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Sattar Y, Faisaluddin M, Almas T, Alhajri N, Shah R, Zghouzi M, Zafrullah F, Sengodon PM, Zia Khan M, Ullah W, Alam M, Balla S, Lakkis N, Kawsara A, Daggubati R, Chadi Alraies M. Cardiovascular outcomes of transradial versus transfemoral percutaneous coronary intervention in End-Stage renal Disease: A Regression-Based comparison. IJC HEART & VASCULATURE 2022; 43:101110. [PMID: 36051245 PMCID: PMC9424587 DOI: 10.1016/j.ijcha.2022.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/14/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Abstract
Background Limited data is available on the comparison of outcomes of transradial (TR) and transfemoral (TF) access for percutaneous coronary intervention (PCI) in patients with end-stage stage renal disease (ESRD). Methods Online databases were queried to compare cardiovascular outcomes among TR. and TF in ESRD patients. The outcomes assessed included differences in mortality, cerebrovascular accidents (CVA), periprocedural myocardial infarction (MI), bleeding, transfusion, and periprocedural cardiogenic shock (CS). Unadjusted odds ratios (OR) were calculated using a random-effect effect model. Results A total of 6 studies including 7,607 patients (TR-PCI = 1,288; TF-PCI = 6,319) were included. The overall mean age was 67.7 years, while the mean age for TR-PCI and TF-PCI was 69.7 years and 67.9 years, respectively. TR-PCI was associated with lower incidence of mortality (OR 0.46 95 % CI 0.30–0.70, p < 0.05, I2 0.00 %), bleeding (OR 0.45 95 % CI 0.29, 0.68, p < 0.05, I2 3.48 %), and transfusion requirement (OR 0.52 95 % CI 0.40, 0.67, p < 0.05, I2 0.00 %) (Fig. 1). There were no differences among TR-PCI and TF-PCI for periprocedural MI, periprocedural CS, and CVA outcomes. Conclusion TR access was associated with lower mortality, bleeding, and transfusion requirement as compared to TF access in patients with ESRD undergoing PCI.
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Affiliation(s)
| | | | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Corresponding authors at: RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, Ireland (T. Almas) and Detroit Medical Center, Detroit, MI, USA (M. Chadi Alraies).
| | - Noora Alhajri
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | | | | | | | | | - Waqas Ullah
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | - M. Chadi Alraies
- Detroit Medical Center, Detroit, MI, USA
- Corresponding authors at: RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, Ireland (T. Almas) and Detroit Medical Center, Detroit, MI, USA (M. Chadi Alraies).
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Yoon JY, Lee JH, Kim HN, Kim N, Jang SY, Bae MH, Yang DH, Park HS, Cho Y. The novel bio-SYNTAX scoring system for predicting the prognosis of patients undergoing percutaneous coronary intervention with left main coronary artery disease. Front Cardiovasc Med 2022; 9:912286. [PMID: 36211557 PMCID: PMC9538309 DOI: 10.3389/fcvm.2022.912286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSimple and effective risk models incorporating biomarkers associated with left main coronary artery (LMCA) stenosis are limited. This study aimed to validate the novel Bio-Clinical SYNTAX score (Bio-CSS) incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with LMCA stenosis.MethodsPatients who underwent percutaneous coronary intervention (PCI) for LMCA stenosis using a drug-eluting stent (n = 275) were included in the study. We developed the Bio-CSS incorporating NT-proBNP and validated the ability of the Bio-CSS to predict major adverse cardiac events (MACEs) and compared its performance to that of the SYNTAX score (SS) and SS II. The MACEs were defined as death, non-fatal myocardial infarction (MI), and repeat revascularizations.ResultsThe Bio-CSS (34.7 ± 18.3 vs. 51.9 ± 28.4, p < 0.001), as well as SS (23.6 ± 7.3 vs. 26.7 ± 8.1, p = 0.003) and SS II (29.4 ± 9.9 vs. 36.1 ± 12.8, p < 0.001), was significantly higher in patients with MACEs. In the Cox proportional hazards model, the log Bio-CSS (hazard ratio 8.31, 95% CI 1.84–37.55) was an independent prognostic factor for MACEs after adjusting for confounding variables. In the receiver operating characteristic curves, the area under the curve of the Bio-CSS was significantly higher compared to those of SS (0.608 vs. 0.706, p = 0.001) and SS II (0.655 vs. 0.706, p = 0.026). Patients were categorized into the three groups based on the tertiles of the Bio-CSS. Patients in the highest tertile of the Bio-CSS had significantly higher MACEs compared to those in the lower two tertiles (log-rank p < 0.001).ConclusionIn patients who underwent PCI for LMCA stenosis, the novel Bio-CSS improved the discrimination accuracy of established combined scores, such as SS and SS II. The addition of NT-proBNP to the clinical and angiographic findings in the Bio-CSS could potentially provide useful long-term prognostic information in these patients.
