization). Patients with BIFrEF had a more complex clinical profile and coronary anatomy. No difference in procedural (30 days) MACE was observed across EF categories, also after adjustment for in-study outcome predictors (BIFrEF vs BIFmEF: adjusted hazard ratio [adj-HR] 1.39, 95% confidence interval [CI] 0.37 to 5.21, p = 0.626; BIFrEF vs BIFpEF: adj-HR 1.11, 95% CI 0.25 to 2.87, p = 0.883; BIFmEF vs BIFpEF: adj-HR 0.81, 95% CI 0.29 to 2.27, p = 0.683). BIFrEF was independently associated with long-term MACE (median follow-up 21 months, interquartile range 10 to 21 months) than both BIFmEF (adj-HR 2.20, 95% CI 1.41 to 3.41, p <0.001) and BIFpEF (adj-HR 1.91, 95% CI 1.41 to 2.60, p <0.001) groups, although no difference was observed between BIFmEF and BIFpEF groups (adj-HR 0.87, 95% CI 0.61 to 1.24, p = 0.449). In conclusion, in patients who underwent PCI of a coronary bifurcation lesion according to contemporary clinical practice, reduced LVEF (<40%), although a strong predictor of long-term MACEs, does not affect procedural outcomes.
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9
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Wang S, Lyu Y, Cheng S, Liu J, Borah BJ. Clinical Outcomes of Patients with Coronary Artery Diseases and Moderate Left Ventricular Dysfunction: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery. Ther Clin Risk Manag 2021; 17:1103-1111. [PMID: 34703239 PMCID: PMC8527105 DOI: 10.2147/tcrm.s336713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two revascularization strategies for patients with coronary artery disease (CAD) and left ventricular dysfunction. However, the comparisons of effectiveness between the two strategies are insufficient. This study is aimed to compare the effectiveness between PCI and CABG among patients with moderate left ventricular dysfunction. Patients and Methods A total of 1487 CAD patients with moderate reduced ejection fraction (36%≤EF≤40%), who underwent either PCI or CABG, were enrolled in a real-world cohort study (No. ChiCTR2100044378). Clinical outcomes included short- and long-term all-cause mortality, rates of heart failure (HF) hospitalization and repeat revascularization. Propensity score matching was used to balance the two cohorts. Results PCI was associated with lower 30-day mortality rate (hazard ratio [HR] [95% CI], 0.35 [0.15–0.83]; P=0.02). At a mean follow-up of 4.5 years, PCI and CABG had similar all-cause death (HR [95% CI], 0.82 [0.56–1.20]; P=0.30) and heart failure (HF) hospitalization (HR [95% CI], 0.93 [0.54–1.60]; P=0.79), but PCI had higher risk of repeat revascularization (HR [95% CI], 8.62 [3.67–20.23]; P<0.001). Improvement in EF measured at 3 months later after revascularization was also similar between PCI and CABG (P for interaction=0.87). Conclusion CAD patients with moderate reduced EF who had PCI had lower short-term mortality rate but higher risk of repeat revascularization during follow-up than patients who had CABG. PCI showed comparable long-term survival, HF hospitalization risk, and EF improvement.
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Affiliation(s)
- Shaoping Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Yi Lyu
- Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China
| | - Shujuan Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bijan J Borah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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10
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Choi SH, Jang HJ, Suh YJ, Park SD, Oh PC, Moon J, Lee K, Suh J, Kang W, Kim TH, Kwon SW. Clinical Implication of Hypoxic Liver Injury for Predicting Hypoxic Hepatitis and In-Hospital Mortality in ST Elevation Myocardial Infarction Patients. Yonsei Med J 2021; 62:877-884. [PMID: 34558866 PMCID: PMC8470566 DOI: 10.3349/ymj.2021.62.10.877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In this study, we aimed to determine the value of hypoxic liver injury (HLI) in the emergency room (ER) for predicting hypoxic hepatitis (HH) and in-hospital mortality in ST elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS 1537 consecutive STEMI patients were enrolled. HLI in the ER was defined as a ≥2-fold increase in serum aspartate transaminase (AST). HH was defined as a ≥20-fold increase in peak serum transaminase. Patients were divided into four groups according to HLI and HH status (group 1, no HLI or HH; group 2, HLI, but no HH; group 3, no HLI, but HH; group 4, both HLI and HH). RESULTS The incidences of HLI and HH in the ER were 22% and 2%, respectively. In-hospital mortality rates were 3.1%, 11.8%, 28.6%, and 47.1% for groups 1, 2, 3, and 4, respectively. Patients with HLI and/or HH had worse Killip class, higher cardiac biomarker elevations, and lower left ventricular ejection fraction. Multivariate logistic regression analysis showed that HLI in the ER was an independent predictor of HH [odds ratio 2.572, 95% confidence interval (CI) 1.166-5.675, p=0.019]. The predictive value of HLI in the ER for the development of HH during hospitalization was favorable [area under the curve (AUC) 0.737, 95% CI 0.643-0.830, sensitivity 0.548, specificity 0.805, for cut-off value AST >80]. Furthermore, in terms of in-hospital mortality, predictive values of HLI in the ER and HH during hospitalization were comparable (AUC 0.701 for HLI at ER and AUC 0.674 for HH). CONCLUSION Among STEMI patients, HLI in the ER is a significant predictor for the development of HH and mortality during hospitalization (INTERSTELLAR ClinicalTrials.gov number, NCT02800421).
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Affiliation(s)
- Seong Huan Choi
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Ho-Jun Jang
- Department of Cardiology, Sejong General Hospital, Bucheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Korea
| | - Sang-Don Park
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jeonggeun Moon
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jon Suh
- Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - WoongChol Kang
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, CHA Medical Center, Ilsan Hospital, Goyang, Korea.
| | - Sung Woo Kwon
- Department of Cardiology, Inha University Hospital, Incheon, Korea.
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11
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Moyon A, Garrigue P, Fernandez S, Hubert F, Balasse L, Brige P, Hache G, Nail V, Blot-Chabaud M, Dignat-George F, Rochais F, Guillet B. Comparison of a New 68Ga-Radiolabelled PET Imaging Agent sCD146 and RGD Peptide for In Vivo Evaluation of Angiogenesis in Mouse Model of Myocardial Infarction. Cells 2021; 10:cells10092305. [PMID: 34571954 PMCID: PMC8466330 DOI: 10.3390/cells10092305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Ischemic vascular diseases are associated with elevated tissue expression of angiomotin (AMOT), a promising molecular target for PET imaging. On that basis, we developed an AMOT-targeting radiotracer, 68Ga-sCD146 and performed the first in vivo evaluation on a myocardial infarction mice model and then, compared AMOT expression and αvβ3-integrin expression with 68Ga-sCD146 and 68Ga-RGD2 imaging. After myocardial infarction (MI) induced by permanent ligation of the left anterior descending coronary artery, myocardial perfusion was evaluated by Doppler ultrasound and by 18F-FDG PET imaging. 68Ga-sCD146 and 68Ga-RGD2 PET imaging were performed. In myocardial infarction model, heart-to-muscle ratio of 68Ga-sCD146 imaging showed a significantly higher radiotracer uptake in the infarcted area of MI animals than in sham (* p = 0.04). Interestingly, we also observed significant correlations between 68Ga-sCD146 imaging and delayed residual perfusion assessed by 18F-FDG (* p = 0.04), with lowest tissue fibrosis assessed by histological staining (* p = 0.04) and with functional recovery assessed by ultrasound imaging (** p = 0.01). 68Ga-sCD146 demonstrated an increase in AMOT expression after MI. Altogether, significant correlations of early post-ischemic 68Ga-sCD146 uptake with late heart perfusion, lower tissue fibrosis and better functional recovery, make 68Ga-sCD146 a promising radiotracer for tissue angiogenesis assessment after MI.
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Affiliation(s)
- Anaïs Moyon
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
- APHM, Service de Radiopharmacie, 13005 Marseille, France
- Correspondence:
| | - Philippe Garrigue
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
- APHM, Service de Radiopharmacie, 13005 Marseille, France
| | - Samantha Fernandez
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
| | - Fabien Hubert
- Medical Faculty, Aix Marseille University, INSERM, MMG, U 1251, 13385 Marseille, France; (F.H.); (F.R.)
| | - Laure Balasse
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
| | - Pauline Brige
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
- Medical Faculty, Aix-Marseille University, UR4264, LIIE, 13385 Marseille, France
| | - Guillaume Hache
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
| | - Vincent Nail
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
- APHM, Service de Radiopharmacie, 13005 Marseille, France
| | - Marcel Blot-Chabaud
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
| | - Françoise Dignat-George
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
- APHM, Service d’Hématologie, Hôpital Conception, 13005 Marseille, France
| | - Francesca Rochais
- Medical Faculty, Aix Marseille University, INSERM, MMG, U 1251, 13385 Marseille, France; (F.H.); (F.R.)
| | - Benjamin Guillet
- Pharmacological Faculty, Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, 13385 Marseille, France; (P.G.); (G.H.); (V.N.); (M.B.-C.); (F.D.-G.); (B.G.)
- Medical Faculty, Aix-Marseille University, CNRS 2012, CERIMED, 13385 Marseille, France; (S.F.); (L.B.); (P.B.)
