1
|
Bilgin M, Akkaya E, Dokuyucu R. Evaluation of Inflammatory Markers in Predicting Coronary Complexity: Insights from the SYNTAX II Score in NSTEMI Patients. J Clin Med 2024; 13:5940. [PMID: 39408000 PMCID: PMC11477675 DOI: 10.3390/jcm13195940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/02/2024] [Accepted: 10/04/2024] [Indexed: 10/20/2024] Open
Abstract
Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is characterized by the absence of pathological ST segment elevation but an increase in biological markers. The SYNTAX II score (SS-II) is calculated to evaluate the complexity of coronary artery disease and to guide treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this study is to evaluate the relationship of socio-demographic data and biochemical markers with SS-II in NSTEMI patients. Materials and Methods: Six hundred patients who were admitted to the private Aktif International Hospital cardiology clinic between January 2020 and January 2024 and were diagnosed with NSTEMI were included in the study. Severity, extent, and clinical evaluation of atherosclerosis were determined using risk factors, laboratory tests, and coronary angiography. Patients were divided into two groups according to their SS-II score: low (≤ 22) and high SS-II (> 32). Socio-demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-HDL-C ratio (MHR) were compared between the two groups. Results: Group 1 (SS-II ≤ 22) included 380 patients, and group 2 (SS-II > 32) included 220 patients. There was a statistically significant difference in HDL, creatine value, white blood cell, troponin I, hs-TnT, and monocyte values in group 2 compared with group 1 (p = 0.001, p = 0.018, p = 0.031, and p = 0.001, respectively). NLR, MLR, MHR, and SS values were statistically significantly higher in group 2 compared with group 1 (p = 0.015, p = 0.002, p = 0.001, and p = 0.001, respectively). The risk factors were found to be significantly associated with high-risk NSTEMI (SS-II > 32) in a logistic regression analysis and included peripheral artery disease (PAD) (OR: 3.028, p = 0.040), troponin I (OR: 3.575, p = 0.015), hs-TnT (OR: 4.221, p = 0.010), NLR (OR: 1.528, p = 0.024). MLR (OR: 5.248, p = 0.012), and MHR (OR: 7.122, p = 0.010). ROC analysis revealed that NLR (AUC: 0.691, p = 0.016), MLR (AUC: 0.731, p = 0.004), and MHR (AUC: 0.824, p = 0.003) had higher predictive power than other parameters in patients with high-risk NSTEMI (SS-II > 32). Conclusions: We found that NLR, MLR, and MHR levels are associated with the severity of coronary artery disease. We think that adding these easily and quickly measurable parameters to routine laboratory results may support the clinician in evaluating the complexity of coronary artery disease and guiding treatment decisions in NSTEMI patients.
Collapse
Affiliation(s)
- Murat Bilgin
- Department of Cardiology, Private Aktif International Hospital, Yalova 77720, Turkey;
| | - Emre Akkaya
- Department of Cardiology, Bossan Hospital, Gaziantep 27580, Turkey;
| | - Recep Dokuyucu
- Department of Physiology, Medical Specialization Training Center (TUSMER), Ankara 06230, Turkey
| |
Collapse
|
2
|
Bruno J, Varayath M, Gahl B, Miazza J, Gebhard CE, Reuthebuch OT, Eckstein FS, Siegemund M, Hollinger A, Santer D. Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG. Sci Rep 2024; 14:21037. [PMID: 39251616 PMCID: PMC11383960 DOI: 10.1038/s41598-024-71028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 08/23/2024] [Indexed: 09/11/2024] Open
Abstract
Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. TRIAL REGISTRATION www. CLINICALTRIALS gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic. CLINICALTRIALS gov/ct2/show/NCT04533698.
Collapse
Affiliation(s)
- Jowita Bruno
- Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Mascha Varayath
- Clinic for Anaesthesiology, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Caroline E Gebhard
- Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Oliver T Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Friedrich S Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
| | - Alexa Hollinger
- Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Cheun TJ, Davies MG. Influence of a Novel Morphology-Driven Classification on Limb Salvage after Isolated Tibial Intervention for Chronic Limb Threatening Ischemia. Ann Vasc Surg 2024; 106:467-478. [PMID: 38815911 DOI: 10.1016/j.avsg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Infra-popliteal interventions for chronic limb-threatening ischemia (CLTI) can be impacted by the morphology of the tibial vessels. The aim of this study was to examine the impact of a novel morphology-driven classification on the outcomes of isolated tibial intervention for CLTI. METHODS A database of patients undergoing isolated tibial interventions for CLTI at a single center between 2010 and 2020 was retrospectively queried. Patients with isolated infra-popliteal disease were identified, and their anatomy was scored as present or absent for lesion calcification (1 point), target vessel diameter<3.0 mm (1 point), lesion length>300 mm (1 point), and poor pedal runoff score (1 point). Patients were then divided into 3 groups: low risk (0 or 1 points), moderate risk (2 points), and high risk (3 or 4 points). Intention to treat analysis by the patient was performed. Limb-based patency (the absence of reintervention, occlusion, critical stenosis [>70%], or hemodynamic compromise with ongoing symptoms of CLTI as it related to the patency of the preoperatively determined target artery pathway) was assessed. Patient-oriented outcomes of amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; above ankle amputation of the index limb or major reintervention: new bypass graft, jump/interposition graft revision) were evaluated. RESULTS 1,607 patients (55% male, average age 60 years, 3,846 vessels) underwent tibial intervention for CLTI. The majority of the patients were diabetic and of Hispanic origin. Morphologically, 27%, 31%, and 42% of the vessels were categorized as low risk, moderate risk, and high risk, respectively. There was a significant worsening of the infra-popliteal Global Limb Anatomic Staging System (GLASS) grading as the morphological risk increased. The 30-day major adverse cardiac events (MACE) were equivalent across the groups and were under the stated objective performance goal (OPG) of ≤10%. In contrast, both the 30-day MALE and the 30-day major amputations were significantly different across the groups, with the low-risk group remaining under the OPG of ≤9% and ≤4%, respectively, while the moderate risk and high risk exceeded the goal threshold. For the OPG, freedom from MALE was 60 ± 5%, 46 ± 5%, and 22 ± 9% at 5 years for low-, moderate-, and high-risk groups, respectively (mean ± standard error of the mean; P = 0.008). Overall AFS was 55 ± 5%, 37 ± 6%, and 18 ± 7% at 5 years for low-, moderate-, and high-risk groups, respectively (mean ± standard error of the mean; P = 0.003). CONCLUSIONS Tibial anatomic morphology impacts isolated tibial endovascular intervention with adverse morphology associated with poorer short- and long-term outcomes. Risk stratification based on anatomic predictors should be an additional consideration as one intervenes on infra-popliteal vessels for CLTI.
Collapse
Affiliation(s)
- Tracey J Cheun
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX; Department of Anesthesia, Long School of Medicine, San Antonio, TX
| | - Mark G Davies
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX; Department of Vascular/Endovascular Surgery, Ascension Health, Waco, TX.
| |
Collapse
|
4
|
Sardjan J, Lesmana CRA, Rusdi L, Kurniawan J, Yunihastuti E, Susilo A, Gani RA. Correlation between controlled attenuation parameter values with SYNTAX score in patients with significant coronary artery disease. Sci Rep 2024; 14:15382. [PMID: 38965252 PMCID: PMC11224258 DOI: 10.1038/s41598-024-63792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver disease, with coronary artery disease (CAD) as the main cause of death in NAFLD patients. However, correlation between the severity of liver steatosis and coronary atherosclerosis is yet to be understood. Here we aim to explore the correlation between controlled attenuation parameter (CAP) values and SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score in adult patients with significant CAD, defined as ≥ 50% stenosis of the left main coronary artery, or ≥ 70% stenosis of the other major coronary arteries. A cross-sectional study was conducted on 124 adult patients with significant CAD who underwent coronary angiography. Transient elastography with CAP was used to assess liver steatosis severity, resulting in a mean CAP value of 256.5 ± 47.3 dB/m, with 52.5% subjects had significant steatosis (CAP value of ≥ 248 dB/m). Median SYNTAX score was 22. A statistically significant correlation was observed between CAP value and SYNTAX score (r = 0.245, p < 0.0001). The correlation was more pronounced in patients with prior history of PCI (r = 0.389, p = 0.037). Patients with high-risk SYNTAX score (> 32) had the highest CAP value (285.4 ± 42.6 dB/m), and it was significantly higher than those with low-risk SYNTAX score (0-22), with a mean difference of 38.76 dB/m (p = 0.006). Patients with significant liver steatosis should undergo periodic CAD assessment and lifestyle modification, especially those with severe liver steatosis.
