1
|
Sellke FW. Bleeding After Cardiovascular Surgery: A Continuing Problem. Circulation 2024; 150:1324-1326. [PMID: 39432577 PMCID: PMC11495651 DOI: 10.1161/circulationaha.124.071147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2024]
Affiliation(s)
- Frank W Sellke
- Alpert Medical School of Brown University and Rhode Island Hospital, Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence
| |
Collapse
|
2
|
Liuzzo G, Patrono C. Weekly Journal Scan: Do older patients with non-ST-segment elevation myocardial infarction receive any benefit from a routine invasive strategy? Eur Heart J 2024:ehae684. [PMID: 39422263 DOI: 10.1093/eurheartj/ehae684] [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: 10/19/2024] Open
Affiliation(s)
- Giovanna Liuzzo
- Department of Cardiovascular Sciences-CUORE, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F. Vito 1, 00168 Rome, Italy
| | - Carlo Patrono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F. Vito 1, 00168 Rome, Italy
- Center of Excellence on Ageing, CAST, 'G. d'Annunzio' University School of Medicine, Chieti, Italy
| |
Collapse
|
3
|
de Winter RW, Somsen YBO, Hoek R, van Diemen PA, Jukema RA, Jonker MP, van Rossum AC, Twisk JWR, Kooistra RA, Janssen J, Porouchani S, Wilgenhof A, Verouden NJ, Danad I, Reiber JHC, Nap A, Knaapen P. Correlation and Agreement of Quantitative Flow Ratio With Fractional Flow Reserve in Saphenous Vein Grafts. J Am Heart Assoc 2024:e034901. [PMID: 39424401 DOI: 10.1161/jaha.124.034901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/26/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND The applicability of quantitative flow ratio (QFR), a nonhyperemic, invasive coronary angiography-derived computation of fractional flow reserve (FFR), has not been studied in coronary artery bypass grafts. We sought to explore the correlation and diagnostic agreement between QFR and FFR in saphenous vein grafts (SVGs). METHODS AND RESULTS A total of 129 prospectively included patients (mean age 73±8 years, 84% male) with prior coronary artery bypass grafting underwent invasive coronary angiography and pressure-derived functional assessment in 150 nonoccluded SVGs. QFR dedicated angiography images of the SVGs were acquired and used for offline QFR computation. The diagnostic performance of QFR was compared with 2-dimensional quantitative coronary angiography, using FFR as a reference. A threshold of ≤0.80 was used to define functional significance. QFR was successfully computed in 140 (93%) SVGs. We found a significant correlation between QFR and FFR (r=0.72, P<0.001). FFR indicated significant disease in 43 (31%) SVGs, whereas QFR analysis showed significant lesions in 53 (38%) bypass grafts. QFR exhibited a higher sensitivity and diagnostic accuracy compared with angiographic lesion assessment (84% versus 63%, P=0.030 and 83% versus 74%, P=0.036, respectively), whereas specificity did not differ (82% versus 79%, P=0.466). Lastly, QFR demonstrated a higher area under the receiver operating curve than quantitative coronary angiography (0.90 versus 0.82, P=0.008) for the detection of FFR-defined significant vein graft disease. CONCLUSIONS This study shows the potential applicability of contemporary QFR computation in venous bypass grafts with a moderate correlation and good diagnostic accuracy compared with functional assessment using FFR.