- APHM, Service de Radiopharmacie, 13005 Marseille, France
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12
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Malebranche D, Hasan S, Fung M, Har B, Champagne P, Schnell G, Wilton SB, Anderson TJ. Patterns of Left-Ventricular Function Assessment in Patients With Acute Coronary Syndromes. CJC Open 2021; 3:733-740. [PMID: 34169252 PMCID: PMC8209391 DOI: 10.1016/j.cjco.2020.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022] Open
Abstract
Background In patients with acute coronary syndromes (ACS), guidelines recommend the assessment of left-ventricular ejection fraction (LVEF). Many patients with ACS undergo multiple assessments of LVEF, the clinical value of which is unknown. Methods Patients with ACS undergoing cardiac catheterization between 2012 and 2016 were evaluated and assessments of LV function identified. To evaluate changes in LVEF over time, available echocardiograms were reviewed in a subsample of patients with LVEF data available (n = 3221). Patients with ACS were classified into 3 groups: group 1 (LVEF > 50%), group 2 (LVEF 35% to 50%), and group 3 (LVEF < 35%). Results Our cohort consisted of 8327 patients with ACS (76% men), presenting with a mean age of 62.4 ± 12.4 years. At index presentation, 66% of patients had an LVEF > 50%, 27% had an LVEF between 35% and 50%, and 7% had severely reduced LVEF of < 35%. More than half of the cohort (n = 4600) had follow-up assessment of LV function, performed over an average of 2.71 ± 1.31 years. In the subsample of 3221 patients, only 1.1% of those in group 1, and 5.1% of those in group 2, deteriorated to an LVEF < 35%. Conclusions Patients with ACS often undergo multiple assessments of LV function. Those with initially preserved EF rarely demonstrate a decline in EF to < 35%. A reduction in low-value cardiac tests may be an important first step in improving the quality of care for patients with ACS.
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Affiliation(s)
- Daniel Malebranche
- Arthur J.E. Child Fellow, Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Sarah Hasan
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinda Fung
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bryan Har
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Champagne
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory Schnell
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Wu X, Reboll MR, Korf-Klingebiel M, Wollert KC. Angiogenesis after acute myocardial infarction. Cardiovasc Res 2020; 117:1257-1273. [PMID: 33063086 DOI: 10.1093/cvr/cvaa287] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/09/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022] Open
Abstract
Acute myocardial infarction (MI) inflicts massive injury to the coronary microcirculation leading to vascular disintegration and capillary rarefication in the infarct region. Tissue repair after MI involves a robust angiogenic response that commences in the infarct border zone and extends into the necrotic infarct core. Technological advances in several areas have provided novel mechanistic understanding of postinfarction angiogenesis and how it may be targeted to improve heart function after MI. Cell lineage tracing studies indicate that new capillary structures arise by sprouting angiogenesis from pre-existing endothelial cells (ECs) in the infarct border zone with no meaningful contribution from non-EC sources. Single-cell RNA sequencing shows that ECs in infarcted hearts may be grouped into clusters with distinct gene expression signatures, likely reflecting functionally distinct cell populations. EC-specific multicolour lineage tracing reveals that EC subsets clonally expand after MI. Expanding EC clones may arise from tissue-resident ECs with stem cell characteristics that have been identified in multiple organs including the heart. Tissue repair after MI involves interactions among multiple cell types which occur, to a large extent, through secreted proteins and their cognate receptors. While we are only beginning to understand the full complexity of this intercellular communication, macrophage and fibroblast populations have emerged as major drivers of the angiogenic response after MI. Animal data support the view that the endogenous angiogenic response after MI can be boosted to reduce scarring and adverse left ventricular remodelling. The improved mechanistic understanding of infarct angiogenesis therefore creates multiple therapeutic opportunities. During preclinical development, all proangiogenic strategies should be tested in animal models that replicate both cardiovascular risk factor(s) and the pharmacotherapy typically prescribed to patients with acute MI. Considering that the majority of patients nowadays do well after MI, clinical translation will require careful selection of patients in need of proangiogenic therapies.
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Affiliation(s)
- Xuekun Wu
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Marc R Reboll
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Mortimer Korf-Klingebiel
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
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14
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Kimura M, Kohno T, Sawano M, Heidenreich PA, Ueda I, Takahashi T, Matsubara T, Ueno K, Hayashida K, Yuasa S, Ohki T, Fukuda K, Kohsaka S. Independent and cumulative association of clinical and morphological heart failure with long-term outcome after percutaneous coronary intervention. J Cardiol 2020; 77:41-47. [PMID: 32888830 DOI: 10.1016/j.jjcc.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heart failure (HF) is a risk factor for adverse post-procedural outcome after revascularization; however, it is unclear how left ventricular systolic dysfunction (LVSD) and clinical HF symptoms affect percutaneous coronary intervention (PCI) outcomes. We investigated the characteristics and long-term outcomes of patients with clinical HF or LVSD after PCI. METHODS This was a Japanese multicenter registry study of adult patients receiving PCI. Among 4689 consecutive patients who underwent PCI at 15 hospitals from January 2009 to December 2012, we analyzed 2634 (56.2%) with documented left ventricular ejection fraction (LVEF). They were divided into four groups based on clinical HF (symptoms or HF hospitalization) and LVEF [≥35% and <35% (HF due to LVSD)]. The primary outcome was major adverse cardiovascular events (MACE), comprising all-cause death, acute coronary syndrome, HF hospitalization, performance of coronary artery bypass grafting, and stroke within 2 years after the initial PCI. RESULTS Our findings revealed 354 patients (13.4%) with HF (clinical HF, n = 173, 48.9%; LVSD, n = 132, 37.3%; both, n = 49; 13.8%). The incidence of MACE was higher in patients with clinical HF or LVSD, and was largely due to higher non-cardiac death and HF hospitalization. After adjustment, clinical HF (hazard ratio 2.16, 95% confidence interval; 1.49-3.14) and lower LVEF (per 10%, hazard ratio 0.89, 95% confidence interval; 0.81-0.99) were independently associated with higher MACE risk. CONCLUSIONS Clinical HF and LVSD were independently associated with adverse long-term clinical outcomes, particularly with non-cardiac death and HF readmission, in patients treated with PCI.
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Affiliation(s)
- Mai Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan.
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Koji Ueno
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Ohki
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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15
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Rashid M, Ludman PF, Mamas MA. British Cardiovascular Intervention Society registry framework: a quality improvement initiative on behalf of the National Institute of Cardiovascular Outcomes Research (NICOR). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 5:292-297. [PMID: 31050720 DOI: 10.1093/ehjqcco/qcz023] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 11/14/2022]
Abstract
The British Cardiovascular Intervention Society (BCIS) percutaneous coronary intervention (PCI) registry is hosted by the National Institute of Cardiovascular Outcomes Research (NICOR) at Bart's Heart Centre and collects clinical characteristics, indications, procedural details, and outcomes of all patients undergoing PCI in the UK. The data are used for audit and research to monitor and improve PCI practices and patient outcomes. Bespoke live data analysis and structured monthly reports are used to provide real-time feedback to all participating hospitals about the provision of care. Risk-adjusted analyses are used as a quality metric and benchmarking PCI practices. The consecutive patients undergoing PCI in all PCI performing hospitals in the UK from 1994 to present. One hundred and thirteen variables encompassing patient demographics, indication, procedural details, complications, and in-hospital outcomes are recorded. Prospective data are collected electronically and encrypted before transfer to central database servers. Data are validated locally and further range checks, sense checks, and assessments of internal consistency are applied during data uploads. Analyses of uploaded data including an assessment of data completeness are provided to all hospitals for validation, with repeat validation rounds prior to public reporting. Endpoints are in-hospital PCI complications, bleeding and mortality. All-cause mortality is obtained via linkage to the Office of National Statistics. No other linkages are available at present. Available for research by application to NICOR at http://www.nicor.org.uk/ using a data sharing agreement.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
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16
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Meijers TA, Aminian A, Teeuwen K, van Wely M, Schmitz T, Dirksen MT, van der Schaaf RJ, Iglesias JF, Agostoni P, Dens J, Knaapen P, Rathore S, Ottervanger JP, Dambrink JHE, Roolvink V, Gosselink ATM, Hermanides RS, van Royen N, van Leeuwen MAH. Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol. BMJ Open 2020; 10:e038042. [PMID: 32690749 PMCID: PMC7375502 DOI: 10.1136/bmjopen-2020-038042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach. METHODS AND ANALYSIS A total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the local Ethics Committee at each recruiting center ('Medisch Ethische Toetsing Commissie Isala Zwolle', 'Commissie voor medische ethiek ZNA', 'Comité Medische Ethiek Ziekenhuis Oost-Limburg', 'Comité d'éthique CHU-Charleroi-ISPPC', 'Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve', 'Ethik Kommission de Ärztekammer Nordrhein' and 'Riverside Research Ethics Committee'). The trial outcomes will be published in peer-reviewed journals of the concerned literature. TRIAL REGISTRATION NUMBER NCT03846752.
