1
|
Tu S, Zhang L, Tian Q, Hu F, Wang Y, Chen L. Five-year outcomes of double kissing mini-culotte stenting vs. mini-culotte stenting using drug-eluting stents for the treatment of true coronary bifurcation lesions. Front Cardiovasc Med 2024; 11:1336750. [PMID: 38655494 PMCID: PMC11035737 DOI: 10.3389/fcvm.2024.1336750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study aimed to compare the clinical outcomes of double kissing mini-culotte (DKMC) stenting with those of mini-culotte (MC) stenting in treating patients with true coronary bifurcation lesions (CBLs) in the clinical real world. Methods This retrospective observational cohort study included 180 consecutive patients with true CBLs (Medina type 1,1,1; 1,0,1; 0,1,1). All eligible patients underwent coronary angiography and percutaneous coronary intervention with two-stent techniques in our hospital; among them, 97 received DKMC treatment and 83 MC treatment. The primary clinical endpoints were the major adverse cardiovascular events (MACE), which included cardiac death, myocardial infarction, and target vessel/lesion revascularization (TVR/TLR). The secondary endpoints were stent thrombosis, in-stent restenosis, and individual components of MACE. Results Quantitative coronary angiography analysis (at 5 years) revealed that late lumen loss (0.25 ± 0.41 mm vs. 0.14 ± 0.32 mm, P = 0.032) and segmental diameter restenosis of the side branch (27.84 ± 12.34% vs. 19.23 ± 9.76%, P = 0.016) were lower in the DKMC treatment group than that in the MC treatment group. Notably, compared to that in the MC treatment group, the cumulative event rate of MACE at 5 years (22.8% vs. 8.3%, P = 0.007) and TVR/TLR (17.7% vs. 6.3%, P = 0.018) was higher in the DKMC treatment group, driven mainly by TVR/TLR. Especially, the DKMC group was related to a significant reduction in the primary and secondary endpoints in high-risk patients. Conclusion DKMC treatment was associated with less late lumen loss and restenosis in the side branch and a lower rate of cumulative MACE and TVR/TLR. DKMC treatment is more effective for treating true CBLs than MC treatment; however, these findings warrant further confirmation through a randomized clinical trial.
Collapse
Affiliation(s)
- Sheng Tu
- Department of Cardiology, Bozhou People’s Hospital, Bozhou Hospital Affiliated to Anhui University of Science and Technology, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, Anhui, China
- Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, China
- Department of Cardiology, Provincial Institute of Coronary Artery Disease, Fujian, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Linlin Zhang
- Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, China
- Department of Cardiology, Provincial Institute of Coronary Artery Disease, Fujian, China
| | - Qingqing Tian
- Department of Cardiology, Bozhou People’s Hospital, Bozhou Hospital Affiliated to Anhui University of Science and Technology, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, Anhui, China
- Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, China
- Department of Cardiology, Provincial Institute of Coronary Artery Disease, Fujian, China
| | - Fudong Hu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ying Wang
- Department of Dermatology, Bozhou People’s Hospital, Bozhou Hospital Affiliated to Anhui University of Science and Technology, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, Anhui, China
| | - Lianglong Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, China
- Department of Cardiology, Provincial Institute of Coronary Artery Disease, Fujian, China
| |
Collapse
|
2
|
Chen M, Zhang T. Improved stereo perception in coronary angiography using the X-ray tube as the viewpoint and validation with 3D printed models. Int J Cardiovasc Imaging 2023; 39:2041-2050. [PMID: 37453945 PMCID: PMC10589187 DOI: 10.1007/s10554-023-02906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Coronary angiography (CAG) provides two-dimensional images, but a clinician who is experienced in percutaneous coronary interventions can use information from these images to interpret spatial depth and infer the three-dimensional (3D) locations of vessels. We hypothesized that CAG results were equivalent to the mirror image of a coronary artery perspective projection, and a stereo perception could be easily established when the viewpoint of the angiogram was the X-ray tube instead of the detector. To eliminate the influence of heartbeat and respiration, a 3D-printed a coronary artery model was constructed for analysis. The effects of gantry movements during digital subtraction angiography (DSA) on the image were used to identify factors that affected DSA image transformation. Then, based on these factors, DSA imaging was simulated using UG NX software with three methods: (i) a perspective projection with the detector as the viewpoint; (ii) a parallel projection; and (iii) a mirror image of the perspective projection with the X-ray tube as the viewpoint. Finally, the resulting 3D images were compared with the DSA image. Our mirror image of the coronary artery perspective projection that used the X-ray tube as the viewpoint fused precisely with the CAG results and provided exact simulations of all the effects of DSA gantry movements on the DSA image. CAG results were equivalent to the mirror image of coronary artery perspective projection, and the stereo perception was easily established using the X-ray tube as the viewpoint.