Collapse
Affiliation(s)
- Jordan Sardjan
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
| | - Cosmas Rinaldi Adithya Lesmana
- Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia.
| | - Lusiani Rusdi
- Division of Cardiology, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
| | - Evy Yunihastuti
- Division of Allergy and Immunology, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General, Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
| | - Adityo Susilo
- Division of Tropical and Infectious Disease, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
| | - Rino Alvani Gani
- Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia
| |
Collapse
|
5
|
Zeng Y, Xu J, Deng Y, Li X, Chen W, Tang Y. Drug-eluting stents for coronary artery disease in the perspective of bibliometric analysis. Front Cardiovasc Med 2024; 11:1288659. [PMID: 38440210 PMCID: PMC10910058 DOI: 10.3389/fcvm.2024.1288659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Drug-eluting stents (DES) play a crucial role in treating coronary artery disease (CAD) by preventing restenosis. These stents are coated with drug carriers that release antiproliferative drugs within the vessel. Over the past two decades, DES have been employed in clinical practice using various materials, polymers, and drug types. Despite optimizations in their design and materials to enhance biocompatibility and antithrombotic properties, evaluating their long-term efficacy and safety necessitates improved clinical follow-up and monitoring. To delineate future research directions, this study employs a bibliometric analysis approach. We comprehensively surveyed two decades' worth of literature on DES for CAD using the Web of Science Core Collection (WOSCC). Out of 5,778 articles, we meticulously screened them based on predefined inclusion and exclusion criteria. Subsequently, we conducted an in-depth analysis encompassing annual publication trends, authorship affiliations, journal affiliations, keywords, and more. Employing tools such as Excel 2021, CiteSpace 6.2R3, VOSviewer 1.6.19, and Pajek 5.17, we harnessed bibliometric methods to derive insights from this corpus. Analysis of annual publication data indicates a recent stabilisation or even a downward trend in research output in this area. The United States emerged as the leading contributor, with Columbia University and CRF at the forefront in both publication output and citation impact. The most cited document pertained to standardized definitions for clinical endpoints in coronary stent trials. Our author analysis identifies Patrick W. Serruys as the most prolific contributor, underscoring a dynamic exchange of knowledge within the field.Moreover, the dual chart overlay illustrates a close interrelation between journals in the "Medicine," "Medical," and "Clinical" domains and those in "Health," "Nursing," and "Medicine." Frequently recurring keywords in this research landscape include DES coronary artery disease, percutaneous coronary intervention, implantation, and restenosis. This study presents a comprehensive panorama encompassing countries, research institutions, journals, keyword distributions, and contributions within the realm of DES therapy for CAD. By highlighting keywords exhibiting recent surges in frequency, we elucidate current research hotspots and frontiers, thereby furnishing novel insights to guide future researchers in this evolving field.
Collapse
Affiliation(s)
- Ying Zeng
- Jiangxi Medical College, Nanchang University, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jiawei Xu
- Jiangxi Medical College, Nanchang University, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yuxuan Deng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiaoxing Li
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wen Chen
- Jiangxi Cancer Hospital, Nanchang, China
| | - Yu Tang
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| |
Collapse
|
6
|
Ahmed TAN, Othman AAA, Demitry SR, Elmaghraby KM. Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease. BMC Cardiovasc Disord 2024; 24:68. [PMID: 38262995 PMCID: PMC10804526 DOI: 10.1186/s12872-023-03657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/05/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The residual burden of coronary artery disease (CAD) after percutaneous coronary intervention (PCI) drew a growing interest. The residual SYNTAX Score (rSS) was a strong prognostic factor of adverse events and all-cause mortality in patients who underwent PCI. In addition, the SYNTAX Revascularization Index (SRI), a derivative of rSS, was used to figure out the treated proportion of CAD and could be used as a prognostic utility in PCI for patients with multi-vessel disease (MVD). PURPOSE We aimed at the assessment of the use of rSS and the SRI as predictors of in-hospital outcomes and up to two-year cumulative follow-up outcomes in patients with MVD who had PCI for the treatment of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI). METHODS We recruited 149 patients who had either STEMI or NSTEMI while having MVD and received treatment with PCI. We divided them into tertiles based on their rSS and SRI values. We calculated baseline SYNTAX Score (bSS) and rSS using the latest version of the calculator on the internet, and we used both scores to calculate SRI. The study end-points were In-hospital composite Major Adverse Cardiovascular Events (MACE) and its components, in-hospital death, and follow-up cumulative MACE up to 2 years. RESULTS Neither rSS nor SRI were significant predictors of in-hospital adverse events, while female sex, hypertension, and left ventricular ejection fraction were independent predictors of in-hospital MACE. At the two-year follow-up, Kaplan-Meyer analysis showed a significantly increased incidence of MACE within the third rSS tertile (rSS > 12) compared to other tertiles (log rank p = 0.03). At the same time, there was no significant difference between the three SRI tertiles. Unlike SRI, rSS was a significant predictor of cumulative MACE on univariate Cox regression (HR = 1.037, p < 0.001). On multivariate Cox regression, rSS was a significant independent predictor of two-year cumulative MACE (HR = 1.038, p = 0.0025) along with female sex, hypertension, and left ventricular ejection fraction. We also noted that all patients with complete revascularization survived well throughout the entire follow-up period. CONCLUSIONS Neither rSS nor SRI could be good predictors of in-hospital MACE, while the rSS was a good predictor of MACE at two-year follow-up. Patients with rSS values > 12 had a significantly higher incidence of cumulative MACE after 2 years. The best prognosis was achieved with complete revascularization.
Collapse
Affiliation(s)
- Tarek A N Ahmed
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt
| | - Amr A A Othman
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt.
| | - Salwa R Demitry
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt
| | - Khaled M Elmaghraby
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt
| |
Collapse
|
7
|
Wan M, Hu K, Lu Y, Wang C, Mao B, Yang Q, Zheng Z, Wu H, Luo Y, Maiti AK. Co-release of cytokines after drug-eluting stent implantation in acute myocardial infarction patients with PCI. Sci Rep 2024; 14:1236. [PMID: 38216681 PMCID: PMC10786845 DOI: 10.1038/s41598-024-51496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
Acute Myocardial Infarction (AMI) after Percutaneous Coronary Intervention (PCI) often requires stent implantation leading to cardiovascular injury and cytokine release. Stent implantation induces cytokines production including TNFα, Hs-CRP, IL-1ß, IL2 receptor, IL6, IL8, and IL10, but their co-release is not extensively established. In 311 PCI patients with Drug-Eluting Stent (DES) implantation, we statistically evaluate the correlation of these cytokines release in various clinical conditions, stent numbers, and medications. We observed that TNFα is moderately correlated with IL-1ß (r2 = 0.59, p = 0.001) in diabetic PCI patients. Similarly, in NSTEMI (Non-ST Segment Elevation) patients, TNFα is strongly correlated with both IL-1ß (r2 = 0.97, p = 0.001) and IL8 (r2 = 0.82, p = 0.001). In CAD (Coronary Artery Disease)-diagnosed patients TNFα is highly correlated (r2 = 0.84, p = 0.0001) with IL8 release but not with IL-1ß. In patients with an increased number of stents, Hs-CRP is significantly coupled with IL8 > 5 pg/ml (t-statistic = 4.5, p < 0.0001). Inflammatory suppressor drugs are correlated as TNFα and IL8 are better suppressed by Metoprolol 23.75 (r2 = 0.58, p < 0.0001) than by Metoprolol 11.87 (r2 = 0.80, p = 0.5306). Increased TNFα and IL-1ß are better suppressed by the antiplatelet drug Brilinta (r2 = 0.30, p < 0.0001) but not with Clopidogrel (r2 = 0.87, p < 0.0001). ACI/ARB Valsartan 80 (r2 = 0.43, p = 0.0011) should be preferred over Benazepril 5.0 (r2 = 0.9291, p < 0.0001) or Olmesartan (r2 = 0.90, p = 0.0001). Thus, the co-release of IL-1ß, IL8 with TNFα, or only IL8 with TNFα could be a better predictor for the outcome of stent implantation in NSTEMI and CAD-diagnosed AMI patients respectively. Cytokine suppressive medications should be chosen carefully to inhibit further cardiovascular damage.
Collapse
Affiliation(s)
- Minying Wan
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, The Affiliated Hospital of Tongji University, Shanghai, 202157, China.
| | - Kun Hu
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, The Affiliated Hospital of Tongji University, Shanghai, 202157, China.
| | - Yi Lu
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, The Affiliated Hospital of Tongji University, Shanghai, 202157, China.
| | - Cheng Wang
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, The Affiliated Hospital of Tongji University, Shanghai, 202157, China
| | - Bin Mao
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, The Affiliated Hospital of Tongji University, Shanghai, 202157, China
| | - Qing Yang
- Department of Cardiology, the First Affiliated Hospital of Nanchang University, Jiangxi, 330006, China
| | - Zhenzhong Zheng
- Department of Cardiology, the First Affiliated Hospital of Nanchang University, Jiangxi, 330006, China
| | - Hao Wu
- Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Yihong Luo
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, The Affiliated Hospital of Tongji University, Shanghai, 202157, China.
| | - Amit K Maiti
- Department of Genetics and Genomics, 28475 Greenfield Rd, MydnavarSouthfield, MI, 48076, USA.
| |
Collapse
|
8
|
Vukašinović A, Klisic A, Ostanek B, Kafedžić S, Zdravković M, Ilić I, Sopić M, Hinić S, Stefanović M, Bogavac-Stanojević N, Marc J, Nešković AN, Kotur-Stevuljević J. Redox Status and Telomere-Telomerase System Biomarkers in Patients with Acute Myocardial Infarction Using a Principal Component Analysis: Is There a Link? Int J Mol Sci 2023; 24:14308. [PMID: 37762611 PMCID: PMC10531660 DOI: 10.3390/ijms241814308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
In the present study, we examined redox status parameters in arterial and venous blood samples, its potential to predict the prognosis of acute myocardial infarction (AMI) patients assessed through its impact on the comprehensive grading SYNTAX score, and its clinical accuracy. Potential connections between common blood biomarkers, biomarkers of redox status, leukocyte telomere length, and telomerase enzyme activity in the acute myocardial infarction burden were assessed using principal component analysis (PCA). This study included 92 patients with acute myocardial infarction. Significantly higher levels of advanced oxidation protein products (AOPP), superoxide anion (O2•-), ischemia-modified albumin (IMA), and significantly lower levels of total oxidant status (TOS) and total protein sulfhydryl (SH-) groups were found in arterial blood than in the peripheral venous blood samples, while biomarkers of the telomere-telomerase system did not show statistical significance in the two compared sample types (p = 0.834 and p = 0.419). To better understand the effect of the examined biomarkers in the AMI patients on SYNTAX score, those biomarkers were grouped using PCA, which merged them into the four the most contributing factors. The "cholesterol-protein factor" and "oxidative-telomere factor" were independent predictors of higher SYNTAX score (OR = 0.338, p = 0.008 and OR = 0.427, p = 0.035, respectively), while the ability to discriminate STEMI from non-STEMI patients had only the "oxidative-telomere factor" (AUC = 0.860, p = 0.008). The results show that traditional cardiovascular risk factors, i.e., high total cholesterol together with high total serum proteins and haemoglobin, are associated with severe disease progression in much the same way as a combination of redox biomarkers (pro-oxidant-antioxidant balance, total antioxidant status, IMA) and telomere length.