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Affiliation(s)
| | - Adel Aminian
- Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Wallonie, Belgium
| | - Koen Teeuwen
- Cardiology, Catharina Hospital, Eindhoven, Noord Brabant, The Netherlands
| | | | - Thomas Schmitz
- Cardiology, Elisabeth-Krankenhaus-Essen GmbH, Essen, Nordrhein-Westfalen, Germany
| | - Maurits T Dirksen
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | | | - Juan F Iglesias
- Cardiology, Geneva University Hospitals, Geneve, Genève, Switzerland
| | | | - Joseph Dens
- Cardiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Paul Knaapen
- Cardiology, Amsterdam UMC - Locatie VUMC, Amsterdam, Noord-Holland, The Netherlands
| | - Sudhir Rathore
- Cardiology, Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | | | | | | | | | | | - Niels van Royen
- Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands
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17
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Manjunath SC, Doddaiah B, Ananthakrishna R, Sastry SL, Patil VS, Devegowda L, Veervhadraiah SB, Bhat P, Nanjappa Manjunath C. Observational study of left ventricular global longitudinal strain in ST-segment elevation myocardial infarction patients with extended pharmaco-invasive strategy: A six months follow-up study. Echocardiography 2020; 37:283-292. [PMID: 31955468 DOI: 10.1111/echo.14588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022] Open
Abstract
AIMS AND OBJECTIVES To evaluate left ventricular (LV) function by assessment of LV global longitudinal strain (GLS) in ST-segment elevation myocardial infarction (STEMI) patients who underwent delayed fibrinolysis and coronary intervention (extended pharmaco-invasive strategy), since LV function is one of the determinants of both immediate and long-term outcomes. METHODS Prospective study of consecutive STEMI patients who underwent extended pharmaco-invasive strategy. The LV function was estimated using LV GLS at baseline and at 6 months. RESULTS The study included eighty-seven STEMI patients who received delayed pharmaco-invasive therapy and coronary intervention. The primary aim of the study was to evaluate a change in LV function by assessment of GLS at 6 months as compared to baseline. Prior to PCI, LV ejection fraction was 48.08 ± 6.23% and GLS was -11.11 ± 2.99%. Procedural success was achieved in all patients. LV ejection fraction after 6 months of follow-up increased to 53.12 ± 5.61% and the GLS improved to -13.03 ± 3.06% In comparison to baseline, there was a significant improvement in both LV ejection fraction and GLS at 6 months of follow-up (P < .001).The cardiac mortality was 1.1% at 6 months. CONCLUSION There is a significant improvement of LV function as assessed by GLS and ejection fraction at short-term follow-up. In a stable cohort of STEMI patients, extended pharmaco-invasive strategy is also a reasonable option if PCI cannot be performed within the first 24 hours, due to logistic and infrastructural constraints.
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Affiliation(s)
- Satvic C Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Balaraju Doddaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Rajiv Ananthakrishna
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Sridhar Lakshmana Sastry
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Vikram S Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Lachikrathman Devegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Sumangala B Veervhadraiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
| | - Prabhavathi Bhat
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India
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18
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Zhang HP, Zhao Y, Ai H, Li H, Tang GD, Zheng NX, Sun FC. Outcomes of coronary rotational atherectomy in patients with reduced left ventricular ejection fraction. J Int Med Res 2019; 48:300060519895144. [PMID: 31878815 PMCID: PMC7783247 DOI: 10.1177/0300060519895144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective We evaluated the safety and efficacy of rotational atherectomy (RA) in
patients with a reduced left ventricular ejection fraction (LVEF). Methods In total, 140 consecutive patients with severe coronary artery calcification
(CAC) who underwent RA were retrospectively enrolled. Patients were grouped
based on LVEF: ≤35% (n = 10), 36% to 50% (n = 11), and >50% (n = 119). We
assessed procedural success and periprocedural complication rates as well as
the incidences of in-hospital and 2-year major adverse cardiac events
(MACEs), defined as hospitalization for myocardial infarction and worsening
heart failure, target vessel revascularization, and cardiac death. Results Procedural success was achieved in nearly all patients in each group. Most
periprocedural complications were minor, and major complications were
uncommon. The 2-year MACE rate was significantly higher in the LVEF ≤35%
than LVEF >50% group (40.0% vs. 6.7%, respectively). Multivariable
regression analysis revealed that the LVEF was the only independent
predictor of 2-year MACEs in patients who underwent RA. Conclusions Patients with a reduced LVEF who underwent RA had procedural success rates
similar to those of patients with preserved left ventricular systolic
function. The LVEF might be an independent predictor of 2-year MACEs in
patients with severe CAC after percutaneous coronary intervention following
RA.
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Affiliation(s)
- Hui-Ping Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Ying Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Hu Ai
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Guo-Dong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Nai-Xin Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Fu-Cheng Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
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19
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Effect of Body Mass Index on Ischemic and Bleeding Events in Patients Presenting With Acute Coronary Syndromes (from the START-ANTIPLATELET Registry). Am J Cardiol 2019; 124:1662-1668. [PMID: 31585697 DOI: 10.1016/j.amjcard.2019.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023]
Abstract
The protective effect of obesity on mortality in acute coronary syndromes (ACS) patients remains debated. We aimed at evaluating the impact of obesity on ischemic and bleeding events as possible explanations to the obesity paradox in ACS patients. For the purpose of this substudy, patients enrolled in the START-ANTIPLATELET registry were stratified according to body mass index (BMI) into 3 groups: normal, BMI <25 kg/m2; overweight, BMI: 25 to 29.9 kg/m2; obese, BMI ≥30 kg/m2. The primary end point was net adverse clinical end points (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. In n = 1,209 patients, n = 410 (33.9%) were normal, n = 538 (44.5%) were overweight and n = 261 (21.6%) were obese. Compared to the normal weight group, obese and overweight patients had a higher prevalence of cardiovascular risk factors but were younger, with a better left ventricular ejection fraction and lower PRECISE-DAPT score. At 1-year follow-up net adverse clinical endpoints was more frequently observed in normal than in overweight and obese patients (15.1%, 8.6%, and9.6%, respectively; p = 0.004), driven by a significantly higher rate of all-cause death (6.3%, 2.6%, and 3.8%, respectively; p = 0.008), whereas no significant differences were noted in terms of myocardial infarction, stroke, and major bleeding. When correcting for confounding variables, BMI loses its power in independently predicting outcomes, failing to confirm the obesity paradox in a real-world ACS population. In conclusion, our study conflicts the obesity paradox in real-world ACS population, and suggest that the reduced rate of adverse events and mortality in obese patients may be explained by relevant differences in the clinical risk profile and medications rather than BMI per se.
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Søndergaard L, Popma JJ, Reardon MJ, Van Mieghem NM, Deeb GM, Kodali S, George I, Williams MR, Yakubov SJ, Kappetein AP, Serruys PW, Grube E, Schiltgen MB, Chang Y, Engstrøm T, Sorajja P, Sun B, Agarwal H, Langdon T, den Heijer P, Bentala M, O’Hair D, Bajwa T, Byrne T, Caskey M, Paulus B, Garrett E, Stoler R, Hebeler R, Khabbaz K, Scott Lim D, Bladergroen M, Fail P, Feinberg E, Rinaldi M, Skipper E, Chawla A, Hockmuth D, Makkar R, Cheng W, Aji J, Bowen F, Schreiber T, Henry S, Hengstenberg C, Bleiziffer S, Harrison JK, Hughes C, Joye J, Gaudiani V, Babaliaros V, Thourani V, Dauerman H, Schmoker J, Skelding K, Casale A, Kovac J, Spyt T, Seshiah P, Smith JM, McKay R, Hagberg R, Matthews R, Starnes V, O’Neill W, Paone G, García JMH, Such M, de la Tassa CM, Cortina JCL, Windecker S, Carrel T, Whisenant B, Doty J, Resar J, Conte J, Aharonian V, Pfeffer T, Rück A, Corbascio M, Blackman D, Kaul P, Kliger C, Brinster D, Teefy P, Kiaii B, Leya F, Bakhos M, Sandhu G, Pochettino A, Piazza N, de Varennes B, van Boven A, Boonstra P, Waksman R, Bafi A, Asgar A, Cartier R, Kipperman R, Brown J, Lin L, Rovin J, Sharma S, Adams D, Katz S, Hartman A, Al-Jilaihawi H, Crestanello J, Lilly S, Ghani M, Bodenhamer RM, Rajagopal V, Kauten J, Mumtaz M, Bachinsky W, Nickenig G, Welz A, Olsen P, Watson D, Chhatriwalla A, Allen K, Teirstein P, Tyner J, Mahoney P, Newton J, Merhi W, Keiser J, Yeung A, Miller C, Berg JT, Heijmen R, Petrossian G, Robinson N, Brecker S, Jahangiri M, Davis T, Batra S, Hermiller J, Heimansohn D, Radhakrishnan S, Fremes S, Maini B, Bethea B, Brown D, Ryan W, Kleiman N, Spies C, Lau J, Herrmann H, Bavaria J, Horlick E, Feindel C, Neumann FJ, Beyersdorf F, Binder R, Maisano F, Costa M, Markowitz A, Tadros P, Zorn G, de Marchena E, Salerno T, Chetcuti S, Labinz M, Ruel M, Lee JS, Gleason T, Ling F, Knight P, Robbins M, Ball S, Giacomini J, Burdon T, Applegate R, Kon N, Schwartz R, Schubach S, Forrest J, Mangi A. Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk: Results From the Randomized SURTAVI Trial. Circulation 2019; 140:1296-1305. [PMID: 31476897 DOI: 10.1161/circulationaha.118.039564] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients with severe aortic stenosis and coronary artery disease, the completely percutaneous approach to aortic valve replacement and revascularization has not been compared with the standard surgical approach. METHODS The prospective SURTAVI trial (Safety and Efficiency Study of the Medtronic CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement) enrolled intermediate-risk patients with severe aortic stenosis from 87 centers in the United States, Canada, and Europe between June 2012 and June 2016. Complex coronary artery disease with SYNTAX score (Synergy Between PCI with Taxus and Cardiac Surgery Trial) >22 was an exclusion criterion. Patients were stratified according to the need for revascularization and then randomly assigned to treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Patients assigned to revascularization in the TAVR group underwent percutaneous coronary intervention, whereas those in the SAVR group had coronary artery bypass grafting. The primary end point was the rate of all-cause mortality or disabling stroke at 2 years. RESULTS Of 1660 subjects with attempted aortic valve implants, 332 (20%) were assigned to revascularization. They had a higher Society of Thoracic Surgeons risk score for mortality (4.8±1.7% versus 4.4±1.5%; P<0.01) and were more likely to be male (65.1% versus 54.2%; P<0.01) than the 1328 patients not assigned to revascularization. After randomization to treatment, there were 169 patients undergoing TAVR and percutaneous coronary intervention, 163 patients undergoing SAVR and coronary artery bypass grafting, 695 patients undergoing TAVR, and 633 patients undergoing SAVR. No significant difference in the rate of the primary end point was found between TAVR and percutaneous coronary intervention and SAVR and coronary artery bypass grafting (16.0%; 95% CI, 11.1-22.9 versus 14.0%; 95% CI, 9.2-21.1; P=0.62), or between TAVR and SAVR (11.9%; 95% CI, 9.5-14.7 versus 12.3%; 95% CI, 9.8-15.4; P=0.76). CONCLUSIONS For patients at intermediate surgical risk with severe aortic stenosis and noncomplex coronary artery disease (SYNTAX score ≤22), a complete percutaneous approach of TAVR and percutaneous coronary intervention is a reasonable alternative to SAVR and coronary artery bypass grafting. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01586910.