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Affiliation(s)
- Jae Yong Yoon
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
- *Correspondence: Jang Hoon Lee
| | - Hong Nyun Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Namkyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Se Yong Jang
- School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
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Tasoudis PT, Varvoglis DN, Tzoumas A, Doulamis IP, Tzani A, Sá MP, Kampaktsis PN, Gallo M. Percutaneous coronary intervention versus coronary artery bypass graft surgery in dialysis-dependent patients: A pooled meta-analysis of reconstructed time-to-event data. J Card Surg 2022; 37:3365-3373. [PMID: 35900307 DOI: 10.1111/jocs.16805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Το perform a systematic review with meta-analysis of published data comparing outcomes between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in dialysis-dependent patients. METHODS We searched PubMed, Scopus, and Cochrane databases for studies including dialysis-dependent patients who underwent either CABG or PCI. This meta-analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We conducted one-stage and two-stage meta-analysis with Kaplan-Meier-derived individual patient data for overall survival and meta-analysis with the random-effects model for the in-hospital mortality and repeat revascularization. RESULTS Twelve studies met our eligibility criteria, including 13,651 and 28,493 patients were identified in the CABG and PCI arms, respectively. Patients who underwent CABG had overall improved survival compared with those who underwent PCI at the one-stage meta-analysis (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.09-1.16, p < .0001) and the two-stage meta-analysis (HR: 1.15, 95% CI: 1.08-1.23, p < .001, I2 = 30.0%). Landmark analysis suggested that PCI offers better survival before the 8.5 months of follow-up (HR: 0.96, 95% CI: 0.92-0.99, p = .043), while CABG offers an advantage after this timepoint (HR: 1.3, 95% CI: 1.22-1.32, p < .001). CABG was associated with increased odds for in-hospital mortality (odds ratio [OR]: 1.70, 95% CI: 1.50-1.92, p < .001, I2 = 0.0%) and decreased odds for repeat revascularization (OR: 0.22, 95% CI: 0.14-0.34, p < .001, I2 = 58.08%). CONCLUSIONS In dialysis-dependent patients, CABG was associated with long-term survival but a higher risk for early mortality. The risk for repeat revascularization was higher with PCI.
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Affiliation(s)
- Panagiotis T Tasoudis
- Department of Cardiothoracic Surgery, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Dimitrios N Varvoglis
- Department of Cardiothoracic Surgery, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Andreas Tzoumas
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aspasia Tzani
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michel P Sá
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Polydoros N Kampaktsis
- Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, New York, USA
| | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
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Fu Y, Sun H, Guo Z, Xu L, Yang X, Wang L, Li K, Chen M, Gao Y. A risk score model to predict in-hospital mortality of patients with end-stage renal disease and acute myocardial infarction. Intern Emerg Med 2021; 16:905-912. [PMID: 33078224 DOI: 10.1007/s11739-020-02529-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/03/2020] [Indexed: 12/28/2022]
Abstract
Chronic kidney disease (CKD) significantly increases the rate of adverse cardiovascular events in patients with coronary artery disease. In this study, we aimed to establish a risk score (RS) model to predict in-hospital mortality risk in patients with end-stage renal disease (ESRD) and acute myocardial infarction (AMI). A total of 113 consecutive patients with ESRD and AMI were retrospectively enrolled between January 1, 2015 and December 31, 2019. All patients received regular hemodialysis and were divided into two groups according to the prognosis during hospitalization. Univariable and multivariable logistic regression analyses were used to identify the risk factors of in-hospital mortality. A RS model was developed based on multiple regression analysis and was internally validated using 1000 bootstrap analysis. The receiver operating characteristic (ROC) curve was performed, and the area under curve (AUC) was analyzed to evaluate the performance of the RS model. AUCs were compared using the Z test. Thirty-three patients died during hospitalization, resulting in in-hospital mortality rate of 29.2%. After multivariate logistic regression, an RS model (0-8) was established based on five independent factors that were assigned with different points according to relative coefficients (coefficient of the index risk factor divided by the lowest coefficient among these five risk factors; rounded to closest integer): 1 for C-reactive protein (CRP) ≥ 14.2 mg/L and left ventricular ejection fraction (LVEF) ≤ V3%; 2 for age ≥ 65 years old, heart rate (HR) at admission ≥ 86 beats per minute (bpm) and D-dimer ≥ 2.4 mg/L FEU. The present RS model had a sensitivity of 85.7%, the specificity of 84%, and an accuracy of 78.1%. In ROC curve analysis, the model demonstrated a good discriminate power in predicting in-hospital mortality (AUC = 0.895, 95% CI 0.814-0.96; P < 0.001), which was significantly better than the predictive power of the Global Registry of Acute Coronary Events risk score (GRACE RS) (AUC = 0.754, 95% CI 0.641-0.868; P < 0.001 after Z test). A novel RS model, which was established to help predict in-hospital mortality of patients with ESRD and AMI, was easy to use and had higher accuracy than the GRACE RS.
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Affiliation(s)
- Yuan Fu
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Sun
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zongsheng Guo
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Xu
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lefeng Wang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kuibao Li
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulei Chen
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Yuanfeng Gao
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
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Antukh DE, Shchekochikhin DY, Nesterov AP, Gilarov MY. Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. TERAPEVT ARKH 2019; 91:137-144. [DOI: 10.26442/00403660.2019.06.000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/22/2022]
Abstract
This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.