Collapse
Affiliation(s)
- Aleksandra Vukašinović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Aleksandra Klisic
- Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro
- Center for Laboratory Diagnostics, Primary Health Care Center, 81000 Podgorica, Montenegro
| | - Barbara Ostanek
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (B.O.); (J.M.)
| | - Srdjan Kafedžić
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravković
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, Clinical Hospital Center Bezanijska Kosa, 11070 Belgrade, Serbia;
| | - Ivan Ilić
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Miron Sopić
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Saša Hinić
- Department of Cardiology, Clinical Hospital Center Bezanijska Kosa, 11070 Belgrade, Serbia;
| | - Milica Stefanović
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
| | - Nataša Bogavac-Stanojević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Janja Marc
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (B.O.); (J.M.)
| | - Aleksandar N. Nešković
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Jelena Kotur-Stevuljević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| |
Collapse
|
9
|
Seecheran NA, Rafeeq S, Maharaj N, Swarath S, Seecheran V, Seecheran R, Seebalack V, Jagdeo CL, Seemongal-Dass R, Quert AYL, Giddings S, Ramlackhansingh A, Sandy S, Motilal S, Seemongal-Dass R. Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart? Cardiol Ther 2023; 12:499-509. [PMID: 37318673 PMCID: PMC10423171 DOI: 10.1007/s40119-023-00320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. METHODS This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. RESULTS The average patient age was 57.8 years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p = 0.003 and -0.237 for the left eye, p = 0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). CONCLUSION A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. TRIAL REGISTRATION NUMBER NCT04233619.
Collapse
Affiliation(s)
- Naveen Anand Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago.
- Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, West Indies, Trinidad and Tobago.
| | - Salma Rafeeq
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Nicole Maharaj
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Steven Swarath
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, Kansas University Medical Center, Wichita, KS, USA
| | - Victoria Seebalack
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Cathy-Lee Jagdeo
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Rajiv Seemongal-Dass
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | | | - Stanley Giddings
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Anil Ramlackhansingh
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sherry Sandy
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Robin Seemongal-Dass
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| |
Collapse
|
10
|
Demola P, Colaiori I, Bosi D, Musto D’Amore S, Vitolo M, Benatti G, Vignali L, Tadonio I, Gabbieri D, Losi L, Magnavacchi P, Sgura FA, Boriani G, Guiducci V. Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study. Front Cardiovasc Med 2023; 10:1188644. [PMID: 37711555 PMCID: PMC10499393 DOI: 10.3389/fcvm.2023.1188644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background Coronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observational study was to estimate long-term clinical outcomes by Quantitative Flow Ratio (QFR) characterization of CAD in a well-represented cohort of patients affected by severe AS treated by TAVI. Methods A total of 439 invasive coronary angiographies of patients deemed eligible for TAVI by local Heart Teams with symptomatic severe AS were retrospectively screened for QFR analysis. The primary endpoint of the study was all-cause mortality. The secondary endpoint was a composite of cardiovascular mortality, stroke/transient ischemic attack (TIA), acute myocardial infarction (AMI), and any hospitalization after TAVI. Results After exclusion of patients with no follow-up data, coronary angiography not feasible for QFR analysis and previous surgical myocardial revascularization (CABG) 48/239 (20.1%) patients had a QFR value lower or equal to 0.80 (QFR + value), while the remaining 191/239 (79.9%) did not present any vessel with a QFR positive value. In the adjusted Cox regression analysis, patients with positive QFR were independently associated with an increased risk of all-casual mortality (Model 1, HR 3.47, 95% CI, 2.35-5.12; Model 2, HR 5.01, 95% CI, 3.17-7.90). In the adjusted covariate analysis, QFR+ involving LAD (37/48, 77,1%) was associated with the higher risk of the composite outcome compared to patients without any positive value of QFR or non-LAD QFR positive value (11/48, 22.9%). Conclusions Pre-TAVI QFR analysis can be used for a safe, simple, wireless functional assessment of CAD. QFR permits to identify patients at high risk of cardiovascular mortality or MACE, and it could be considered by local Heart Teams.
Collapse
Affiliation(s)
- Pierluigi Demola
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Iginio Colaiori
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Bosi
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Benatti
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Luigi Vignali
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Iacopo Tadonio
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | - Luciano Losi
- U.O. Cardiologia, Ospedale “Guglielmo da Saliceto”, Piacenza, Italy
| | | | - Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo Guiducci
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
11
|
Tam DY, Ruel M, Fremes SE. Commentary: Does the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score even matter? J Thorac Cardiovasc Surg 2023; 165:1415-1417. [PMID: 34303535 DOI: 10.1016/j.jtcvs.2021.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Beska B, Ratcovich H, Bagnall A, Burrell A, Edwards R, Egred M, Jordan R, Khan A, Mills GB, Morrison E, Raharjo DE, Singh F, Wilkinson C, Zaman A, Kunadian V. Angiographic and Procedural Characteristics in Frail Older Patients with Non-ST Elevation Acute Coronary Syndrome. Interv Cardiol 2023; 18:e04. [PMID: 37614703 PMCID: PMC10442670 DOI: 10.15420/icr.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/10/2022] [Indexed: 08/25/2023] Open
Abstract
Background Angiographic and procedural characteristics stratified by frailty status are not known in older patients with non-ST elevation acute coronary syndrome (NSTEACS). We evaluated angiographic and procedural characteristics in older adults with NSTEACS by frailty category, as well as associations of baseline and residual SYNTAX scores with long-term outcomes. Methods In this study, 271 NSTEACS patients aged ≥75 years underwent coronary angiography. Frailty was assessed using the Fried criteria. Angiographic analysis was performed using QAngio® XA Medis in a core laboratory. Major adverse cardiovascular events (MACE) consisted of all-cause mortality, MI, stroke or transient ischaemic attack, repeat unplanned revascularisation and significant bleeding. Results Mean (±SD) patient age was 80.5 ± 4.9 years. Compared with robust patients, patients with frailty had more severe culprit lesion calcification (OR 5.40; 95% CI [1.75-16.8]; p=0.03). In addition, patients with frailty had a smaller mean improvement in culprit lesion stenosis after percutaneous coronary intervention (50.6%; 95% CI [45.7-55.6]) than robust patients (58.6%; 95% CI [53.5-63.7]; p=0.042). There was no association between frailty phenotype and completeness of revascularisation (OR 0.83; 95% CI [0.36-1.93]; p=0.67). A high baseline SYNTAX score (≥33) was associated with adjusted (age and sex) 5-year MACE (HR 1.40; 95% CI [1.08-1.81]; p=0.01), as was a high residual SYNTAX score (≥8; adjusted HR 1.22; 95% CI [1.00-1.49]; p=0.047). Conclusion Frail adults presenting with NSTEACS have more severe culprit lesion calcification. Frail adults were just as likely as robust patients to receive complete revascularisation. Baseline and residual SYNTAX score were associated with MACE at 5 years.
Collapse
Affiliation(s)
- Benjamin Beska
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Hanna Ratcovich
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Department of Cardiology, Rigshospitalet, Copenhagen University HospitalCopenhagen, Denmark
| | - Alan Bagnall
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Amy Burrell
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
| | - Richard Edwards
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Mohaned Egred
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | | | - Amina Khan
- Leeds Teaching Hospitals NHS TrustLeeds, UK
| | - Greg B Mills
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
| | - Emma Morrison
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
| | | | - Fateh Singh
- Sandwell and West Birmingham Hospitals NHS TrustBirmingham, UK
| | - Chris Wilkinson
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle UniversityNewcastle, UK
| | - Azfar Zaman
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| |
Collapse
|
13
|
Khedr AAEG, Dawoud MF, Salama ASA, Allah TMA, El-Deeb BS. Multi-slice coronary computed tomography angiography in assessment of coronary artery disease on the basis of syntax score. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:18. [DOI: 10.1186/s43055-023-00958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/31/2022] [Indexed: 09/01/2023] Open
Abstract
Abstract
Background
The SYNTAX score (SS) was created to aid the Heart Team in assessing the severity and extent of coronary artery disease (CAD) in patients with multi-vessel disease, hence helping in the decision between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). SS is an important tool that assesses the angiographic complexity of the CAD based on Invasive coronary angiography (ICA). The study aims to evaluate the role of coronary Multi-Slice Computed Tomography (MSCT) angiography in the assessment of CAD on the basis of SS.
Results
Our study involved 60 patients with a male to female ratio 78.4% to 21.6%. The mean age of the patients was 57 years. Then, we applicate SYNTAX score II (SS-II) by incorporating a combination of SS-I and clinical variables. MSCT findings were compared with the data collected by cardiac catheterization. SYNTAX scores produced from coronary CT-angiography (CCTA) and those derived from ICA are concordant (P = 0.001). Direct correlation and significant relationship between SS-II for PCI and the mortality rate with the CT-derived SS-I. There was an inverse relationship between the CT-derived SS-I and SS-II for CABG. There was an inverse relationship between the CT-derived-SS with CABG mortality rate.
Conclusions
MSCT is a noninvasive imaging modality that has a significant value and high diagnostic accuracy compared to ICA in the evaluation of the complexity of CAD using SS and can be applied in clinical practice to determine the most convenient treatment procedure and predict long-term prognosis.