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Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
| | - Jeffrey J. Popma
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, TX (M.J.R.)
| | - Nicolas M. Van Mieghem
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (G.M.D.)
| | - Susheel Kodali
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Mathew R. Williams
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, NYU-Langone Medical Center, New York (M.R.W.)
| | - Steven J. Yakubov
- Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus (S.J.Y.)
| | - Arie P. Kappetein
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, Germany (E.G.)
| | | | - Yanping Chang
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
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Adenosine stress perfusion cardiac magnetic resonance imaging in patients undergoing intracoronary bone marrow cell transfer after ST-elevation myocardial infarction: the BOOST-2 perfusion substudy. Clin Res Cardiol 2019; 109:539-548. [PMID: 31401672 DOI: 10.1007/s00392-019-01537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
AIMS In the placebo-controlled, double-blind BOne marrOw transfer to enhance ST-elevation infarct regeneration (BOOST) 2 trial, intracoronary autologous bone marrow cell (BMC) transfer did not improve recovery of left ventricular ejection fraction (LVEF) at 6 months in patients with ST-elevation myocardial infarction (STEMI) and moderately reduced LVEF. Regional myocardial perfusion as determined by adenosine stress perfusion cardiac magnetic resonance imaging (S-CMR) may be more sensitive than global LVEF in detecting BMC treatment effects. Here, we sought to evaluate (i) the changes of myocardial perfusion in the infarct area over time (ii) the effects of BMC therapy on infarct perfusion, and (iii) the relation of infarct perfusion to LVEF recovery at 6 months. METHODS AND RESULTS In 51 patients from BOOST-2 (placebo, n = 10; BMC, n = 41), S-CMR was performed 5.1 ± 2.9 days after PCI (before placebo/BMC treatment) and after 6 months. Infarct perfusion improved from baseline to 6 months in the overall patient cohort as reflected by the semi-quantitative parameters, perfusion defect-infarct size ratio (change from 0.54 ± 0.20 to 0.43 ± 0.22; P = 0.006) and perfusion defect-upslope ratio (0.54 ± 0.23 to 0.68 ± 0.22; P < 0.001), irrespective of randomised treatment. Perfusion defect-upslope ratio at baseline correlated with LVEF recovery (r = 0.62; P < 0.001) after 6 months, with a threshold of 0.54 providing the best sensitivity (79%) and specificity (74%) (area under the curve, 0.79; 95% confidence interval, 0.67-0.92). CONCLUSION Infarct perfusion improves from baseline to 6 months and predicts LVEF recovery in STEMI patients undergoing early PCI. Intracoronary BMC therapy did not enhance infarct perfusion in the BOOST-2 trial.
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Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study. Cardiol Ther 2019; 8:267-281. [PMID: 31350729 PMCID: PMC6828855 DOI: 10.1007/s40119-019-0143-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Rotational atherectomy (RA) historically was contraindicated in patients with impaired left ventricular (LV) function due to inherent cardio-depressive effects. Contemporary RA practice is less aggressive than traditional RA and no longer withheld from patients with reduced ejection fraction (EF). The aim of this analysis is to explore the outcomes of rotational atherectomy (RA) in patients with reduced left ventricular ejection fraction (LVEF). Methods Patients undergoing RA (n = 644) were divided into three groups according to LVEF (severely reduced ≤ 35%, n = 82; moderately reduced 36–54%, n = 170; and preserved LVEF ≥ 55%, n = 392). Results Compared to patients with preserved LVEF, those with severely reduced LVEF had higher rates of angiographic failure (12.2 vs. 3.3%, p = 0.003) and in-hospital major adverse cardiac events (MACE: 9.8 vs. 2.3%, p = 0.004) driven by more peri-procedural myocardial infarction (MI: 6.1 vs. 1.5%, p = 0.049). In-hospital outcomes were similar between patients with preserved and moderately reduced LVEF. At 5-year follow-up, a stepwise increase in all-cause death was observed with lower LVEF (preserved: 15%, moderately reduced: 23%, severely reduced: 43%; p < 0.001). On the other hand, revascularization and MI rates at 5 years were not affected by LVEF. Conclusions Compared to patients with preserved LVEF, those with severely reduced LVEF have worse acute outcomes after RA, whereas a moderate reduction of LVEF poses no additional acute hazard after RA. Up to 5 years, the extent of left ventricular dysfunction was associated with a stepwise increase in mortality. Electronic supplementary material The online version of this article (10.1007/s40119-019-0143-4) contains supplementary material, which is available to authorized users.
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Achilli F, Pontone G, Bassetti B, Squadroni L, Campodonico J, Corrada E, Facchini C, Mircoli L, Esposito G, Scarpa D, Pidello S, Righetti S, Di Gennaro F, Guglielmo M, Muscogiuri G, Baggiano A, Limido A, Lenatti L, Di Tano G, Malafronte C, Soffici F, Ceseri M, Maggiolini S, Colombo GI, Pompilio G. G-CSF for Extensive STEMI. Circ Res 2019; 125:295-306. [PMID: 31138020 DOI: 10.1161/circresaha.118.314617] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
RATIONALE In the exploratory Phase II STEM-AMI (Stem Cells Mobilization in Acute Myocardial Infarction) trial, we reported that early administration of G-CSF (granulocyte colony-stimulating factor), in patients with anterior ST-segment-elevation myocardial infarction and left ventricular (LV) dysfunction after successful percutaneous coronary intervention, had the potential to significantly attenuate LV adverse remodeling in the long-term. OBJECTIVE The STEM-AMI OUTCOME CMR (Stem Cells Mobilization in Acute Myocardial Infarction Outcome Cardiac Magnetic Resonance) Substudy was adequately powered to evaluate, in a population showing LV ejection fraction ≤45% after percutaneous coronary intervention for extensive ST-segment-elevation myocardial infarction, the effects of early administration of G-CSF in terms of LV remodeling and function, infarct size assessed by late gadolinium enhancement, and myocardial strain. METHODS AND RESULTS Within the Italian, multicenter, prospective, randomized, Phase III STEM-AMI OUTCOME trial, 161 ST-segment-elevation myocardial infarction patients were enrolled in the CMR Substudy and assigned to standard of care (SOC) plus G-CSF or SOC alone. In 119 patients (61 G-CSF and 58 SOC, respectively), CMR was available at baseline and 6-month follow-up. Paired imaging data were independently analyzed by 2 blinded experts in a core CMR lab. The 2 groups were similar for clinical characteristics, cardiovascular risk factors, and pharmacological treatment, except for a trend towards a larger infarct size and longer symptom-to-balloon time in G-CSF patients. ANCOVA showed that the improvement of LV ejection fraction from baseline to 6 months was 5.1% higher in G-CSF patients versus SOC (P=0.01); concurrently, there was a significant between-group difference of 6.7 mL/m2 in the change of indexed LV end-systolic volume in favor of G-CSF group (P=0.02). Indexed late gadolinium enhancement significantly decreased in G-CSF group only (P=0.04). Moreover, over time improvement of global longitudinal strain was 2.4% higher in G-CSF patients versus SOC (P=0.04). Global circumferential strain significantly improved in G-CSF group only (P=0.006). CONCLUSIONS Early administration of G-CSF exerted a beneficial effect on top of SOC in patients with LV dysfunction after extensive ST-segment-elevation myocardial infarction in terms of global systolic function, adverse remodeling, scar size, and myocardial strain. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01969890.
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Affiliation(s)
- Felice Achilli
- From the Departments of Cardiology (F.A., S.R., C.M., F.S.), ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging (G. Pontone, M.G., G.M., A.B.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Italy (G.P.)
| | - Beatrice Bassetti
- Vascular Biology and Regenerative Medicine Unit (B.B., G. Pompilio), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Lidia Squadroni
- Department of Cardiology, San Carlo Borromeo Hospital, Milano, Italy (L.S.)
| | - Jeness Campodonico
- Intensive Cardiac Care Unit (J.C.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Elena Corrada
- Cardiovascular Department, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (E.C.)
| | | | - Luca Mircoli
- Cardiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy (L.M.)