Collapse
Affiliation(s)
- Ruben W de Winter
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Roel Hoek
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Mathé P Jonker
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Albert C van Rossum
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology & Data Science Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | | | | | - Sina Porouchani
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Adriaan Wilgenhof
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Niels J Verouden
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Ibrahim Danad
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | | | - Alexander Nap
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Paul Knaapen
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| |
Collapse
|
4
|
Lu T, Zhu C, Cui H, Wu Z, Lu Z, Meng Y, Yang Q, Meng L, Song Y, Wang S. Clinical Outcomes of Concomitant Coronary Artery Bypass Grafting During Ventricular Septal Myectomy. J Am Heart Assoc 2024; 13:e036565. [PMID: 39377214 DOI: 10.1161/jaha.124.036565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND The clinical characteristics and survival outcomes of patients who underwent concomitant coronary artery bypass grafting during septal myectomy have not been well studied. METHODS AND RESULTS We reviewed patients who underwent both septal myectomy and coronary artery bypass grafting from 2009 to 2020. Causes of concomitant grafting and their impact on survival were analyzed. The median follow-up period was 5.1 years. A total of 320 patients underwent both grafting and myectomy. Of these, 69.7% and 28.1% underwent grafting attributed to atherosclerotic coronary artery disease and myocardial bridging, respectively. Patients who underwent grafting for coronary artery disease tended to be older, had a longer bypass time, and required more grafts compared with patients undergoing procedures because of myocardial bridging (all P<0.05). Postoperatively, the left ventricular outflow gradient significantly decreased from 85.4 mm Hg to 12.8 mm Hg (P<0.001) without perioperative death. The cumulative survival rates were 96.2% and 97.6% at 5 years in the coronary artery disease and myocardial bridging groups, respectively, and they were comparable to that of general myectomy cohort (hazard ratio [HR], 1.06 [95% CI, 0.47-2.36], P=0.895 and HR 0.75 [95% CI, 0.23-2.46], P=0.636, respectively). Sudden death accounted for 45.5% (5 of 11) of postoperative mortality. Analysis of composite end point events showed decreased morbidity with at least one arterial graft in the overall cohort (HR, 0.47 [95% CI, 0.23-0.94], P=0.034). CONCLUSIONS Concomitant grafting in septal myectomy was found to be a safe procedure. Patients who underwent such surgery experienced favorable postoperative outcomes comparable to those who underwent septal myectomy alone, with a 5-year survival rate of >95% and improved functional class of >90%.
Collapse
Affiliation(s)
- Tao Lu
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Changsheng Zhu
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hao Cui
- Department of Cardiovascular Surgery Center Beijing Anzhen Hospital, Capital Medical University Beijing China
| | - Zining Wu
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zhengyang Lu
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yanhai Meng
- Department of Intensive Care Unit Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qiulan Yang
- Department of Intensive Care Unit Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Liukun Meng
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yunhu Song
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shuiyun Wang
- Department of Adult Cardiac Surgery Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Department of Cardiovascular Surgery Fuwai Hospital, Chinese Academy of Medical Sciences Shenzhen China
| |
Collapse
|
5
|
Luo Q, Li Z, Liu B, Ding J. Hydrogel formulations for orthotopic treatment of myocardial infarction. Expert Opin Drug Deliv 2024; 21:1463-1478. [PMID: 39323051 DOI: 10.1080/17425247.2024.2409906] [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: 07/25/2024] [Revised: 08/25/2024] [Accepted: 09/24/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Myocardial infarction (MI) causes extensive structural and functional damage to the cardiac tissue due to the significant loss of cardiomyocytes. Early reperfusion is the standard treatment strategy for acute MI, but it is associated with adverse effects. Additionally, current therapies to alleviate pathological changes post-MI are not effective. Subsequent pathological remodeling of the damaged myocardium often results in heart failure. Oral drugs aimed at reducing myocardial damage and remodeling require repeated administration of high doses to maintain therapeutic levels. This compromises efficacy and patient adherence and may cause adverse effects, such as hypotension and liver and/or kidney dysfunction. Hydrogels have emerged as an effective delivery platform for orthotopic treatment of MI due to their high water content and excellent tissue compatibility. AREA COVERED Hydrogels create an optimal microenvironment for delivering drugs, proteins, and cells, preserving their efficacy and increasing their bioavailability. Current research focuses on discovering functional hydrogels for mitigating myocardial damage and regulating repair processes in MI treatment. EXPERT OPINION Hydrogels offer a promising approach in enhancing cardiac repair and improving patient outcomes post-MI. Advancements in hydrogel technology are poised to transform MI therapy, paving the way for personalized treatment strategies and enhanced recovery.