Collapse
|
14
|
Current status of adult cardiac surgery-Part 1. Curr Probl Surg 2022; 59:101246. [PMID: 36496252 DOI: 10.1016/j.cpsurg.2022.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
15
|
Sturmberg JP, Kissling B, Kühlein T. Shared decision-making in the realm of uncertainty: The example of coronary artery disease through an EBM and complexity science lens. J Eval Clin Pract 2022. [PMID: 36419338 DOI: 10.1111/jep.13794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
Patients look to their clinicians for explanations and treatments that achieve predictable cures with certainty. Clinicians usually respond accordingly. Acknowledging uncertainty, while necessary, is difficult, anxiety-provoking and at times overwhelming for patients and clinicians alike. We here present three case studies to illustrate the uncertainties of managing patients with potentially life-threatening illnesses. Research aims to provide answers to clinical problems. But, conducting research almost inevitably entails a reduction of real-world complexities. Research ultimately can only provide 'partial or in general answers' mostly revealing new questions. Due to the complexity of clinical care, research cannot really achieve certainty and predictability for an individual within his specific living context and values. In an unavoidably uncertain environment, instead of oversimplifying, clinicians like patients-as far as possible-ought to better embrace a complexity thinking frame. This provides a deeper understanding how living bodies function as-a-whole within their living contexts. Uncertainty and unpredictability, being inherent elements of complexity thinking, cannot be overcome. However, it may be made easier to cope with uncertainty by at least adopting the thinking in probabilities for benefits and harms of patient related outcomes as introduced in Sackett's Evidence-Based Medicine framework. Through the lenses of evidence-based medicine and complexity sciences this paper critically explores the clinical management of three patients diagnosed as having coronary artery disease. They all received the same treatment even though they presented with very different clinical complaints arising from different disease manifestations. Looking at these case studies the authors reflect on the reasons behind this astonishing, but widely seen medical behaviour of 'one size fits all'. They critically reflect the importance of research and evidence in view of a person-centred solution.
Collapse
Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| |
Collapse
|
16
|
Farnier M, Chagué F, Maza M, Bichat F, Masson D, Cottin Y, Zeller M. High lipoprotein(a) levels predict severity of coronary artery disease in patients hospitalized for acute myocardial infarction. Data from the French RICO survey. J Clin Lipidol 2022; 16:685-693. [DOI: 10.1016/j.jacl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/21/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
|
17
|
Hwang D, Park J, Yang HM, Yang S, Kang J, Han JK, Park KW, Kang HJ, Koo BK, Kim HS. Angiographic complete revascularization versus incomplete revascularization in patients with diabetes mellitus. Cardiovasc Diabetol 2022; 21:56. [PMID: 35439958 PMCID: PMC9019985 DOI: 10.1186/s12933-022-01488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Considering the nature of diabetes mellitus (DM) in coronary artery disease, it is unclear whether complete revascularization is beneficial or not in patients with DM. We investigated the clinical impact of angiographic complete revascularization in patients with DM. Methods A total of 5516 consecutive patients (2003 patients with DM) who underwent coronary stenting with 2nd generation drug-eluting stent were analyzed. Angiographic complete revascularization was defined as a residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score of 0. The patient-oriented composite outcome (POCO, including all-cause death, any myocardial infarction, and any revascularization) and target lesion failure (TLF) at three years were analyzed. Results Complete revascularization was associated with a reduced risk of POCO in DM population [adjusted hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.52–0.93, p = 0.016], but not in non-DM population (adjusted HR 0.90, 95% CI 0.69–1.17, p = 0.423). The risk of TLF was comparable between the complete and incomplete revascularization groups in both DM (adjusted HR 0.75, 95% CI 0.49–1.16, p = 0.195) and non-DM populations (adjusted HR 1.11, 95% CI 0.75–1.63, p = 0.611). The independent predictors of POCO were incomplete revascularization, multivessel disease, left main disease and low ejection fraction in the DM population, and old age, peripheral vessel disease, and low ejection fraction in the non-DM population. Conclusions The clinical benefit of angiographic complete revascularization is more prominent in patients with DM than those without DM after three years of follow-up. Relieving residual disease might be more critical in the DM population than the non-DM population. Trial registration The Grand Drug-Eluting Stent registry NCT03507205. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01488-7.
Collapse
Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| |
Collapse
|
18
|
SYNTAX score for clinical decision-making: Necessity, nicety, or neither? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:90-91. [DOI: 10.1016/j.carrev.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/18/2022]
|
19
|
Mulari S, Eskin A, Lampinen M, Nummi A, Nieminen T, Teittinen K, Ojala T, Kankainen M, Vento A, Laurikka J, Kupari M, Harjula A, Tuncbag N, Kankuri E. Ischemic Heart Disease Selectively Modifies the Right Atrial Appendage Transcriptome. Front Cardiovasc Med 2021; 8:728198. [PMID: 34926599 PMCID: PMC8674465 DOI: 10.3389/fcvm.2021.728198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although many pathological changes have been associated with ischemic heart disease (IHD), molecular-level alterations specific to the ischemic myocardium and their potential to reflect disease severity or therapeutic outcome remain unclear. Currently, diagnosis occurs relatively late and evaluating disease severity is largely based on clinical symptoms, various imaging modalities, or the determination of risk factors. This study aims to identify IHD-associated signature RNAs from the atrial myocardium and evaluate their ability to reflect disease severity or cardiac surgery outcomes. Methods and Results: We collected right atrial appendage (RAA) biopsies from 40 patients with invasive coronary angiography (ICA)-positive IHD undergoing coronary artery bypass surgery and from 8 patients ICA-negative for IHD (non-IHD) undergoing valvular surgery. Following RNA sequencing, RAA transcriptomes were analyzed against 429 donors from the GTEx project without cardiac disease. The IHD transcriptome was characterized by repressed RNA expression in pathways for cell-cell contacts and mitochondrial dysfunction. Increased expressions of the CSRNP3, FUT10, SHD, NAV2-AS4, and hsa-mir-181 genes resulted in significance with the complexity of coronary artery obstructions or correlated with a functional cardiac benefit from bypass surgery. Conclusions: Our results provide an atrial myocardium-focused insight into IHD signature RNAs. The specific gene expression changes characterized here, pave the way for future disease mechanism-based identification of biomarkers for early detection and treatment of IHD.
Collapse
Affiliation(s)
- Severi Mulari
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arda Eskin
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University (METU), Ankara, Turkey
| | - Milla Lampinen
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Annu Nummi
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomo Nieminen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Teittinen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teija Ojala
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matti Kankainen
- Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Antti Vento
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Laurikka
- Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markku Kupari
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ari Harjula
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nurcan Tuncbag
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University (METU), Ankara, Turkey
- Department of Chemical and Biological Engineering, College of Engineering, Koc University, Istanbul, Turkey
- School of Medicine, Koc University, Istanbul, Turkey
| | - Esko Kankuri
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
20
|
Lee G, Vervoort D, Sud M, Fremes SE. Commentary: Coronary artery bypass grafting versus percutaneous coronary intervention in left main disease: Plausibility does not equal evidence. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01277-0. [PMID: 34544613 DOI: 10.1016/j.jtcvs.2021.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maneesh Sud
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
21
|
Weferling M, Hamm CW, Kim WK. Percutaneous Coronary Intervention in Transcatheter Aortic Valve Implantation Patients: Overview and Practical Management. Front Cardiovasc Med 2021; 8:653768. [PMID: 34017866 PMCID: PMC8129193 DOI: 10.3389/fcvm.2021.653768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary artery disease (CAD) is present in 40-75% of patients undergoing transcatheter aortic valve implantation (TAVI) for severe symptomatic aortic stenosis. Currently, the indication for TAVI is expanding toward younger patients at lower surgical risk. Given the progressive nature of CAD, the necessity for coronary angiography (CA), including percutaneous coronary intervention (PCI), will subsequently increase as in the future TAVI patients will be younger and have a longer life expectancy. Data on the impact of PCI in patients with severe CAD scheduled for TAVI are controversial, and although European and US guidelines recommend PCI before TAVI, the optimal timing for PCI remains unclear due to a lack of evidence. Depending on the valve type, position, and axial alignment of the implanted device, CA and/or PCI after TAVI can be challenging. Hence, every interventionalist should be familiar with the different types of transcatheter heart valves and their characteristics and technical issues that can arise during invasive coronary procedures. This review provides an overview of current data regarding the prevalence and clinical implications of CAD and PCI in TAVI patients and includes useful guidance for practical management in the clinical routine.
Collapse
Affiliation(s)
- Maren Weferling
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt, Germany.,Department of Cardiology, University Hospital of Giessen, Giessen, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt, Germany.,Department of Cardiology, University Hospital of Giessen, Giessen, Germany.,Department of Cardio-Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| |
Collapse
|
22
|
RDW Value may Increase the Diagnostic Accuracy of MPS. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:76-80. [PMID: 33935539 PMCID: PMC8085445 DOI: 10.14744/semb.2019.58159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/02/2019] [Indexed: 11/27/2022]
Abstract
Objectives: As the feasibility of obtaining health care has improved in the last decade, there is an increase in the number of performing unnecessary coronary angiogram. Red Cell Distribution Width (RDW), which shows erythrocyte dispersion volume, is associated with coronary artery disease. The present study aims to evaluate the relationship between RDW value and the severity of coronary artery disease in patients who undergo myocardial perfusion scintigraphy (MPS) as an evaluation for coronary ischemia and after which patients had a coronary angiography. Methods: This retrospective study included 452 patients diagnosed as stabile angina that had MPS to evaluate coronary ischemia and after which coronary angiography was performed. Complete blood count was obtained on the same day. Patients were first divided into two groups: patients with and without ischemia on MPS. Then, the group who had ischemia on the MPS where divided into another two groups: patients who had RDW values ≥13.5 and the others who had RDW value <13.5. Patients who had fixed perfusion defect, chronic kidney disease, thyroid dysfunction, hematological disease, those who use iron supplements, and those who had active infectious disease were excluded from this study. Results: The basic characteristics were the same between study groups. We found that severe coronary vessel disease, single vessel, two vessels and three vessels diseases were higher in patients who had ischemia on the MPS and RDW values ≥13.5 (p-value were 0.032, 0.004, 0.042 respectively). RDW values ≥13.5 was found to be an independent predictor for the presence of severe coronary artery disease (p<0.001 OR: 3.55). Conclusion: Patients who have MPS for ischemic evaluation and RDW values of ≥ 13.5 were more severe coronary heart diseases. As a result, the findings suggest that using of RDW value is a cheap and feasible parameter that may prevent performing unnecessary coronary angiography for patients after MPS.