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy (G.E.)
| | - Daniele Scarpa
- Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (D.S.)
| | - Stefano Pidello
- Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy (S.P.)
| | - Stefano Righetti
- From the Departments of Cardiology (F.A., S.R., C.M., F.S.), ASST-Monza, San Gerardo Hospital, Monza, Italy
| | | | - Marco Guglielmo
- Cardiovascular Imaging (G. Pontone, M.G., G.M., A.B.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Giuseppe Muscogiuri
- Cardiovascular Imaging (G. Pontone, M.G., G.M., A.B.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging (G. Pontone, M.G., G.M., A.B.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Alberto Limido
- Coronary Intensive Care Unit, ASST-Settelaghi, Ospedale di Circolo-Fondazione Macchi, Varese, Italy (A.L.)
| | - Laura Lenatti
- Cardiology, Alessandro Manzoni Hospital, Lecco, Italy (L.L.)
| | | | - Cristina Malafronte
- From the Departments of Cardiology (F.A., S.R., C.M., F.S.), ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Federica Soffici
- From the Departments of Cardiology (F.A., S.R., C.M., F.S.), ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Martina Ceseri
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy (M.C.)
| | | | - Gualtiero I Colombo
- Immunology and Functional Genomics Unit (G.I.C.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Giulio Pompilio
- Vascular Biology and Regenerative Medicine Unit (B.B., G. Pompilio), Centro Cardiologico Monzino IRCCS, Milano, Italy
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Doshi R, Patel K, Gupta N, Gupta R, Meraj P. Characteristics and in-hospital outcomes of hospitalisations with heart failure with reduced or preserved ejection fraction undergoing percutaneous coronary intervention. Ir J Med Sci 2018; 188:791-799. [PMID: 30328085 DOI: 10.1007/s11845-018-1910-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies comparing characteristics and in-hospital outcomes for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) for hospitalisations undergoing percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI) remain limited. AIM This sought to investigate characteristics and in-hospital outcomes for HFpEF and HFpEF hospitalisations undergoing STEMI-PCI. METHODS The National inpatient sample database from years 2012 to 2014 was queried and appropriate International Classification of Disease, Ninth Revision, Clinical Modification codes were utilised to identify study cohorts. A total of 400,590 hospitalisations underwent STEMI-PCI, of which, 31,180 presented with acute heart failure (89.3% with acute HFrEF and 10.7% with acute HFpEF). The HFpEF cohort was older (65.6 vs. 69.9 years), consisted of more females (35% vs. 48.7%), and presented with significantly higher comorbidities as demonstrated by higher Charlson's Comorbidity Index ≥ 3 (59.6 vs. 68%) (P < 0.001 for all). However, lower in-hospital mortality (9.2% vs. 8.0%, P = 0.04) was observed with HFpEF hospitalisations, which accompanied by lower mechanical circulatory support (MCS) device (20.3 vs. 12.3%, P < 0.001) use after propensity score matching. These translated to lower median hospitalisation cost ($28,116 vs. $27,823, P < 0.001) with HFpEF without significant change in median length of hospitalisation stay (6 vs. 6 days, P = 0.08). CONCLUSIONS This study highlights the distinct risk profile for hospitalisations with HFpEF undergoing STEMI-PCI. HFpEF hospitalisations are associated with the lesser need for MCS, lower in-hospital mortality, and ultimately lower hospitalisation cost compared to HFrEF.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St W11, Reno, NV, 89502, USA.
| | - Krunalkumar Patel
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Neelesh Gupta
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Rajeev Gupta
- Department of Cardiology, Mediclinic Al Jowhara Hospital, Al Ain, United Arab Emirates
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
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Shah S, Benedetto U, Caputo M, Angelini GD, Vohra HA. Comparison of the survival between coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with poor left ventricular function (ejection fraction <30%): a propensity-matched analysis. Eur J Cardiothorac Surg 2018; 55:238-246. [DOI: 10.1093/ejcts/ezy236] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/22/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shaneel Shah
- University of Bristol Academy, Bristol Royal Infirmary, Bristol, UK
| | | | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
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Perera D, Clayton T, Petrie MC, Greenwood JP, O'Kane PD, Evans R, Sculpher M, Mcdonagh T, Gershlick A, de Belder M, Redwood S, Carr-White G, Marber M. Percutaneous Revascularization for Ischemic Ventricular Dysfunction: Rationale and Design of the REVIVED-BCIS2 Trial: Percutaneous Coronary Intervention for Ischemic Cardiomyopathy. JACC. HEART FAILURE 2018; 6:517-526. [PMID: 29852933 DOI: 10.1016/j.jchf.2018.01.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Evaluate whether PCI in combination with optimal medical therapy (OMT) will reduce all-cause death and hospitalization for HF compared to a strategy of OMT alone. BACKGROUND Ischemic cardiomyopathy (ICM) is the most common cause of heart failure (HF) and is associated with significant mortality and morbidity. Surgical revascularization has been shown to improve long-term outcomes in some patients, but surgery itself carries a major early hazard. Percutaneous coronary intervention (PCI) may allow a better balance between risk and benefit. METHODS REVIVED-BCIS2 is a prospective, multi-center, open-label, randomized controlled trial, funded by the National Institute for Health Research in the United Kingdom. Follow-up will be for at least 2 years from randomization. Secondary outcomes include left ventricular ejection fraction (LVEF), quality of life scores, appropriate implantable cardioverter defibrillator therapy and acute myocardial infarction. Patients with LVEF ≤35%, extensive coronary disease and demonstrable myocardial viability are eligible for inclusion and those with a myocardial infarction within 4 weeks, decompensated HF or sustained ventricular arrhythmias within 72 h are excluded. A trial of 700 patients has more than 85% power to detect a 30% relative reduction in hazard. RESULTS A total of 400 patients have been enrolled to date. CONCLUSIONS International guidelines do not provide firm recommendations on the role of PCI in managing severe ICM, because of a lack of robust evidence. REVIVED-BCIS2 will provide the first randomized data on the efficacy and safety of PCI in ICM and has the potential to inform guidelines pertaining to both revascularization and HF. (Study of Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival in Heart Failure [REVIVED-BCIS2]; NCT01920048) (REVascularisation for Ischaemic VEntricular Dysfunction; ISRCTN45979711).
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Affiliation(s)
- Divaka Perera
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom.
| | - Tim Clayton
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Peter D O'Kane
- Royal Bournemouth and Christchurch Hospital, United Kingdom
| | - Richard Evans
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, United Kingdom
| | | | - Anthony Gershlick
- Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Simon Redwood
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Gerald Carr-White
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- National Institute for Health Research Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
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Jackson M, Austin D, Kwok CS, Rashid M, Kontopantelis E, Ludman P, de Belder M, Mamas MA, Zaman A. The impact of diabetes on the prognostic value of left ventricular function following percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society. Catheter Cardiovasc Interv 2018; 92:E393-E402. [DOI: 10.1002/ccd.27642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Jackson
- The James Cook University Hospital; Middlesbrough United Kingdom
| | - David Austin
- The James Cook University Hospital; Middlesbrough United Kingdom
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University; Stoke-on-Trent United Kingdom
- Royal Stoke University Hospital; Stoke-On-Trent United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University; Stoke-on-Trent United Kingdom
- Royal Stoke University Hospital; Stoke-On-Trent United Kingdom
| | | | - Peter Ludman
- Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Mark de Belder
- The James Cook University Hospital; Middlesbrough United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University; Stoke-on-Trent United Kingdom
- Royal Stoke University Hospital; Stoke-On-Trent United Kingdom
| | - Azfar Zaman
- Department of Cardiology; Freeman Hospital and Institute of Cellular Medicine, Newcastle University; Newcastle Upon Tyne United Kingdom
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Gaspar A, Lourenço AP, Pereira MÁ, Azevedo P, Roncon-Albuquerque R, Marques J, Leite-Moreira AF. Randomized controlled trial of remote ischaemic conditioning in ST-elevation myocardial infarction as adjuvant to primary angioplasty (RIC-STEMI). Basic Res Cardiol 2018. [PMID: 29516192 DOI: 10.1007/s00395-018-0672-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical trials.gov). From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively. Combined primary outcome of cardiac mortality and hospitalization for HF was reduced in RIC compared with SOC (n = 231 and 217, respectively; HR = 0.35, 95% CI 0.15-0.78) as well as each outcome in isolation. No difference was found in serum troponin I levels between groups. Median and maximum follow-up time were 2.1 and 3.7 years, respectively. In-hospital HF (RR = 0.68, 95% CI 0.47-0.98), need for diuretics (RR = 0.68, 95% CI 0.48-0.97) and inotropes and/or intra-aortic balloon pump (RR = 0.17, 95% CI 0.04-0.76) were decreased in RIC. On planned 12 months follow-up echocardiography (n = 193 and 173 in RIC and SOC, respectively) ejection fraction (EF) recovery was enhanced in patients presenting with impaired left ventricular (LV) function (10% absolute difference in median EF compared with SOC; P < 0.001). In addition to previously reported improved myocardial salvage index and reduced infarct size RIC was shown beneficial in a combined hard clinical endpoint of cardiac mortality and hospitalization for HF. Improved EF recovery was also documented in patients with impaired LV function.