Collapse
Affiliation(s)
- Miao Chen
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Tianpeng Zhang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China.
| |
Collapse
|
3
|
Rahpeima E, Bijani M, Karimi S, Alkamel A, Dehghan A. Effect of the Implementation of Interdisciplinary Discharge Planning on Treatment Adherence and Readmission in Patients Undergoing Coronary Artery Angioplasty. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e08. [PMID: 36264696 PMCID: PMC9714981 DOI: 10.17533/udea.iee.v40n2e08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To determine the effect of interdisciplinary discharge planning on treatment adherence and readmission in the patients undergoing coronary artery angioplasty in the south of Iran in 2020. METHODS This experimental study had an intervention group and a control group with pre-test and post-test. 70 patients participated in the study who were randomly divided into the groups (intervention group (n=35) and control group (n=35)). In the intervention group, discharge planning was performed based on an interdisciplinary approach. Treatment adherence before, immediately, and one month after the intervention was evaluated with a 10-question survey scored from 1 to 5 (maximum score = 50), as well as readmission three months after the discharge was examined in both groups. RESULTS Before the intervention, there was no statistically significant difference between the intervention and the control groups in the treatment adherence score (18.22 versus 17.37; p=0.84) but immediately and one month after the intervention statistically significant differences between the groups were showed (21.51 versus 46.14 and 23.28 versus 43.12, respectively; p<0.001). Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. CONCLUSIONS The implementation of interdisciplinary discharge planning had positive effects on treatment adherence and readmission rate in patients undergoing coronary artery angioplasty; therefore, it is suggested that health care system managers make the necessary plans to institutionalize this new educational approach for other patients discharge planning.
Collapse
Affiliation(s)
| | | | - Shahnaz Karimi
- Department of Medical Education, Medical Education Research Center,
| | | | | |
Collapse
|
4
|
Choi IJ, Lim S, Choo EH, Hwang BH, Kim CJ, Park MW, Lee JM, Park CS, Kim HY, Yoo KD, Jeon DS, Youn HJ, Chung WS, Kim MC, Jeong MH, Ahn Y, Chang K. Impact of Intravascular Ultrasound on Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2021; 14:2431-2443. [PMID: 34756537 DOI: 10.1016/j.jcin.2021.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to examine the impact of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) on long-term clinical outcomes in patients with acute myocardial infarction (AMI). BACKGROUND IVUS-guided PCI has been associated with improved cardiovascular outcomes. However, the beneficial effect of IVUS-guided PCI in patients with AMI in the drug-eluting stent era remains unclear. METHODS Patients who underwent PCI with drug-eluting stents were selected from 10,719 patients enrolled in a multicenter AMI registry. The included patients were classified into 2 groups according to the use or nonuse of IVUS. The primary outcome was a composite of major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, and target lesion revascularization, during long-term follow-up. RESULTS A total of 9,846 patients were treated with IVUS-guided PCI (n = 2,032) or angiography-guided PCI (n = 7,814). IVUS-guided PCI was associated with reduced MACE (HR: 0.779; 95% CI: 0.689-0.880; P < 0.001). The results were consistent after multivariable regression and propensity score matching. One-year landmark analysis showed a lower risk for MACE within 1 year (HR: 0.766; 95% CI: 0650-0.903; P = 0.002) and beyond 1 year (HR: 0.796; 95% CI: 0663-0.956; P = 0.014) after index PCI. CONCLUSIONS The use of IVUS was associated with better long-term cardiovascular outcomes. The clinical benefit of IVUS was maintained both within and beyond 1 year after index PCI. The use of IVUS in PCI should be considered for patients with AMI.