Collapse
|
23
|
Liu Y, Wang W, Song J, Zhang K, Xu B, Li P, Shao C, Yang M, Chen J, Tang YD. Association Between Lipoprotein(a) and Peri-procedural Myocardial Infarction in Patients With Diabetes Mellitus Who Underwent Percutaneous Coronary Intervention. Front Endocrinol (Lausanne) 2021; 11:603922. [PMID: 33613445 PMCID: PMC7888338 DOI: 10.3389/fendo.2020.603922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background High lipoprotein(a) (Lp[a]) levels are associated with increased risks of cardiovascular events in Percutaneous Coronary Intervention (PCI) patients with diabetes mellitus (DM). Peri-procedural myocardial infarction (PMI) occurs commonly during the PCI, whereas the relationship between Lp(a) and PMI remains unclear. Our study aimed to evaluate the association between Lp(a) value and the incidence of PMI in a larger-scale diabetic cohort undergoing PCI throughout 2013. Methods A total of 2,190 consecutive patients with DM were divided into two groups according to the median Lp(a) level of 175 mg/L: Low Lp(a) group (N = 1095) and high Lp(a) group (N = 1095). PMI was defined based on the 2018 universal definition of myocardial infarction. Results Patients with high Lp(a) levels exhibited higher rates of PMI compared to those with low Lp(a) levels (2.3% versus 0.8%, P = 0.006). The multivariable logistic analysis showed that PMI was independently predicted by Lp(a) as a dichotomous variable (OR 2.64, 95%CI 1.22-5.70) and as a continuous variable (OR 1.57, 95% CI 1.12-2.20). However, further investigation found that this association was only maintained in men, whose Lp(a) levels were significantly associated with the frequency of PMI, both as a dichotomous variable (OR 3.66, 95%CI 1.34-10.01) and as a continuous variable (OR 1.81, 95%CI 1.18-2.78). Lp(a) wasn't a risk factor of PMI in women. Conclusions High Lp(a) levels had forceful correlations with the increased frequency of PMI in male diabetic patients undergoing PCI. Lp(a) might act as a marker of risk stratification and a therapeutic target to reduce PCI-related ischemic events.
Collapse
Affiliation(s)
- Yupeng Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiac Catheterization Laboratory, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
24
|
Baumann AAW, Mishra A, Worthley MI, Nelson AJ, Psaltis PJ. Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine. Ther Adv Chronic Dis 2020; 11:2040622320938527. [PMID: 32655848 PMCID: PMC7331770 DOI: 10.1177/2040622320938527] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Recent analyses suggest the incidence of acute coronary syndrome is declining in high- and middle-income countries. Despite this, overall rates of non-ST-elevation myocardial infarction (NSTEMI) continue to rise. Furthermore, NSTEMI is a greater contributor to mortality after hospital discharge than ST-elevation myocardial infarction (STEMI). Patients with NSTEMI are often older, comorbid and have a high likelihood of multivessel coronary artery disease (MVD), which is associated with worse clinical outcomes. Currently, optimal treatment strategies for MVD in NSTEMI are less well established than for STEMI or stable coronary artery disease. Specifically, in relation to percutaneous coronary intervention (PCI) there is a paucity of randomized, prospective data comparing multivessel and culprit lesion-only PCI. Given the heterogeneous pathological basis for NSTEMI with MVD, an approach of complete revascularization may not be appropriate or necessary in all patients. Recognizing this, this review summarizes the limited evidence base for the interventional management of non-culprit disease in NSTEMI by comparing culprit-only and multivessel PCI strategies. We then explore how a personalized, precise approach to investigation, therapy and follow up may be achieved based on patient-, disease- and lesion-specific factors.
Collapse
Affiliation(s)
- Angus A. W. Baumann
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Aashka Mishra
- Flinders Medical School, Flinders University, Adelaide, South Australia, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, USA
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | | |
Collapse
|
25
|
Yamaya S, Morino Y, Taguchi Y, Ninomiya R, Ishida M, Fusazaki T, Itoh T, Kimura T. Comparison of Archival Angiographic Findings in Patients Later Developing Acute Coronary Syndrome or Stable Angina. Int Heart J 2020; 61:454-462. [DOI: 10.1536/ihj.19-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shohei Yamaya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yuya Taguchi
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Ryo Ninomiya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Takumi Kimura
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| |
Collapse
|
26
|
An investigation into hemodynamically significant coronary artery lesions predictors assessed by fractional flow reserve: A propensity score matching analysis. North Clin Istanb 2020; 7:35-39. [PMID: 32232201 PMCID: PMC7103741 DOI: 10.14744/nci.2019.79058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/26/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Fractional flow reserve (FFR) provides more useful information regarding myocardial metabolism and demand-supply convenience as compared to anatomical measurements. In this study, we aimed to investigate FFR predictors after propensity score matching (PSM) analysis in patients with intermediate coronary lesions. METHODS Patients who underwent coronary angiography between January 2014 and March 2015 due to suspicion of coronary artery disease were included in this study. Patients were divided into two groups according to the FFR status and predictors of FFR before and after PSM analysis were investigated. RESULTS A total of 290 patients (a total of 310 lesions) were included in this study (61±12 years, 75.5% male). In univariate analysis, after PSM analysis, Diameter stenosis (DS) and proximal LAD lesion (PLL) were associated with lower FFR values. CONCLUSION This study indicated that the majority of traditional FFR predictors did not reach the limit of significance after PSM analysis and we suggest that DS and PLL are one step ahead of predicting lesion severity compared to other traditional risk factors.
Collapse
|
27
|
Jahangiri M, Mani K, Yates MT, Nowell J. The EXCEL Trial: The Surgeons' Perspective. Eur Cardiol 2020; 15:e67. [PMID: 33294035 PMCID: PMC7689871 DOI: 10.15420/ecr.2020.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/05/2020] [Indexed: 01/06/2023] Open
Abstract
There have been several investigations comparing the efficacy of percutaneous coronary intervention and coronary artery bypass grafting surgery for treatment of left main stem disease. This includes the Evaluation of XIENCE versus Coronary Artery Bypass Graft Surgery for Effectiveness of Left Main Revascularizaton (EXCEL) trial, which has garnered significant controversy surrounding its experimental design and reporting of its results. The authors review the methodology, results, caveats and statements on the EXCEL trial. They also review the other trials in the management of left main stem disease comparing percutaneous coronary intervention with coronary artery bypass grafting, as well as the SYNTAX score and its role in future guidelines for revascularisation. These findings have significant implications for current practice, influencing the growing role for multidisciplinary team meeting and allowing clinicians and patients to make the right choice.
Collapse
Affiliation(s)
| | - Krishna Mani
- Department of Cardiac Surgery, St. George's Hospital London, UK
| | - Martin T Yates
- Department of Cardiac Surgery, St. George's Hospital London, UK
| | - Justin Nowell
- Department of Cardiac Surgery, St. George's Hospital London, UK
| |
Collapse
|
28
|
Tien TQ, Bang HT, Cuong LT, An NT. Simultaneous endovascular repair for abdominal aortic aneurysm and coronary artery bypass grafting in an octogenarian: A case report. Int J Surg Case Rep 2019; 66:72-75. [PMID: 31812640 PMCID: PMC6911948 DOI: 10.1016/j.ijscr.2019.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is commonly associated with abdominal aortic aneurysms (AAAs) in elderly patients. When severe CAD requiring coronary artery bypass grafting (CABG) is associated with an impending AAA in a high-risk patient, the options for the suitable timing of CABG and AAA repair strategy (one-stage or two-stage) are still being debated. PRESENTATION OF CASE An 87-year-old man with non-ST-segment elevation myocardial infarction and a giant abdominal aortic aneurysm was transferred to our centre. Coronary angiography revealed triple-vessel coronary disease, and computed tomography confirmed a giant infrarenal fusiform abdominal aortic aneurysm 9 cm in maximal diameter. We simultaneously performed endovascular aneurysm repair prior to on-pump beating-heart coronary artery bypass grafting. The postoperative course was uneventful, and the patient was discharged on the 15th postoperative day. CONCLUSION Combined endovascular aneurysm repair and on-pump beating heart coronary artery bypass grafting in a one-stage operation is a promising strategy to improve therapeutic efficiency in octogenarians. More studies are needed to compare the efficacy and safety of one-stage and two-stage operations to treat concomitant coronary artery disease and aortovascular pathology in the high-risk octogenarian patients.