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Affiliation(s)
- António Gaspar
- Department of Cardiology, Hospital de Braga, Braga, Portugal.,Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - André P Lourenço
- Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Pedro Azevedo
- Department of Cardiology, Hospital de Braga, Braga, Portugal
| | - Roberto Roncon-Albuquerque
- Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Jorge Marques
- Department of Cardiology, Hospital de Braga, Braga, Portugal
| | - Adelino F Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Paul A, George PV. Left ventricular global longitudinal strain following revascularization in acute ST elevation myocardial infarction - A comparison of primary angioplasty and Streptokinase-based pharmacoinvasive strategy. Indian Heart J 2017; 69:695-699. [PMID: 29174244 PMCID: PMC5717277 DOI: 10.1016/j.ihj.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/09/2017] [Accepted: 04/17/2017] [Indexed: 01/18/2023] Open
Abstract
Objective Tenecteplase-based pharmacoinvasive percutaneous coronary intervention (PCI) has been shown to yield outcomes comparable to primary PCI in the setting of acute ST elevation myocardial infarction (STEMI). This study was designed to compare the efficacy of pharmacoinvasive PCI following successful thrombolysis with Streptokinase versus primary PCI in patients with STEMI. Methodology We conducted a prospective single center observational study in 120 patients with STEMI who underwent primary PCI (n = 60) and Streptokinase-based pharmacoinvasive PCI (n = 60). Patients with Killips class 3 or 4 at presentation, and those with evidence of failed fibrinolysis were excluded. The primary outcome was LV systolic function after angioplasty, as assessed by 2D global longitudinal strain (GLS) using speckle tracking echocardiography (STE), as well as 2D LVEF using Simpson's biplane method. Results LV systolic function after PCI was significantly lower in the pharmacoinvasive arm as compared to the primary PCI arm, both by 2D STE (GLS: −9% vs −11%; p = 0.03) and 2D Simpson's biplane method (LVEF: 40.7% vs 45.1%; p = 0.02). TIMI flow in the culprit vessel prior to angioplasty was better in the pharmacoinvasive arm indicating successful thrombolysis, whereas post angioplasty flow was not different. There was no in-hospital mortality in either group. There was a trend toward increased incidence of acute kidney injury in the pharmacoinvasive arm. Conclusion LV systolic function is significantly better after primary angioplasty as compared to pharmacoinvasive PCI following successful thrombolysis with Streptokinase.
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Affiliation(s)
- Amal Paul
- Department of Cardiology, Christian Medical College Vellore, Tamilnadu 632004, India.
| | - Paul V George
- Department of Cardiology, Christian Medical College Vellore, Tamilnadu 632004, India.
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Toma A, Stähli BE, Gick M, Gebhard C, Kaufmann BA, Mashayekhi K, Ferenc M, Buettner HJ, Neumann FJ. Comparison of Benefit of Successful Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients With Versus Without Reduced (≤40%) Left Ventricular Ejection Fraction. Am J Cardiol 2017; 120:1780-1786. [PMID: 28867125 DOI: 10.1016/j.amjcard.2017.07.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
Successful recanalization of chronic total occlusions (CTO) has been associated with improved survival. Data on outcomes in patients with left ventricular (LV) systolic dysfunction undergoing percutaneous coronary intervention for CTO, however, are scarce. Between January 2005 and December 2013, a total of 2,002 consecutive patients undergoing elective CTO percutaneous coronary intervention at a tertiary care center were divided into patients with (LV ejection fraction ≤ 40%) and without (LV ejection fraction > 40%) LV systolic dysfunction as defined by transthoracic echocardiography. The primary end point was all-cause mortality. Median follow-up was 2.6 (1.1 to 3.1) years. A total of 348 (17.4%) patients had LV dysfunction. All-cause mortality was higher in patients with LV dysfunction (30.2%) than in those with normal LV function (8.2%, p <0.001), and associations remained significant after adjustment for baseline differences (adjusted hazard ratio [HR] 3.39, 95% confidence interval [CI] 2.57 to 4.47, p <0.001). Successful CTO recanalization was independently associated with reduced all-cause mortality, with similar relative risk reductions in both the preserved (6.6% vs 16.9%, adjusted HR 0.48, 95% CI 0.34 to 0.70, p <0.001) and the reduced LV function groups (26.2% vs 45.2%, adjusted HR 0.63, 95% CI 0.41 to 0.98, p = 0.04, interaction p = 0.28). In conclusion, irrespective of LV function, successful CTO recanalization is associated with a clear survival benefit.
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Affiliation(s)
- Aurel Toma
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany.
| | - Barbara E Stähli
- Department of Cardiology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Gick
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Catherine Gebhard
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Beat A Kaufmann
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Heinz Joachim Buettner
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
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Hulme W, Sperrin M, Kontopantelis E, Ratib K, Ludman P, Sirker A, Kinnaird T, Curzen N, Kwok CS, De Belder M, Nolan J, Mamas MA. Increased Radial Access Is Not Associated With Worse Femoral Outcomes for Percutaneous Coronary Intervention in the United Kingdom. Circ Cardiovasc Interv 2017; 10:e004279. [PMID: 28196898 DOI: 10.1161/circinterventions.116.004279] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach. METHODS AND RESULTS Using the British Cardiovascular Intervention Society (BCIS) database, a retrospective analysis of 235 250 transfemoral access percutaneous coronary intervention procedures was undertaken in all 92 centers in England and Wales between 2007 and 2013. Recent femoral proportion and recent femoral volume were determined, and in-hospital vascular complications and 30-day mortality were evaluated. After case-mix adjustment, no independent association was observed between 30-day mortality for cases undertaken through the transfemoral access and center femoral proportion, the risk-adjusted odds ratio for recent femoral proportion was nonsignificant (odds ratio, 0.99; 95% confidence interval, 0.97-1.02; P=0.472 per 0.1 increase in proportion), and similarly recent femoral volume (per 100 procedures) was not found to be significant (odds ratio, 1.00; 95% confidence interval, 0.98-1.01; P=0.869). The in-hospital vascular complication rate was 1.0%, and this outcome was not significantly associated with recent femoral proportion after risk-adjustment (odds ratio, 0.97; 95% confidence interval, 0.94-1.00; P=0.060 per 0.1 increase in proportion). CONCLUSIONS The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.
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Affiliation(s)
- William Hulme
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Matthew Sperrin
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Evangelos Kontopantelis
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Karim Ratib
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Peter Ludman
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Alex Sirker
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Tim Kinnaird
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Nick Curzen
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Chun Shing Kwok
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Mark De Belder
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - James Nolan
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Mamas A Mamas
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.).
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Rashid M, Rushton CA, Kwok CS, Kinnaird T, Kontopantelis E, Olier I, Ludman P, De Belder MA, Nolan J, Mamas MA. Impact of Access Site Practice on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention Following Thrombolysis for ST-Segment Elevation Myocardial Infarction in the United Kingdom. JACC Cardiovasc Interv 2017; 10:2258-2265. [DOI: 10.1016/j.jcin.2017.07.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/05/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
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Reboll MR, Korf-Klingebiel M, Klede S, Polten F, Brinkmann E, Reimann I, Schönfeld HJ, Bobadilla M, Faix J, Kensah G, Gruh I, Klintschar M, Gaestel M, Niessen HW, Pich A, Bauersachs J, Gogos JA, Wang Y, Wollert KC. EMC10 (Endoplasmic Reticulum Membrane Protein Complex Subunit 10) Is a Bone Marrow-Derived Angiogenic Growth Factor Promoting Tissue Repair After Myocardial Infarction. Circulation 2017; 136:1809-1823. [PMID: 28931551 DOI: 10.1161/circulationaha.117.029980] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/31/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinical trials of bone marrow cell-based therapies after acute myocardial infarction (MI) have produced mostly neutral results. Treatment with specific bone marrow cell-derived secreted proteins may provide an alternative biological approach to improving tissue repair and heart function after MI. We recently performed a bioinformatic secretome analysis in bone marrow cells from patients with acute MI and discovered a poorly characterized secreted protein, EMC10 (endoplasmic reticulum membrane protein complex subunit 10), showing activity in an angiogenic screen. METHODS We investigated the angiogenic potential of EMC10 and its mouse homolog (Emc10) in cultured endothelial cells and infarcted heart explants. We defined the cellular sources and function of Emc10 after MI using wild-type, Emc10-deficient, and Emc10 bone marrow-chimeric mice subjected to transient coronary artery ligation. Furthermore, we explored the therapeutic potential of recombinant Emc10 delivered by osmotic minipumps after MI in heart failure-prone FVB/N mice. RESULTS Emc10 signaled through small GTPases, p21-activated kinase, and the p38 mitogen-activated protein kinase (MAPK)-MAPK-activated protein kinase 2 (MK2) pathway to promote actin polymerization and endothelial cell migration. Confirming the importance of these signaling events in the context of acute MI, Emc10 stimulated endothelial cell outgrowth from infarcted mouse heart explants via p38 MAPK-MK2. Emc10 protein abundance was increased in the infarcted region of the left ventricle and in the circulation of wild-type mice after MI. Emc10 expression was also increased in left ventricular tissue samples from patients with acute MI. Bone marrow-derived monocytes and macrophages were the predominant sources of Emc10 in the infarcted murine heart. Emc10 KO mice showed no cardiovascular phenotype at baseline. After MI, however, capillarization of the infarct border zone was impaired in KO mice, and the animals developed larger infarct scars and more pronounced left ventricular remodeling compared with wild-type mice. Transplanting KO mice with wild-type bone marrow cells rescued the angiogenic defect and ameliorated left ventricular remodeling. Treating FVB/N mice with recombinant Emc10 enhanced infarct border-zone capillarization and exerted a sustained beneficial effect on left ventricular remodeling. CONCLUSIONS We have identified Emc10 as a previously unknown angiogenic growth factor that is produced by bone marrow-derived monocytes and macrophages as part of an endogenous adaptive response that can be enhanced therapeutically to repair the heart after MI.
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Affiliation(s)
- Marc R Reboll
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Mortimer Korf-Klingebiel
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Stefanie Klede
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Felix Polten
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Eva Brinkmann
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Ines Reimann
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Hans-Joachim Schönfeld
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Maria Bobadilla
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Jan Faix
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - George Kensah
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Ina Gruh
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Michael Klintschar
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Matthias Gaestel
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Hans W Niessen
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Andreas Pich
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Johann Bauersachs
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Joseph A Gogos
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Yong Wang
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.)
| | - Kai C Wollert
- From Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (M.R.R., M.K.-K., S.K., E.B., I.R., Y.W., K.C.W.), Core Unit Proteomics, Institute of Toxicology (F.P., A.P.), Department of Biophysical Chemistry (J.F.), Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Cardiothoracic, Transplantation, and Vascular Surgery (G.K., I.G.), Institute of Legal Medicine (M.K.), Institute of Physiological Chemistry (M.G.), and Department of Cardiology and Angiology (J.B.), Hannover Medical School, Germany; F. Hoffmann-La Roche, Pharma Research and Early Development, Basel, Switzerland (H.-J.S., M.B.); Department of Pathology and Department of Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Physiology and Cellular Biophysics and Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, NY (J.A.G.).