Collapse
Affiliation(s)
- Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hee Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's hospital, The Catholic University of Korea, Seoul, Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min Chul Kim
- Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea
| | - Youngkeun Ahn
- Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea
| | - Kiyuk Chang
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
5
|
Niimi N, Sawano M, Ikemura N, Nagai T, Nakano S, Shoji S, Shiraishi Y, Ueda I, Numasawa Y, Suzuki M, Noma S, Fukuda K, Kohsaka S. Applicability and Eligibility of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) for Patients who Underwent Revascularization with Percutaneous Coronary Intervention. J Clin Med 2020; 9:jcm9092889. [PMID: 32906673 PMCID: PMC7564619 DOI: 10.3390/jcm9092889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022] Open
Abstract
In the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial, an early invasive strategy did not decrease mortality compared to a conservative strategy for stable ischemic heart disease (SIHD) patients with moderate-to-severe ischemia, and the role of revascularization would be revised. However, the applicability and potential influence of this trial in daily practice remains unclear. Our objective was to assess the eligibility and representativeness of the ISCHEMIA trial on the patients with percutaneous coronary intervention (PCI). From a multicenter registry, we extracted a consecutive 13,223 SIHD patients with PCI (baseline cohort). We applied ISCHEMIA eligibility criteria and compared the baseline characteristics between the eligible patients and the actual study participants (randomized controlled trial (RCT) patients). In 3463 patients with follow-up information (follow-up cohort), the 2 year composite of major adverse cardiac events was evaluated between the eligible patients and RCT patients, as well as eligible and non-eligible patients in the registry. In the baseline cohort, 77.3% of SIHD patients with moderate-to-severe ischemia were eligible for the ISCHEMIA. They were comparable with RCT patients for baseline characteristics and outcomes unlike the non-eligible patients. In conclusion, the trial results seem applicable for the majority of PCI patients with moderate-to-severe ischemia except for the non-eligible patients.
Collapse
Affiliation(s)
- Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
| | - Mitsuaki Sawano
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba Prefecture 272-8513, Japan;
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan;
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University, International Medical Center, Saitama Prefecture 350-1298, Japan;
| | - Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi Prefecture 326-0843, Japan;
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama Hospital, Saitama Prefecture 351-0102, Japan;
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi Prefecture 321-0974, Japan;
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (N.I.); (S.S.); (Y.S.); (I.U.); (K.F.)
- Correspondence: ; Tel.: +81-3-3353-1211
| |
Collapse
|
6
|
Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2479652. [PMID: 32149092 PMCID: PMC7042514 DOI: 10.1155/2020/2479652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
Objective Whether optimal cardiovascular health metrics may reduce the risk of cardiovascular events in secondary prevention is uncertain. The study was conducted to evaluate the influence of lifestyle changes on clinical outcomes among the subjects underwent percutaneous coronary intervention (PCI). Methods The study group consists of 17,099 consecutive PCI patients. We recorded data on subject lifestyle behavior changes after their procedure. Patients were categorized as ideal, intermediate, or poor CV health according to a modified Life's Simple 7 score (on body mass, smoking, physical activity, diet, cholesterol, blood pressure, and glucose). Multivariable COX regression was used to evaluate the association between CV health and revascularization event. We also tested the impact of cumulative cardiovascular health score on reoccurrence of cardiovascular event. Results During a 3-year median follow-up, 1,583 revascularization events were identified. The observed revascularization rate was 8.0%, 9.3%, and 10.6% in the group of patients with optimal (a modified Life's Simple 7 score of 11–14), average (score = 9 or 10), or inadequate (less or equal than 8) CV health, respectively. After multivariable analysis, the adjusted hazard ratios were 0.83 (95% CI: 0.73–0.94) and 0.89 (95% CI: 0.79–0.99) for patients with optimal and average lifestyle changes comparing with the inadequate tertile (P for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93–0.98; P for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93–0.98; Conclusion Ideal CV health related to lower incidence of cardiovascular events, even after the percutaneous coronary intervention. Revascularization can be reduced by lifestyle changes. The cardiovascular health metrics could be extrapolated to secondary prevention and need for further validation.
Collapse
|
7
|
Lüscher TF. Chronic coronary syndromes: expanding the spectrum and natural history of ischaemic heart disease. Eur Heart J 2020; 41:333-336. [PMID: 31942993 DOI: 10.1093/eurheartj/ehaa001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
| |
Collapse
|