Collapse
Affiliation(s)
- Qiang Luo
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, P. R. China
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Zhibo Li
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, P. R. China
| |
Collapse
|
6
|
Ikemura N, Spertus JA, Nguyen D, Fu Z, Jones PG, Reynolds HR, Bangalore S, Bhargava B, Senior R, Elghamaz A, Goodman SG, Lopes RD, Pracoń R, López-Sendón J, Maggioni AP, Kohsaka S, Roth GA, White HD, Mavromatis K, Boden WE, Rodriguez F, Hochman JS, Maron DJ. International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial. Circ Cardiovasc Qual Outcomes 2024; 17:e010534. [PMID: 39301726 PMCID: PMC11479829 DOI: 10.1161/circoutcomes.123.010534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/25/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results. METHODS We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions. RESULTS Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points. CONCLUSIONS In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
Collapse
Affiliation(s)
- Nobuhiro Ikemura
- University of Missouri – Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, MO
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - John A Spertus
- University of Missouri – Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Dan Nguyen
- University of Missouri – Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Zhuxuan Fu
- University of Missouri – Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Philip G Jones
- University of Missouri – Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine
| | - Sripal Bangalore
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine
| | | | - Roxy Senior
- Northwick Park Hospital, London, United Kingdom
| | | | | | | | | | - José López-Sendón
- IdiPaz Research Institute and Hospital Universitario La Paz, Madrid, Spain
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Gregory A. Roth
- Division of Cardiology, the University of Washington, Seattle, WA
| | - Harvey D. White
- Health New Zealand Te Whatu Ora, Te Toka Tumai, Green Lane Cardiovascular Service and University of Auckland, New Zealand
| | | | - William E. Boden
- Veterans Affairs New England Healthcare System, Boston University School of Medicine, MA
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Judith S Hochman
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine
| | - David J. Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
7
|
Ruel M, Chikwe J. Coronary Artery Bypass Grafting: Past and Future. Circulation 2024; 150:1067-1069. [PMID: 39348453 DOI: 10.1161/circulationaha.124.068312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada (M.R.)
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA (J.C.)
| |
Collapse
|
8
|
Wilson T, James MT, Southern D, Har B, Graham MM, Brass N, Bainey K, Fedak PWM, Sajobi TT, Wilton SB. Hospital and Physician Variability in Revascularization Decisions and Outcomes for Patients With 3-Vessel and Left Main Coronary Artery Disease: A Population-Based Cohort Study. J Am Heart Assoc 2024; 13:e035356. [PMID: 39248266 DOI: 10.1161/jaha.123.035356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/22/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Hospital- and physician-level variation for selection of percutaneous coronary intervention versus coronary artery bypass grafting (CABG) for patients with coronary artery disease has been associated with outcome differences. However, most studies excluded patients treated medically. METHODS AND RESULTS From 2010 to 2019, adults with 3-vessel or left main coronary artery disease at 3 hospitals (A, B, C) in Alberta, Canada, were categorized by treatment with medical therapy, percutaneous coronary intervention, or CABG. Multilevel regression models determined the proportion of variation in treatment attributable to patient, physician, and hospital factors, and survival models assessed outcomes including death and major adverse cardiovascular events over 5 years. Of 22 580 patients (mean age, 67 years; 80% men): 6677 (29%) received medical management, 9171 (41%) percutaneous coronary intervention, and 6732 (30%) CABG. Hospital factors accounted for 10.8% of treatment variation. In adjusted models (site A as reference), patients at sites B and C had 49% (95% CI, 44%-53%) and 43% (95% CI, 37%-49%) lower rates of medical therapy, respectively, and 31% (95% CI, 24%-38%) and 32% (95% CI, 24%-40%) lower rates of CABG. During 5.0 years median follow-up, 3287 (14.6%) patients died, with no intersite mortality differences. There were no between-site differences in acute coronary syndromes or stroke; patients at sites B and C had 24% lower risk (95% CI, 13%-34% and 11%-35%, respectively) of heart failure hospitalization. CONCLUSIONS Hospital-level variation in selection of percutaneous coronary intervention, CABG, or medical therapy for patients with complex coronary artery disease was not associated with differences in 5-year mortality rates. Research and quality improvement initiatives comparing revascularization practices should include medically managed patients.