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Abstract
Heart failure (HF) remains the leading cause of hospitalization in older adults and is associated with increased morbidity and mortality despite the use of guideline-directed medical therapy. There has been tremendous progress in the development of novel transcatheter and interventional therapies for HF over the past decade. The evolution of structural heart disease interventions and interventional HF has led to a multidisciplinary heart team approach in the management of HF patients. Careful selection of the appropriate patient population and end points in future randomized controlled trials will be crucial to demonstrate the potential efficacy of the novel interventional HF therapies.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Jinnette Dawn Abbott
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA.
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Lee M, Martinsen B, Shlofmitz R, Shlofmitz E, Lee A, Chambers J. Orbital atherectomy treatment of severely calcified coronary lesions in patients with impaired left ventricular ejection fraction: one-year outcomes from the ORBIT II study. EUROINTERVENTION 2017; 13:329-337. [DOI: 10.4244/eij-d-16-00301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wollert KC, Meyer GP, Müller-Ehmsen J, Tschöpe C, Bonarjee V, Larsen AI, May AE, Empen K, Chorianopoulos E, Tebbe U, Waltenberger J, Mahrholdt H, Ritter B, Pirr J, Fischer D, Korf-Klingebiel M, Arseniev L, Heuft HG, Brinchmann JE, Messinger D, Hertenstein B, Ganser A, Katus HA, Felix SB, Gawaz MP, Dickstein K, Schultheiss HP, Ladage D, Greulich S, Bauersachs J. Intracoronary autologous bone marrow cell transfer after myocardial infarction: the BOOST-2 randomised placebo-controlled clinical trial. Eur Heart J 2017; 38:2936-2943. [DOI: 10.1093/eurheartj/ehx188] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/23/2017] [Indexed: 01/21/2023] Open
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Boudoulas KD, Stefanadis C, Boudoulas H. The Role of Interventional Cardiology to Our Understanding of Basic Mechanisms Related to Coronary Atherosclerosis: “Thinking outside the box”. Hellenic J Cardiol 2017; 58:110-114. [DOI: 10.1016/j.hjc.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 12/11/2022] Open
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Iqbal MB, Nadra IJ, Ding L, Fung A, Aymong E, Chan AW, Hodge S, Della Siega A, Robinson SD. Culprit Vessel Versus Multivessel Versus In-Hospital Staged Intervention for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease. JACC Cardiovasc Interv 2017; 10:11-23. [DOI: 10.1016/j.jcin.2016.10.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/03/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
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Hulme W, Sperrin M, Rushton H, Ludman PF, De Belder M, Curzen N, Kinnaird T, Kwok CS, Buchan I, Nolan J, Mamas MA. Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes? An Analysis From the British Cardiovascular Intervention Society. Circ Cardiovasc Interv 2016; 9:e003333. [PMID: 27162213 DOI: 10.1161/circinterventions.115.003333] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 03/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transradial access is associated with reduced access site-related bleeding complications and mortality post percutaneous coronary intervention. The objective of this study is to examine the relationship between access site practice and clinical outcomes and how this may be influenced by operator and center experience/expertise. METHODS AND RESULTS The influence of operator and center experience/expertise was studied on 30-day mortality, in-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial infarction and target vessel revascularization) and in-hospital major bleeding based on access site adopted (radial versus femoral). Operator/center experience/expertise were defined by both total volume and transradial access proportion. A total of 164 395 procedures between 2012 and 2013 in the National Health Service in England and Wales were analyzed. After case-mix adjustment, transradial access was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (odds ratio, 0.61; 95% confidence interval, 0.55-0.68; P<0.001). The magnitude of this risk reduction was modified by increases in total procedural volume and radial proportion at the operator level (odds ratio reduction of 11% per 100 extra procedures, 95% confidence interval, 3%-19%; odds ratio reduction of 6% per 10%-point increase in radial proportion, 95% confidence interval, 1%-11%) with no significant impact of operator radial volume, center total volume, center radial volume, and center radial proportion. CONCLUSIONS The lower mortality associated with transradial access adoption relates to both the total procedural volume and the proportion of procedures undertaken radially by operator, with operators undertaking the greatest proportion of their procedures radially having the largest relative reduction in mortality risk.
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Affiliation(s)
- William Hulme
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Matthew Sperrin
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Helen Rushton
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Peter F Ludman
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Mark De Belder
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Nick Curzen
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Tim Kinnaird
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Chun Shing Kwok
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Iain Buchan
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - James Nolan
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.)
| | - Mamas A Mamas
- From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
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Iqbal J, Kwok CS, Kontopantelis E, de Belder MA, Ludman PF, Giannoudi M, Gunning M, Zaman A, Mamas MA. Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Surgery. Circ Cardiovasc Interv 2016; 9:e003151. [PMID: 27069103 DOI: 10.1161/circinterventions.115.003151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with ST-segment-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). We report outcomes in patients with STEMI undergoing PPCI with or without previous CABG surgery in a large real-world, all-comer population. METHODS AND RESULTS Clinical, demographic, procedural, and outcomes data were collected for all patients undergoing PPCI in England and Wales from January 2007 to December 2012. All-cause mortality at 30 days and 1 year were evaluated in the whole and a propensity-matched cohort. Of 79 295 patients with STEMI studied, 2658 (3.4%) patients had prior CABG, of whom 44% (n=1168) underwent PPCI to native vessels and 56% (n=1490) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. Patients with prior CABG (with primary PCI to native artery or graft) had higher mortality at 30 days (6.2% with PPCI to native artery, 6.1% with PPCI to bypass graft) than patients with no prior CABG (4.5%; P<0.001). However, after risk factor adjustments, there was no significant difference in outcomes. There were also no significant differences in 30-day mortality, in-hospital major adverse cardiovascular events, in-hospital stroke, and in-hospital bleeding in the propensity-matched population. CONCLUSIONS A prior history of CABG in patients presenting with STEMI and undergoing PPCI does not independently confer additional risk of mortality, although it is a marker of other high-risk features.
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Affiliation(s)
- Javaid Iqbal
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Chun Shing Kwok
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Evangelos Kontopantelis
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Mark A de Belder
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Peter F Ludman
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Marilena Giannoudi
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Mark Gunning
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Azfar Zaman
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.)
| | - Mamas A Mamas
- From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.); Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.).
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Wood AD, Mannu GS, Clark AB, Tiamkao S, Kongbunkiat K, Bettencourt-Silva JH, Sawanyawisuth K, Kasemsap N, Barlas RS, Mamas M, Myint PK. Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study. Stroke 2016; 47:2695-2701. [PMID: 27703088 DOI: 10.1161/strokeaha.116.014512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. METHODS We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. RESULTS In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68-2.70]), shock (2.13 [1.64-2.77]), arrhythmias (1.70 [1.21-2.39]), respiratory failure (2.09 [1.87-2.33]), pneumonia (2.00 [1.81-2.20]), and sepsis (1.39 [1.19-1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]). CONCLUSIONS RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.
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Affiliation(s)
- Adrian D Wood
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Gurdeep S Mannu
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Allan B Clark
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Somsak Tiamkao
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Kannikar Kongbunkiat
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Joao H Bettencourt-Silva
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Kittisak Sawanyawisuth
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Narongrit Kasemsap
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Raphae S Barlas
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Mamas Mamas
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.)
| | - Phyo Kyaw Myint
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
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Kwok CS, Bachmann MO, Mamas MA, Stirling S, Shepstone L, Myint PK, Zaman MJ. Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome: A prospective registry study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:191-198. [PMID: 26676673 DOI: 10.1177/2048872615623038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to study the prognostic impact of left ventricular function on mortality and examine the effect of age on the prognostic value of left ventricular function. METHODS We examined the myocardial ischaemia national audit project registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50%), moderate (ejection fraction 30-49%) and poor (ejection fraction <30%) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables. RESULTS Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was drawn from 414,305. After controlling for confounders, 339,887 participants were included in the regression models. For any age group, mortality was higher with a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95% confidence interval 1.88-2.37 for age <65 years and 1.28, 95% confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively. CONCLUSIONS In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the patient's age.