Collapse
Affiliation(s)
- Tran Quyet Tien
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh, Viet Nam; Cho Ray Hospital, Ho Chi Minh, Viet Nam
| | - Ho Tat Bang
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh, Viet Nam.
| | - Lam Thao Cuong
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh, Viet Nam
| | | |
Collapse
|
29
|
Zhou X, Zhang P, Liang T, Chen Y, Liu D, Yu H. Relationship between circulating levels of angiotensin-converting enzyme 2-angiotensin-(1-7)-MAS axis and coronary heart disease. Heart Vessels 2019; 35:153-161. [PMID: 31359146 PMCID: PMC7100072 DOI: 10.1007/s00380-019-01478-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
As a counter-regulatory arm of the renin angiotensin system (RAS), the angiotensin-converting enzyme 2-angiotensin-(1–7)-MAS axis (ACE2-Ang-(1–7)-MAS axis) plays a protective role in cardiovascular diseases. However, the link between circulating levels of ACE2-Ang-(1–7)-Mas axis and coronary atherosclerosis in humans is not determined. The object of present study was to investigate the association of circulating levels of ACE2, Ang-(1–7) and Ang-(1–9) with coronary heart disease (CHD) defined by coronary angiography (CAG). 275 patients who were referred to CAG for the evaluation of suspected CHD were enrolled and divided into two groups: CHD group (diameter narrowing ≥ 50%, n = 218) and non-CHD group (diameter narrowing < 50%, n = 57). Circulating ACE2, Ang-(1–7) and Ang-(1–9) levels were detected by enzyme-linked immunosorbent assay (ELISA). In females, circulating ACE2 levels were higher in the CHD group than in the non-CHD group (5617.16 ± 5206.67 vs. 3124.06 ± 3005.36 pg/ml, P = 0.009), and subgroup analysis showed the significant differences in ACE2 levels between the two groups only exist in patients with multi-vessel lesions (P = 0.009). In multivariate logistic regression, compared with the people in the lowest ACE2 quartile, those in the highest quartile had an OR of 4.33 (95% CI 1.20–15.61) for the CHD (P for trend = 0.025), the OR was 5.94 (95% CI 1.08–32.51) for the third ACE2 quartile and 9.58 (95% CI 1.61–56.95) for the highest ACE2 quartile after adjusting for potential confounders (P for trend = 0.022). However, circulating Ang-(1–7) and Ang-(1–9) levels had no significant differences between the two groups. In males, there were no significant differences in the levels of ACE2-Ang-(1–7)-MAS axis between two groups. Together, circulating ACE2 levels, but not Ang-(1–7) and Ang-(1–9) levels, significantly increased in female CHD group when compared with non-CHD group, increased ACE2 was independently associated with CHD in female and in patients with multi-vessel lesions even after adjusting for the confounding factors, indicating that ACE2 may participate as a compensatory mechanism in CHD.
Collapse
Affiliation(s)
- Xiaomin Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ping Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tao Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongyue Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Cardiology, Shantou Central Hospital and Affiliated Shantou Hospital of SunYat-Sen University, Shantou, China
| | - Dan Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Cardiology, Hospital of Panyu District, Guangzhou, China
| | - Huimin Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China. .,Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, Foshan, China.
| |
Collapse
|
30
|
Rahmani R, Majidi B, Ariannejad H, Shafiee A. The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:514-517. [PMID: 31495747 DOI: 10.1016/j.carrev.2019.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/23/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND In patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), Global Registry for Acute Coronary Events (GRACE) score is a valid tool for risk stratification. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score is an angiographic scoring system to guide the decision-making between coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI). The aim of the present study was to assess the accuracy of the GRACE score in predicting the severity and extent of coronary artery stenosis by SYNTAX score. METHODS A total of 330 patients with acute coronary syndrome (ACS) were enrolled in the study. For every patient, the GRACE score was calculated. All patients underwent coronary angiography within 2 days and the SYNTAX scoring system was used to evaluate the severity and extent of coronary stenotic lesions. Based on ROC curve analysis, the cut-off value of GRACE score that could predict SYNTAX score ≥ 23 was calculated. RESULTS GRACE score was 107.12 ± 34.4 in patients with SYNTAX SCORE < 23 and 134.80 ± 48.3 in patients with SYNTAX score ≥ 23 (p value = 0.001). A positive correlation was observed between the GRACE score and angiographic SYNTAX score (r = 0.34 p < 0.001). We found that a GRACE score of 109 is the optimal cut-off to predict SYNTAX score ≥ 23 with a sensitivity of 73.5% and specificity of 60% (p < 0.001). Its negative predictive value was 94.0%. CONCLUSION GRACE score had significant but modest value to predict the severity and extent of coronary artery stenosis in patients with ACS.
Collapse
Affiliation(s)
- Reza Rahmani
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Babak Majidi
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ariannejad
- Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
31
|
Sikora-Frac M, Zaborska B, Maciejewski P, Budaj A, Bednarz B. Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus. Cardiol J 2019; 28:923-931. [PMID: 31257568 PMCID: PMC8747832 DOI: 10.5603/cj.a2019.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/09/2019] [Indexed: 12/03/2022] Open
Abstract
Background Many patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF. Methods Sixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S′) were measured and Tei index was calculated before and 3 months after PCI. Results Before PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (Δ) of LVEF, GLS, S′, and Tei index. LV function improvement expressed as ΔGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (β = 0.003, 95% confidence interval: 0.0004–0.005; p = 0.02). Conclusions Percutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function.
Collapse
Affiliation(s)
- Malgorzata Sikora-Frac
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland.
| | - Beata Zaborska
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Pawel Maciejewski
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Bronislaw Bednarz
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| |
Collapse
|
32
|
Schick D, Babendreyer A, Wozniak J, Awan T, Noels H, Liehn E, Bartsch JW, Vlacil AK, Grote K, Zayat R, Goetzenich A, Ludwig A, Dreymueller D. Elevated expression of the metalloproteinase ADAM8 associates with vascular diseases in mice and humans. Atherosclerosis 2019; 286:163-171. [PMID: 30910225 DOI: 10.1016/j.atherosclerosis.2019.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Members of the family of a disintegrin and metalloproteinases (ADAMs) and their substrates have been previously shown to modulate the inflammatory response in cardiac diseases, but studies investigating the relevance of ADAM8 are still rare. Our aim is to provide evidence for the inflammatory dysregulation of ADAM8 in vascular diseases and its association with disease severity. METHODS Western-type diet fed Apoe-/- and Ldlr-/- mice and artery ligation served as murine model for atherosclerosis and myocardial infarction, respectively. Human bypass grafts were used to study the association with coronary artery disease (CAD), with the simplified acute physiology score II (SAPS II) as a measure of postoperative organ dysfunction. Human primary vascular and blood cells were analyzed under basal and inflammatory conditions. mRNA levels were determined by RT-qPCR, ADAM8 protein levels by ELISA, immunohistochemistry or flow cytometry. RESULTS ADAM8/ADAM8 expression is associated with atherosclerosis and CAD such as myocardial infarction in both mice and humans, especially in endothelial cells and leukocytes. We observed a strong in vivo and in vitro correlation of ADAM8 with the vascular disease markers VCAM-1, ICAM-1, TNF, IL-6, and CCL-2. Serum analysis revealed a significant elevation of soluble ADAM8 serum levels correlating with soluble CXCL16 levels and SAPS II. CONCLUSIONS We demonstrate a general association of ADAM8 with cardiovascular diseases in mice and humans predominantly acting in endothelial cells and leukocytes. The correlation with postoperative organ dysfunctions in CAD patients highlights the value of further studies investigating the specific function of ADAM8 in cardiovascular diseases.
Collapse
Affiliation(s)
- Daniel Schick
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Aaron Babendreyer
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Justyna Wozniak
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Tanzeela Awan
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Heidi Noels
- Institute of Molecular Cardiovascular Research, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Elisa Liehn
- Institute of Molecular Cardiovascular Research, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany; National Heart Center Singapore, Singapore, Human Genetic Laboratory, University of Medicine Craiova, Romania
| | - Jörg-W Bartsch
- Department of Neurosurgery, Philipps University Marburg, University Hospital Marburg, Baldingerstrasse, 35033, Marburg, Germany
| | - Ann-Kathrin Vlacil
- Clinic for Internal Medicine, Cardiology, Philipps University Marburg, University Hospital Marburg, Marburg, Germany
| | - Karsten Grote
- Clinic for Internal Medicine, Cardiology, Philipps University Marburg, University Hospital Marburg, Marburg, Germany
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52066, Aachen, Germany
| | - Andreas Goetzenich
- Department of Thoracic and Cardiovascular Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52066, Aachen, Germany
| | - Andreas Ludwig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Daniela Dreymueller
- Institute of Experimental and Clinical Pharmacology and Toxicology, PZMS, ZHMB, Saarland University, UKS Bldg. 46, 66421, Homburg, Germany.
| |
Collapse
|
33
|
Aksu U, Gulcu O, Aksakal E, Kalkan K, Öztürk M, Korkmaz AF, Uslu A, Demirelli S. The association between CRP / Albumin ratio and in-stent restenosis development in patients with ST-segment elevation myocardial infarction. J Clin Lab Anal 2019; 33:e22848. [PMID: 30737841 PMCID: PMC6528603 DOI: 10.1002/jcla.22848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although interventional methods are the first-line treatment options in ST-segment elevation myocardial infarction (STEMI), the incidence of stent restenosis (SR) is frequent. We investigated the relationship between CRP/albumin ratio (CAR), a novel indicator of inflammatory response, and SR in this study. METHOD This study was carried out on the patients who underwent coronary angiography in our clinic between January 2017 and September 2017. Two groups were generated according to restenosis status (group 1: restenosis (-), group 2: restenosis (+)), and clinical biochemical and angiographical features were compared. As baseline demographic and angiographic characteristics are slightly different in two groups, propensity score matching analysis was performed to reduce bias. 45 SR patients were matched on a 1:1 basis were enrolled final cohort. RESULTS The mean age of the patients was 55 ± 5.1 and 80% were male; Cox regression model was performed to demonstrate independent predictor of restenosis development; and during the one-year follow-up period, CAR (P < 0.001) was found an independent predictor of SR CONCLUSION: In this study, we demonstrate that there may be a strong relationship between SR development and CAR. We implied that inflammatory reaction may be an important diagnostic tool for prediction of SR development in STEMI patients.