Collapse
Affiliation(s)
- Todd Wilson
- Department of Medicine University of Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Danielle Southern
- Centre for Health Informatics, Cumming School of Medicine University of Calgary Alberta Canada
| | - Bryan Har
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada
| | - Neil Brass
- CKHui Heart Centre University of Alberta Alberta Canada
| | - Kevin Bainey
- Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada
| | - Paul W M Fedak
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| |
Collapse
|
9
|
Lee J, Kang DY, Kim H, Choi Y, Jo S, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Routine Stress Testing After PCI in Patients With and Without Acute Coronary Syndrome: A Secondary Analysis of the POST-PCI Randomized Clinical Trial. JAMA Cardiol 2024; 9:770-780. [PMID: 38922632 PMCID: PMC11209198 DOI: 10.1001/jamacardio.2024.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/24/2024] [Indexed: 06/27/2024]
Abstract
Importance The appropriate follow-up surveillance strategy for patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) remains unknown. Objective To assess clinical outcomes in patients with and without ACS who have undergone high-risk PCI according to a follow-up strategy of routine stress testing at 12 months after PCI vs standard care alone. Design, Setting, and Participants The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial was a randomized clinical trial that compared follow-up strategies of routine functional testing vs standard care alone 12 months after high-risk PCI. Patients were categorized as presenting with or without ACS. Patients were enrolled in the trial from November 2017 through September 2019, and patients were randomized from 11 sites in South Korea; data analysis was performed in 2022. Intervention Patients categorized as presenting with or without ACS were randomized to either a routine functional testing or standard care alone follow-up strategy 12 months after high-risk PCI. Main Outcomes and Measures The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years following randomization. Kaplan-Meier event rates through 2 years and Cox model hazard ratios (HRs) were generated, and interactions were tested. Results Of 1706 included patients, 350 patients (20.5%) were female, and the mean (SD) patient age was 64.7 (10.3) years. In total, 526 patients (30.8%) presented with ACS. Compared with those without ACS, patients with ACS had a 55% greater risk of the primary outcome (HR, 1.55; 95% CI, 1.03-2.33; P = .03) due to higher event rates in the first year. The 2-year incidences of the primary outcome were similar between strategies of routine functional testing or standard care alone in patients with ACS (functional testing: 16 of 251 [6.6%]; standard care: 23 of 275 [8.5%]; HR, 0.76; 95% CI, 0.40-1.44; P = .39) and in patients without ACS (functional testing: 30 of 598 [5.1%]; standard care: 28 of 582 [4.9%]; HR, 1.04; 95% CI, 0.62-1.74; P = .88) (P for interaction for ACS = .45). Although a landmark analysis suggested that the rates of invasive angiography and repeat revascularization were higher after 1 year in the routine functional testing group, the formal interactions between ACS status and either invasive angiography or repeat revascularization were not significant. Conclusion and Relevance Despite being at higher risk for adverse clinical events in the first year after PCI than patients without ACS, patients with ACS who had undergone high-risk PCI did not derive incremental benefit from routine surveillance stress testing at 12 months compared with standard care alone during follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT03217877.
Collapse
Affiliation(s)
- Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Cardiology, KyungHee Medical Center, KyungHee University, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sangyong Jo
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St Mary’s Hospital, Seoul, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Su Nam Lee
- Division of Cardiology, St Vincent’s Hospital, Suwon, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
10
|
Saraste A, Knuuti J. Value of Ischemia in Prognosis and Guiding Revascularization Among Patients With Chronic Coronary Artery Disease. Circ Cardiovasc Imaging 2024; 17:e017378. [PMID: 39247986 DOI: 10.1161/circimaging.124.017378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Affiliation(s)
- Antti Saraste
- Heart Center (A.S.), Turku University Hospital and University of Turku, Finland
- PET Centre (A.S., J.K.), Turku University Hospital and University of Turku, Finland
| | - Juhani Knuuti
- PET Centre (A.S., J.K.), Turku University Hospital and University of Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Finland (J.K.)
| |
Collapse
|
11
|
Krishna Mohan GV, Babar NN, Sompalli S, Mian MU, Israr F, Chaudhari SS, Wei CR, Allahwala D. Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e69167. [PMID: 39398848 PMCID: PMC11468466 DOI: 10.7759/cureus.69167] [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] [Accepted: 09/11/2024] [Indexed: 10/15/2024] Open
Abstract
This meta-analysis evaluated the clinical outcomes of intravascular ultrasound (IVUS)-guided versus angiography-guided percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). A comprehensive literature search was conducted across major electronic databases, identifying relevant studies published up to August 15, 2024. Thirteen randomized controlled trials (RCTs) met the inclusion criteria, comparing IVUS-guided and angiography-guided PCI. The primary outcomes were major adverse cardiac events (MACE) and stent thrombosis, while secondary outcomes included all-cause mortality, cardiac mortality, myocardial infarction, and revascularization rates. Pooled analysis revealed that IVUS-guided PCI significantly reduced the risk of MACE (risk ratio (RR): 0.63, 95% CI: 0.50-0.79) and stent thrombosis (RR: 0.52, 95% CI: 0.30-0.90) compared to angiography-guided PCI. Secondary outcomes also favored IVUS guidance, with significant reductions in cardiac mortality, myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR). While a trend towards reduced all-cause mortality was observed with IVUS guidance, it did not reach statistical significance. Notably, low heterogeneity across studies strengthened the reliability of these findings. Meta-regression analysis indicated that the presence of myocardial infarction did not significantly moderate the effect of IVUS on clinical outcomes, suggesting consistent benefits across patient subgroups. These results highlight the potential of IVUS-guided PCI to improve cardiovascular outcomes and reduce the need for repeat procedures. The findings support the growing body of evidence favoring IVUS use in PCI, particularly in complex lesions and high-risk patients. However, considerations such as cost-effectiveness and the need for specialized training remain important factors in the widespread adoption of IVUS-guided PCI in clinical practice.