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Affiliation(s)
- Chun Shing Kwok
- 1 Cardiovascular Research Group, Keele University, UK.,2 Aberdeen Gerontological and Epidemiological Interdisciplinary Research Group (AGEING), University of Aberdeen, UK
| | | | - Mamas A Mamas
- 1 Cardiovascular Research Group, Keele University, UK
| | | | - Lee Shepstone
- 3 Norwich Medical School, University of East Anglia, UK
| | - Phyo Kyaw Myint
- 2 Aberdeen Gerontological and Epidemiological Interdisciplinary Research Group (AGEING), University of Aberdeen, UK
| | - M Justin Zaman
- 3 Norwich Medical School, University of East Anglia, UK.,4 Department of Medicine, James Paget University Hospital, UK
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Lamblin N, Meurice T, Tricot O, Lemesle G, Deneve M, de Groote P, Bauters C. Effect of left ventricular systolic dysfunction on secondary medical prevention and clinical outcome in stable coronary artery disease patients. Arch Cardiovasc Dis 2016; 110:35-41. [PMID: 27591820 DOI: 10.1016/j.acvd.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited recent data are available in the literature on whether the presence of left ventricular systolic dysfunction (LVSD) affects the therapeutic management of patients with stable coronary artery disease (CAD). AIMS The objectives of this study were to analyse prevalence, effect on therapeutics and prognosis of LVSD in stable CAD. METHODS We prospectively included 4184 CAD outpatients free from any myocardial infarction or coronary revascularization for>1year. Left ventricular ejection fraction (EF) was available for 4124 (98.6%) patients. Follow-up was performed at 2years. All events were adjudicated blindly. RESULTS The mean EF was 57.5±10.8%, and 201 (4.9%) patients had an EF≤35%. The prescription of renin-angiotensin system inhibitors and beta-blockers was inversely related to EF, and reached>90% in patients with EF≤35%. Seventy-five (37.3%) of the patients with EF≤35% received a mineralocorticoid receptor antagonist. Eighty-five (42.3%) of the patients with EF≤35% had an implantable cardioverter defibrillator. Clinical follow-up data were obtained for 4090 patients (99.2%). Event rates were higher in patients with low EF (adjusted hazard ratio [95% confidence interval] for EF≤35%, with EF≥60% as reference: 3.93 [2.60-5.93] and 7.12 [3.85-13.18], for all-cause death and cardiovascular death, respectively). CONCLUSIONS In patients with stable CAD, LVSD is well taken into account by cardiologists, with extensive use of evidence-based medications and interventions. Despite this, LVSD remains a major prognostic indicator in this population.
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Affiliation(s)
- Nicolas Lamblin
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Olivier Tricot
- Centre hospitalier de Dunkerque, 59240 Dunkerque, France
| | - Gilles Lemesle
- CHRU de Lille, 59037 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Pascal de Groote
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France
| | - Christophe Bauters
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France.
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Briceno N, Kapur NK, Perera D. Percutaneous mechanical circulatory support: current concepts and future directions. Heart 2016; 102:1494-507. [DOI: 10.1136/heartjnl-2015-308562] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Kinnaird T, Kwok CS, Kontopantelis E, Ossei-Gerning N, Ludman P, deBelder M, Anderson R, Mamas MA. Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013: An Analysis of 527 121 Cases From the British Cardiovascular Intervention Society Database. Circ Cardiovasc Interv 2016; 9:e003449. [PMID: 27486140 DOI: 10.1161/circinterventions.115.003449] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 06/23/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND As coronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) the current evidence base is limited to small series. Using a national PCI database, the incidence, predictors, and outcomes of CP as a complication of PCI were defined. METHODS AND RESULTS Data were prospectively collected and retrospectively analyzed from the British Cardiovascular Intervention Society data set on all PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. In total, 1762 CPs were recorded from 527 121 PCI procedures (incidence of 0.33%). Patients with CP were more often women or older, with a greater burden of comorbidity and underwent more complex PCI procedures. Factors predictive of CP included age per year (odds ratio [OR], 1.03; 95% confidence intervals, 1.02-1.03; P<0.001), previous coronary artery bypass graft (OR, 1.44; 95% confidence intervals, 1.17-1.77; P<0.001), left main (OR, 1.54; 95% confidence intervals, 1.21-1.96; P<0.001), use of rotational atherectomy (OR, 2.37; 95% confidence intervals, 1.80-3.11; P<0.001), and chronic total occlusions intervention (OR, 3.96; 95% confidence intervals, 3.28-4.78; P<0.001). Adjusted odds of adverse outcomes were higher in patients with CP for all major adverse coronary events, including stroke, bleeding, and mortality. Emergency surgery was required in 3% of cases. Predictors of mortality in patients with CP included age, diabetes mellitus, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use, and stent type. CONCLUSIONS Using a national PCI database for the first time, the incidence, predictors, and outcomes of CP were defined. Although CP as a complication of PCI occurred rarely, it was strongly associated with poor outcomes.
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Affiliation(s)
- Tim Kinnaird
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
| | - Chun Shing Kwok
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
| | - Evangelos Kontopantelis
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
| | - Nicholas Ossei-Gerning
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
| | - Peter Ludman
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
| | - Mark deBelder
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
| | - Richard Anderson
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
| | - Mamas A Mamas
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.)
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Park SD, Moon J, Kwon SW, Suh YJ, Kim TH, Jang HJ, Suh J, Park HW, Oh PC, Shin SH, Woo SI, Kim DH, Kwan J, Kang W. Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry. PLoS One 2016; 11:e0159416. [PMID: 27415006 PMCID: PMC4945029 DOI: 10.1371/journal.pone.0159416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Besides contrast-induced acute kidney injury(CI-AKI), adscititious vital organ damage such as hypoxic liver injury(HLI) may affect the survival in patients with ST-elevation myocardial infarction (STEMI). We sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI). METHODS A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) from the INTERSTELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as an increase of ≥0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after the index procedure. HLI was defined as ≥2-fold increase in serum aspartate transaminase above the upper normal limit on admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded. RESULTS Over a mean follow-up period of 2.2±1.6 years, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in the no organ damage group; 21.3% and 21.3% in CI-AKI group; 18.5% and 14.6% in HLI group; and 57.7% and 50.0% in combined CI-AKI and HLI group. Survival probability plots of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI group was associated with the worst prognosis (p<0.0001 for both). CONCLUSION Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR ClinicalTrials.gov number, NCT02800421.).
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Affiliation(s)
- Sang-Don Park
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Republic of Korea
| | - Tae-Hoon Kim
- Department of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Ho-Jun Jang
- Department of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jon Suh
- Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyun Woo Park
- Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Sung-Hee Shin
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Seong-Il Woo
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Dae-Hyeok Kim
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Jun Kwan
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - WoongChol Kang
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of Korea
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Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices. JACC Cardiovasc Interv 2016; 9:1374-83. [DOI: 10.1016/j.jcin.2016.04.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/15/2016] [Accepted: 04/19/2016] [Indexed: 12/26/2022]
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Briceno N, Perera D. To Revascularise or Not To Revascularise, That Is the Question: the Diagnostic and Management Conundrum of Ischaemic Cardiomyopathy. Curr Cardiol Rep 2016; 18:54. [PMID: 27115418 PMCID: PMC4846708 DOI: 10.1007/s11886-016-0726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ischaemic cardiomyopathy is an important cardiovascular condition that has differing pathophysiological substrates and clinical manifestations. Contemporary management involves the administration of heart failure pharmacotherapy and device therapy where indicated, which has good prognostic data to support it. Whilst the role of revascularisation is clear in those patients presenting with an acute coronary syndrome or angina, the role in those patients presenting either incidentally, with predominant heart failure symptoms, or in those presenting with acute heart failure with an associated elevated troponin is less well defined and lacks randomised outcome data to support its adoption. The aim of this review is therefore to discuss the challenges in the diagnosis of ischaemic cardiomyopathy with a review of the existing imaging modalities that can facilitate, and to revisit the variety of clinical presentations that can occur, with particular emphasis on the contemporary role of revascularisation in these cohorts of patients.
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Affiliation(s)
- Natalia Briceno
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK.
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Coronary Atherosclerosis: Pathophysiologic Basis for Diagnosis and Management. Prog Cardiovasc Dis 2016; 58:676-92. [PMID: 27091673 DOI: 10.1016/j.pcad.2016.04.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022]
Abstract
Coronary atherosclerosis is a long lasting and continuously evolving disease with multiple clinical manifestations ranging from asymptomatic to stable angina, acute coronary syndrome (ACS), heart failure (HF) and sudden cardiac death (SCD). Genetic and environmental factors contribute to the development and progression of coronary atherosclerosis. In this review, current knowledge related to the diagnosis and management of coronary atherosclerosis based on pathophysiologic mechanisms will be discussed. In addition to providing state-of-the-art concepts related to coronary atherosclerosis, special consideration will be given on how to apply data from epidemiologic studies and randomized clinical trials to the individual patient. The greatest challenge for the clinician in the twenty-first century is not in absorbing the fast accumulating new knowledge, but rather in applying this knowledge to the individual patient.
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50
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Mamas MA, Nolan J, de Belder MA, Zaman A, Kinnaird T, Curzen N, Kwok CS, Buchan I, Ludman P, Kontopantelis E. Changes in Arterial Access Site and Association With Mortality in the United Kingdom: Observations From a National Percutaneous Coronary Intervention Database. Circulation 2016; 133:1655-67. [PMID: 26969759 DOI: 10.1161/circulationaha.115.018083] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 02/19/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice. METHODS AND RESULTS Using the British Cardiovascular Intervention Society database, we investigated outcomes for growth of TRA in different regions in England and Wales in 448 853 patients who underwent percutaneous coronary intervention from 2005 to 2012. Multiple logistic regression was used to quantify the effect of TRA on 30-day mortality and quantify lives saved and lost by differences in TRA adoption. TRA use increased from 14.0% to 58.6% in 417 038 PCI patients with large variations in different parts of the country. TRA was independently associated with a decreased risk of 30-day mortality (odds ratio=0.70; 95% confidence interval=0.66-0.74), with significant but small differences observed across different regions. The number of estimated lives saved was 450 (95% confidence interval=275-650), and we estimate that an additional 264 (95% confidence interval=153-399) lives would have been saved if TRA adoption were uniform nationally. CONCLUSIONS TRA has become the dominant percutaneous coronary intervention approach in the United Kingdom, with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, and inequalities have resulted in missed opportunities for further improvements.
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Affiliation(s)
- Mamas A Mamas
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
| | - James Nolan
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Mark A de Belder
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Azfar Zaman
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Tim Kinnaird
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Nick Curzen
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Chun Shing Kwok
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Iain Buchan
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Peter Ludman
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Evangelos Kontopantelis
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
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