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Sattar S, Ahmed N, Akhter Z, Aijaz S, Lakhani S, Malik R, Pathan A. In-Hospital outcomes in acute coronary syndrome patients with concomitant severe chronic kidney disease undergoing percutaneous coronary intervention. Pak J Med Sci 2019; 35:291-297. [PMID: 31086503 PMCID: PMC6500806 DOI: 10.12669/pjms.35.2.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine in-hospital mortality and major adverse cardiac events (MACE) in acute coronary syndrome (AMI) patients with underlying severe chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Methods We conducted a retrospective cohort study from June'2013-December'2017 at Tabba Heart Institute, Karachi. Data was drawn from institutes' database modeled after US National Cardiovascular data CathPCI registry. All AMI (STEMI: ST-elevation myocardial infarction and NSTEMI: non-ST-elevation myocardial infarction) patients undergoing PCI with creatinine clearance <30ml/min or ESRD on hemodialysis were included in the study. Results During 54 months study period, 160 severe CKD patients underwent PCI. Mean age was 62.9±12.2 years. Men were 61.9%, hypertensive (81.3%) and diabetic (63.8%). Excluding dialysis patients, Creatinine clearance was 21.1±6.6ml/min/1.73m2. STEMI were 46.9% and 61.9% were Killip I. Mean SYNTAX score was 16.6±7.3. MACE occurred in 32.5% patients, of which 6(11.5%) had new hemodialysis and mortality: 17.5% were deceased. MACE predictor were cardiogenic shock (OR: 2.81, 95%CI: 1.17-6.74) and prior heart failure (OR: 6.84, 95%CI: 1.39-33.74), Predictor of mortality was cardiogenic shock or cardiac arrest (OR: 7.90, 95%CI: 2.95-21.17). Conclusion Severe CKD patients undergoing PCI for AMI have drastically poor outcomes therefore individualization and patient-centric care management is mandatory.
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Affiliation(s)
- Saadia Sattar
- Saadia Sattar, M.Sc Epi-Bio. Research Consultant, Department of Clinical Research, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Naseer Ahmed
- Naseer Ahmed, MBBS Cardiology Fellow, Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Zohaib Akhter
- Zohaib Akhter, M.Sc Epi-Bio. Research Consultant, Department of Clinical Research, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Saba Aijaz
- Saba Aijaz, FCPS. Consultant Cardiologist, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Shakir Lakhani
- Shakir Lakhani, FCPS. Consultant Cardiologist, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Rehan Malik
- Rehan Malik, Research Officer, Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Asad Pathan
- Asad Pathan, FACC. Consultant Cardiologist, Cardiology, Tabba Heart Institute, Karachi, Pakistan
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Hammoudeh AJ, Al-Bayyari N, Obeidat O, Al-Mousa EN, Tabbalat RA, Alhaddad IA. Incidence and impact on prognosis of impaired kidney function in Middle Eastern patients undergoing percutaneous coronary intervention: results from the first Jordanian PCI Registry. ASIAINTERVENTION 2019; 5:18-26. [PMID: 36483935 PMCID: PMC9706756 DOI: 10.4244/aij-d-17-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/06/2018] [Indexed: 06/17/2023]
Abstract
AIMS The aim of this study was to evaluate the impact on prognosis of renal impairment (RI) in Middle Eastern patients after percutaneous coronary intervention (PCI). METHODS AND RESULTS PCI patients (N=2,426) were divided into three groups according to the estimated glomerular filtration rate (eGFR, ml/min/1.73 m2): normal renal function (eGFR ≥90), mild RI (eGFR 60-89), or moderate to severe RI (eGFR <60). Mean age of participants was 56±11 years. Normal renal function was present in 41.6%, mild RI in 44.2%, and moderate to severe RI in 14.2%. Patients with moderate to severe RI were older and had higher prevalence of hypertension and diabetes mellitus compared with other patients (p≤0.002). At one year, patients with moderate to severe RI had a higher incidence of cardiac mortality (3.78%) compared with patients with mild (1.77%) or no RI (1.49%), p=0.03. In multivariate analysis, moderate to severe RI was associated with higher one-year cardiac mortality compared to mild or no RI (odds ratio=3.7; 95% CI: 2.8-5.0, p=0.001). CONCLUSIONS Impaired renal function was present in about six out of 10 Middle Eastern patients undergoing PCI. Moderate to severe RI carries a higher risk of cardiac mortality at one year compared with mild or no RI.
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Affiliation(s)
| | - Nahla Al-Bayyari
- Department of Nutrition and Food Technology, Faculty of Al-Huson University College, Al-Balqa Applied University, Al-Salt, Jordan
| | - Omar Obeidat
- Division of Cardiology, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan
| | | | | | - Imad A Alhaddad
- Division of Cardiology, Department of Internal Medicine, Jordan Hospital Medical Center, Amman, Jordan
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