Collapse
Affiliation(s)
| | - Nawabzada Nadir Babar
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | | | - Farhan Israr
- Medicine, Khyber Medical College, Peshawar, PAK
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Sandipkumar S Chaudhari
- Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, USA
- Family Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
| | | |
Collapse
|
12
|
Rajkumar CA, Al-Lamee RK. Do Current Clinical Guidelines Set Percutaneous Coronary Intervention Up to Fail? Insights From the ORBITA-2 Trial. Circ Cardiovasc Qual Outcomes 2024; 17:e011201. [PMID: 39288216 DOI: 10.1161/circoutcomes.124.011201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Affiliation(s)
- Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., R.K.A.-L.)
- Imperial College Healthcare National Health Service Trust, London, United Kingdom (C.A.R., R.K.A.-L.)
| | - Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., R.K.A.-L.)
- Imperial College Healthcare National Health Service Trust, London, United Kingdom (C.A.R., R.K.A.-L.)
| |
Collapse
|
13
|
Murai K, Kataoka Y, Kiyoshige E, Iwai T, Sawada K, Matama H, Miura H, Honda S, Fujino M, Yoneda S, Nakao K, Takagi K, Otsuka F, Asaumi Y, Nishimura K, Noguchi T. Change in Pd/Pa: Clinical Implications for Predicting Future Cardiac Events at Deferred Coronary Lesions. Circ Cardiovasc Interv 2024; 17:e013830. [PMID: 39053911 PMCID: PMC11404766 DOI: 10.1161/circinterventions.124.013830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions. METHODS Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively. RESULTS The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion-related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; P=0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; P=0.048), and smaller FFR (0.84 [0.82-0.87] versus 0.86 [0.83-0.90]; P=0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05-1.28]; P=0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01-1.16]; P=0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30-6.69; P=0.01) and major adverse cardiac event (95% CI, 1.08-3.17; P=0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01-12.80]; P=0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06-5.62]; P=0.62). CONCLUSIONS Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81.
Collapse
Affiliation(s)
- Kota Murai
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Eri Kiyoshige
- Department of Preventive Medicine and Epidemiology (E.K., K. Nishimura), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology (E.K., K. Nishimura), National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|
14
|
Sack F, Irwin A, van der Zalm R, Ho L, Celermajer DJ, Celermajer DS. Healthcare-related carbon footprinting-lower impact of a coronary stenting compared to a coronary surgery pathway. Front Public Health 2024; 12:1386826. [PMID: 39234076 PMCID: PMC11371610 DOI: 10.3389/fpubh.2024.1386826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
Healthcare is a major generator of greenhouse gases, so consideration of this contribution to climate change needs to be quantified in ways that can inform models of care. Given the availability of activity-based financial data, environmentally-extended input-output (EEIO) analysis can be employed to calculate systemic carbon footprints for healthcare activities, allowing comparison of different patient care pathways. We thus quantified and compared the carbon footprint of two common care pathways for patients with stable coronary artery disease, with similar clinical outcomes: coronary stenting and coronary artery bypass surgery (CABG). Healthcare cost data for these two pathways were disaggregated and the carbon footprint associated with this expenditure was calculated by connecting the flow of money within the economy to the greenhouse gases emitted to support the full range of associated activities. The systemic carbon footprint associated with an average stable patient CABG pathway, at a large tertiary referral hospital in Sydney, Australia in 2021-22, was 11.5 tonnes CO2-e, 4.9 times greater than the 2.4 tonnes CO2-e footprint of an average comparable stenting pathway. These data suggest that a stenting pathway for stable coronary disease should be preferred on environmental grounds and introduces EEIO analysis as a practical tool to assist in health-care related carbon footprinting.