Collapse
Affiliation(s)
- Uğur Aksu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Emrah Aksakal
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Öztürk
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Ali Fuat Korkmaz
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| |
Collapse
|
34
|
Hassan AK, Abd–El Rahman H, Hassan SG, Ahmed TA, Youssef AAA. Validity of tortuosity severity index in chest pain patients with abnormal exercise test and normal coronary angiography. Egypt Heart J 2018; 70:381-387. [PMID: 30591760 PMCID: PMC6303525 DOI: 10.1016/j.ehj.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Coronary tortuosity (CT) had different definitions and scores in literature with unclear pathophysiological impact. OBJECTIVES To study degree of CT and it's relation to ischemic changes in patients with angina but normal coronary angiography (CA). METHODS We conducted a prospective study at University hospitals between May 2016 and January 2017. We included 200 consecutive patients who underwent CA due to chest pain assumed to be of cardiac origin, and their CA was normal (no diameter stenosis >30%, nor myocardial bridging). Patients were prospectively divided into 2 groups based on the presence (n = 113) or absence (n = 87) of ischemic changes during stress study and compared for clinical, echocardiographic and CA characteristics. A newly proposed Tortuosity Severity Index (TSI) was developed into significant (mild/moderate CT with more than 4 curvatures in total, or severe/extreme CT with any number of curvatures) or not significant TSI (mild CT with curvatures less than or equal to 4 curvatures in total). RESULTS Patients with ischemic changes had the highest rate of CT (76.5 vs 18%, p = 0.004) compared to those without. CT mostly affects the left anterior descending (LAD) coronary artery in mid and distal segments. Females, elderly, and hypertensives with left ventricular hypertrophy were strongly related to CT. Multivariate logistic regression analysis identified CT with significant TSI as the only predictor of ischemic changes in these patients (OR = 6.2, CI = 2.5-15.3, P = <0.001). CONCLUSIONS Coronary tortuosity is a strong predictor of anginal pain among patients with normal CA, despite positive stress study. This finding is more pronounced among elderly, hypertensive female patients.
Collapse
Affiliation(s)
- Ayman K.M. Hassan
- Department of Cardiology, Faculty of Medicine, Assiut University, Egypt
| | | | | | | | | |
Collapse
|
35
|
Esper RB, Farkouh ME, Ribeiro EE, Hueb W, Domanski M, Hamza TH, Siami FS, Godoy LC, Mathew V, French J, Fuster V. SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. J Am Coll Cardiol 2018; 72:2826-2837. [DOI: 10.1016/j.jacc.2018.09.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
|
36
|
Coughlan JJ, Blake N, Chongprasertpon N, Ibrahim M, Arnous S, Kiernan TJ. Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre. Open Heart 2018; 5:e000804. [PMID: 30018777 PMCID: PMC6045701 DOI: 10.1136/openhrt-2018-000804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 11/04/2022] Open
Abstract
Purpose In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre. Methods This prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days. Results 56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort. Conclusions PCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.
Collapse
Affiliation(s)
- J J Coughlan
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Nial Blake
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | | | - Munir Ibrahim
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Samer Arnous
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | |
Collapse
|
37
|
Yammine M, Itagaki S, Pawale A, Toyoda N, Reddy RC. SYNTAX score may predict the severity of atherosclerosis of the ascending aorta. J Thorac Dis 2017; 9:3859-3865. [PMID: 29268395 DOI: 10.21037/jtd.2017.09.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The objective of this study was to investigate the association of the coronary SYNTAX score with the degree of atherosclerosis of the ascending aorta in patients who underwent coronary artery bypass grafting (CABG). Methods A total of 152 patients (mean age 65 years, 66% male) were analyzed who underwent isolated CABG with both SYNTAX score and the intraoperative 5-point scale grading of the severity of atherosclerosis in the ascending aorta available. The patient were stratified into low, intermediate, and high SYNTAX score groups [≤22 (n=36), 22-33 (n=42), and ≥33 (n=76)]. Results The mean SYNTAX score was 31±11. Patient demographics and comorbidity were comparable in each group. The prevalence of severe atherosclerosis (Grade ≥III) in the ascending aorta was 17.5% (n=27) in the whole population and was different in each group with higher prevalence in higher score groups (8.3% vs. 9.5% vs. 26.3%, P=0.018). After adjusting for age, sex and other relevant comorbidity, SYNTAX score remained a predictor of severe atherosclerosis [adjusted OR 1.63, 95% CI: 1.01-2.62, P=0.046 (per 10 point increase); adjusted OR 5.20, 95% CI: 1.15-23.5, P=0.032 (high vs. low score)]. Conclusions SYNTAX score was associated with the severity of atherosclerosis in the ascending aorta. Patients with high scores have a 5 times higher chance of severe disease compared to patients with low scores and should warrant preoperative and intraoperative comprehensive assessment of the ascending aorta.
Collapse
Affiliation(s)
- Maroun Yammine
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Amit Pawale
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Nana Toyoda
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Ramachandra C Reddy
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
38
|
Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II. Eur Radiol 2017; 28:2151-2158. [PMID: 29222675 DOI: 10.1007/s00330-017-5184-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/24/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The application of SYNTAX score II based on coronary CT angiography (CCTA) for selecting further treatment options has not been studied. This study aimed to investigate the diagnostic performance of CCTA combined with SYNTAX score II for selecting the revascularization method compared with invasive coronary angiography (ICA) based on 2014 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines. METHODS From January-May 2011, 160 patients who underwent both CCTA and ICA within 30 interval days were included. The diagnostic performance of CCTA, CCTA plus CT-SYNTAX score I and CT-SYNTAX score II was analysed using ICA counterparts as references. RESULTS Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CCTA plus CT-SYNTAX I for selecting coronary artery bypass grafting (CABG) candidates using ICA plus ICA-SYNTAX I as reference, were 70.6 %, 95.8 %, 66.7 %, 96.5 % and 93.1 %, respectively. The diagnostic performance of CCTA plus CT-SYNTAX II showed improvement with values of 83.3 %, 97.3 %, 71.4 %, 98.6 % and 96.3 %, respectively, using ICA plus ICA-SYNTAX II as reference. CONCLUSIONS CCTA combined with CT-SYNTAX score II is an accurate method for selecting CABG surgery candidates compared with ICA-SYNTAX score II. KEY POINTS • SYNTAX plus CCTA can be highly specific for selecting the revascularization method. • SYNTAX II was complemented by including clinical considerations to SYNTAX I. • CCTA plus CT-SYNTAX II is an accurate method for selecting CABG candidates.
Collapse
|
39
|
Kappetein AP, Serruys PW, Sabik JF, Leon MB, Taggart DP, Morice MC, Gersh BJ, Pocock SJ, Cohen DJ, Wallentin L, Ben-Yehuda O, van Es GA, Simonton CA, Stone GW. Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial. EUROINTERVENTION 2017; 12:861-72. [PMID: 27639738 DOI: 10.4244/eijv12i7a141] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD. METHODS AND RESULTS The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is a prospective, open-label, multicentre, international study of 1,900 randomised subjects. Patients with significant LMCAD with a SYNTAX score ≤32 and local Heart Team consensus that the subject is appropriate for revascularisation by both PCI and CABG are consented and randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo follow-up for five years. The primary endpoint is the three-year composite rate of death, stroke or myocardial infarction, assessed at a median follow-up of at least three years (with at least two-year follow-up in all patients), powered for sequential non-inferiority and superiority testing. CONCLUSIONS The EXCEL study will define the contemporary roles of CABG and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and intermediate SYNTAX scores.
Collapse
Affiliation(s)
- Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
He C, Song Y, Wang CS, Yao Y, Tang XF, Zhao XY, Gao RL, Yang YJ, Xu B, Yuan JQ. Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2017; 119:1493-1499. [PMID: 28341359 DOI: 10.1016/j.amjcard.2017.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
This prospective, single-center, observational study evaluated prognostic value of clinical SYNTAX score (CSS) on 2-year outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). The SYNTAX score (SS) is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. However, SS was a sole angiographic grading tool only with no consideration for clinical factors. There are few studies investigating the prognostic value of CSS in patients with ACS who underwent PCI. From January 2013 to December 2013, 6,099 consecutive patients with ACS admitted to FuWai hospital and underwent PCI were enrolled in this study. Based on CSS, patients were divided into low CSS group (CSS ≤ 6.5; 2,012 patients), mid-CSS group (6.5 < CSS < 13.8; 2,056 patients), and high CSS group (CSS ≥ 13.8; 2,031 patients). At 2-year follow-up, rates of cardiac death and major adverse cardiac events (MACE) were significantly higher in the high CSS group. Compared with baseline SS, CSS demonstrated significantly improved performance for 2-year cardiac death (receiver-operating characteristic curve C-statistic: 0.74 vs 0.62, p <0.001) but not for MACE (receiver-operating characteristic curve C-statistic: 0.60 vs 0.59, p = 0.29). By multivariable analysis, the CSS combined with PCI history and hypertension were strong predictors for cardiac death and CSS, intra-aortic balloon pump support, diabetes, and successful PCI were independent predictors for MACE. In conclusion, compared with the anatomic SS, CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.
Collapse
Affiliation(s)
- Chen He
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuang-Shi Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
41
|
Topcu S, Aksu U, Kalkan K, Gülcü O, Kalayci Karabay A, Aksakal E, Tanboğa İH, Sevimli S. Aortic valve sclerosis is associated with the extent of coronaryartery disease in stable coronary artery disease. Turk J Med Sci 2017; 47:614-620. [PMID: 28425255 DOI: 10.3906/sag-1601-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 10/09/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Aortic valve sclerosis (AVS) is characterized by lipid deposition and calcific infiltration on the edge of aortic leaflets without significant restriction of motion. The SYNTAX Score (SS) is an important method for evaluating coronary artery disease (CAD). Many studies showed that there is an important relation between the SS and undesired cardiac outcomes. In our study, we investigated the correlation between the SS and AVS by including both ACS and stable CAD cases. MATERIALS AND METHODS We enrolled 543 patients with CAD who underwent coronary angiography into this cross-sectional study between September 2013 and September 2014. RESULTS The study population was divided into two groups according to SS values above and below 22. Diabetes mellitus (DM) incidence was greater in the group with high SS values (26.3% vs. 19.2%, P = 0.052.). Left ventricular ejection fraction (LVEF) and glomerular filtration rate were lower. Low-density lipoprotein cholesterol and triglyceride levels were lower while platelet counts were higher. In multivariate analysis, for the stable coronary artery group AVS existence, platelet count, LVEF value, and chronic obstructive pulmonary disease were found as independent predictors. CONCLUSION Our study results demonstrated that AVS is significantly associated with the complexity of CAD, especially in patients with stable CAD. This study provides new information regarding the role of AVS in CAD complexity.
Collapse
Affiliation(s)
- Selim Topcu
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Uğur Aksu
- Department of Cardiology, Kars State Hospital, Kars, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gülcü
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Arzu Kalayci Karabay
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Turkey
| | - Enbiya Aksakal
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | | | - Serdar Sevimli
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| |
Collapse
|
42
|
Shomanova Z, Florian A, Bietenbeck M, Waltenberger J, Sechtem U, Yilmaz A. Diagnostic value of global myocardial perfusion reserve assessment based on coronary sinus flow measurements using cardiovascular magnetic resonance in addition to myocardial stress perfusion imaging. Eur Heart J Cardiovasc Imaging 2017; 18:851-859. [DOI: 10.1093/ehjci/jew315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 12/01/2016] [Indexed: 02/01/2023] Open
|
43
|
Cherry-Picking Historical Data to Legitimize Contemporary Practice. J Am Coll Cardiol 2017; 69:404-408. [DOI: 10.1016/j.jacc.2016.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/10/2016] [Indexed: 11/19/2022]
|
44
|
Piccolo R, Pilgrim T, Heg D, Franzone A, Rat-Wirtzler J, Räber L, Silber S, Serruys PW, Jüni P, Windecker S. Comparative Effectiveness and Safety of New-Generation Versus Early-Generation Drug-Eluting Stents According to Complexity of Coronary Artery Disease: A Patient-Level Pooled Analysis of 6,081 Patients. JACC Cardiovasc Interv 2016; 8:1657-66. [PMID: 26585615 DOI: 10.1016/j.jcin.2015.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the 2-year safety and effectiveness of new- versus early-generation drug-eluting stents (DES) according to the severity of coronary artery disease (CAD) as assessed by the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score. BACKGROUND New-generation DES are considered the standard-of-care in patients with CAD undergoing percutaneous coronary intervention. However, there are few data investigating the effects of new- over early-generation DES according to the anatomic complexity of CAD. METHODS Patient-level data from 4 contemporary, all-comers trials were pooled. The primary device-oriented clinical endpoint was the composite of cardiac death, myocardial infarction, or ischemia-driven target-lesion revascularization (TLR). The principal effectiveness and safety endpoints were TLR and definite stent thrombosis (ST), respectively. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated at 2 years for overall comparisons, as well as stratified for patients with lower (SYNTAX score ≤11) and higher complexity (SYNTAX score >11). RESULTS A total of 6,081 patients were included in the study. New-generation DES (n = 4,554) compared with early-generation DES (n = 1,527) reduced the primary endpoint (HR: 0.75 [95% CI: 0.63 to 0.89]; p = 0.001) without interaction (p = 0.219) between patients with lower (HR: 0.86 [95% CI: 0.64 to 1.16]; p = 0.322) versus higher CAD complexity (HR: 0.68 [95% CI: 0.54 to 0.85]; p = 0.001). In patients with SYNTAX score >11, new-generation DES significantly reduced TLR (HR: 0.36 [95% CI: 0.26 to 0.51]; p < 0.001) and definite ST (HR: 0.28 [95% CI: 0.15 to 0.55]; p < 0.001) to a greater extent than in the low-complexity group (TLR pint = 0.059; ST pint = 0.013). New-generation DES decreased the risk of cardiac mortality in patients with SYNTAX score >11 (HR: 0.45 [95% CI: 0.27 to 0.76]; p = 0.003) but not in patients with SYNTAX score ≤11 (pint = 0.042). CONCLUSIONS New-generation DES improve clinical outcomes compared with early-generation DES, with a greater safety and effectiveness in patients with SYNTAX score >11.
Collapse
Affiliation(s)
- Raffaele Piccolo
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Anna Franzone
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Julie Rat-Wirtzler
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Sigmund Silber
- Department of Cardiology, Heart Center at the Isar, Munich, Germany
| | - Patrick W Serruys
- International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Peter Jüni
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
| |
Collapse
|
45
|
Zhang JX, Dong HZ, Chen BW, Cong HL, Xu J. Characteristics of coronary arterial lesions in patients with coronary heart disease and hypertension. SPRINGERPLUS 2016; 5:1208. [PMID: 27516946 PMCID: PMC4967058 DOI: 10.1186/s40064-016-2828-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022]
Abstract
Objective
The aim of this study was to investigate the correlations between risk factors such as hypertension and the complex degrees of coronary arterial lesions (CAL). Methods We selected 462 patients with coronary heart disease (CHD) with confirmed the stenosis (≥50 %) in at least one major coronary artery on coronary angiography and divided them into the “CHD with hypertension” group (CHD-HT, n = 306) and the CHD group (n = 156). The characteristics of CAL and the occurrence of 2-year postoperative major adverse cardiac cerebrovascular events (MACCE) in the two groups were observed. Results The mean SYNTAX scores (SS) was higher in the CHD-HT group than in the CHD group (P < 0.05). The proportions of complex, calcified, and diffused long lesions in the PCI patients’ target vascular lesions, as well as the total MACCE incidence, were significantly higher in the CHD-HT group than in the CHD group (P < 0.05). Logistic multifactor regression analysis showed that age, male sex, hypertension, diabetes, hyperlipidemia, and previous history of myocardial infarction were positively correlated with the SS (P < 0.05). Conclusions The patients with CHD-HT exhibited complicated and diffused CAL, and arterial hypertension can be considered as a risk factor for the complexity of coronary lesions in patients with ischemic heart disease.
Collapse
Affiliation(s)
- Jing-Xia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Hong-Zhi Dong
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Bing-Wei Chen
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Hong-Liang Cong
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Jing Xu
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| |
Collapse
|
46
|
Bhatt HA, Sanghani DR, Lee D, Julliard KN, Fernaine GA. Predictors of Peak Troponin Level in Acute Coronary Syndromes: Prior Aspirin Use and SYNTAX Score. Int J Angiol 2016; 25:54-63. [PMID: 26900312 DOI: 10.1055/s-0035-1547396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The peak troponin level has been associated with cardiovascular (CV) mortality and adverse CV events. The association of peak troponin with CV risk factors and severity and complexity of coronary artery disease remains unknown. We assessed the predictors of peak troponin in patients with acute coronary syndrome (ACS). This study aims to determine the predictors of peak troponin in ACS. Cardiac catheterization (CC) reports and electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 219 patients were eligible for the study. All major CV risk factors, comorbidities, laboratory data, CC indications, and coronary lesion characteristics were included. Univariate and multivariate regression analyses were done. On multivariate linear regression analysis, ST-elevation myocardial infarction (p = 0.001, β = 65.16) and increasing synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (p = 0.002, β = 1.15) were associated with higher peak troponin. The Pearson correlation between SYNTAX score and peak troponin was r = 0.257, p = 0.001. History of daily aspirin use was associated with lower peak troponin (p = 0.002, β = -24.32). Prior statin use (p = 0.321, β = -8.98) and the presence of CV risk factors were not associated with peak troponin. Coronary artery disease severity and complexity, urgency of CC, and prior aspirin use are associated with peak troponin levels in ACS. Our findings may help predict patient population with ACS who would be at a greater risk for short- and long-term CV morbidity and mortality due to elevated peak troponin.
Collapse
Affiliation(s)
- Hemal A Bhatt
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
| | - Dharmesh R Sanghani
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
| | - David Lee
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
| | - Kell N Julliard
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
| | - George A Fernaine
- Department of Cardiology, Lutheran Medical Center, Brooklyn, New York
| |
Collapse
|
47
|
Erkan AF, Tanindi A, Kocaman SA, Ugurlu M, Tore HF. Epicardial Adipose Tissue Thickness Is an Independent Predictor of Critical and Complex Coronary Artery Disease by Gensini and Syntax Scores. Tex Heart Inst J 2016; 43:29-37. [PMID: 27047282 DOI: 10.14503/thij-14-4850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Epicardial adipose tissue thickness is associated with the severity and extent of atherosclerotic coronary artery disease. We prospectively investigated whether epicardial adipose tissue thickness is related to coronary artery disease extent and complexity as denoted by Gensini and Syntax scores, and whether the thickness predicts critical disease. After performing coronary angiography in 183 patients who had angina or acute myocardial infarction, we divided them into 3 groups: normal coronary arteries, noncritical disease (≥1 coronary lesion with <70% stenosis), and critical disease (≥1 coronary lesion with <70% stenosis). We used transthoracic echocardiography to measure epicardial adipose tissue thickness, then calculated Gensini and Syntax scores by reviewing the angiograms. Mean thicknesses were 4.3 ± 0.9, 5.2 ± 1.5, and 7.5 ± 1.9 mm in patients with normal coronary arteries, noncritical disease, and critical disease, respectively (P <0.001). At progressive thicknesses (<5, 5-7, and >7 mm), mean Gensini scores were 4.1 ± 5.5, 19.8 ± 15.6, and 64.9 ± 32.4, and mean Syntax scores were 4.7 ± 5.9, 16.6 ± 8.5, and 31.7 ± 8.7, respectively (both P <0.001). Thickness had strong and positive correlations with both scores (Gensini, r =0.82, P <0.001; and Syntax, r =0.825, P <0.001). The cutoff thickness value to predict critical disease was 5.75 mm (area under the curve, 0.875; 95% confidence interval, 0.825-0.926; P <0.001). Epicardial adipose tissue thickness is independently related to coronary artery disease extent and complexity as denoted by Gensini and Syntax scores, and it predicts critical coronary artery disease.
Collapse
|
48
|
|
49
|
Holmes DR, Mack MJ. Moore's Law: Apples and Oranges. JACC Cardiovasc Interv 2015; 8:1667-9. [PMID: 26585616 DOI: 10.1016/j.jcin.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022]
Affiliation(s)
- David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Michael J Mack
- Heart Hospital Baylor Plano, Baylor University, Dallas, Texas
| |
Collapse
|
50
|
Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond. Prog Cardiovasc Dis 2015; 58:316-34. [PMID: 26529569 DOI: 10.1016/j.pcad.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.
Collapse
|