Collapse
Affiliation(s)
- Fabian Sack
- Integrated Sustainability Analysis, School of Physics, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Irwin
- Integrated Sustainability Analysis, School of Physics, The University of Sydney, Camperdown, NSW, Australia
| | - Raymond van der Zalm
- Sydney Environment Institute, The University of Sydney Quadrangle, Camperdown, NSW, Australia
| | - Lorraine Ho
- Performance Monitoring, Systems Improvement and Innovation Unit, Sydney Local Health District, Royal Prince Alfred Hospital, Stanmore, NSW, Australia
| | - Danielle J. Celermajer
- Sydney Environment Institute, The University of Sydney Quadrangle, Camperdown, NSW, Australia
| | - David S. Celermajer
- Faculty of Medicine and Health, Central Clinical School, Heart Research Institute, The University of Sydney, Newtown, NSW, Australia
| |
Collapse
|
15
|
German CA, Davis AM, Polonsky TS. Management of Patients With Chronic Coronary Disease. JAMA 2024; 332:585-586. [PMID: 39046710 DOI: 10.1001/jama.2024.9813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
This JAMA Clinical Guidelines Synopsis summarizes the 2023 American Heart Association (AHA)/American College of Cardiology (ACC) guideline on management of patients with chronic coronary disease.
Collapse
Affiliation(s)
- Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrew M Davis
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Tamar S Polonsky
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
16
|
McNamara DA, Akram MF, Burgess AL, Stickland D, VanOosterhout SM, Parker JL, Madder RD, Wohns D, Willekes CL, McNamara RF. Treatment Adherence Rates and Long-Term Mortality in a Quaternary Multidisciplinary Heart Team: An Observational Cohort. J Am Heart Assoc 2024; 13:e035097. [PMID: 39119965 DOI: 10.1161/jaha.124.035097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND A multidisciplinary heart team (HT) approach to patients with complex coronary artery disease has a class IB recommendation, yet there are limited data on adherence to HT treatment recommendations and long-term clinical follow-up. The objective of this study was to assess adherence rates to HT recommendations and assess long-term mortality rates among patients with complex CAD. METHODS AND RESULTS Six hundred eighty-four sequential HT cases for complex coronary artery disease from January 2015 to May 2017 were reviewed. After excluding cases with significant comorbid valve disease, baseline characteristics were compared based on HT treatment recommendations: optimal medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting. Adherence rates were manually extracted, and 5-year mortality rates were obtained from the Michigan Death Registry. Seventy-two percent of 405 included patients were men (mean age 66±11 years), with high rates of medical comorbidities. Estimated surgical risk scores were lowest in the coronary artery bypass grafting group. Optimal medical therapy was recommended in 138 patients (34%), percutaneous coronary intervention in 95 (23%), and coronary artery bypass grafting in 172 (42%). Adherence to HT recommendations across groups was high (96%) and did not differ between treatment groups. Over 5 years of follow-up, there were 119 deaths, resulting in a cumulative mortality rate of 29%. CONCLUSIONS In the largest HT cohort in the United States to date, high rates of adherence to HT recommendations were observed among high-risk patients with coronary artery disease. High rates of adherence to HT recommendations were observed irrespective of treatment group recommendation, suggesting that HT recommendations were individualized and acceptable to both patients and physicians alike.
Collapse
Affiliation(s)
- David A McNamara
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - Mahrukh F Akram
- Division of Internal Medicine Corewell Health/Michigan State University College of Human Medicine Grand Rapids MI USA
| | - Andrea L Burgess
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - DeeAnn Stickland
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - Stacie M VanOosterhout
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - Jessica L Parker
- Office of Research and Education Corewell Health Grand Rapids MI USA
| | - Ryan D Madder
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - David Wohns
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - Charles L Willekes
- Division of Cardiothoracic Surgery, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| | - Richard F McNamara
- Division of Cardiology, Frederick Meijer Heart and Vascular Institute Corewell Health Grand Rapids MI USA
| |
Collapse
|
17
|
Lugo-Gavidia LM, Alcocer-Gamba MA, Martinez-Cervantes A. Challenges and Advances in Interventional Cardiology for Coronary Artery Disease Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1323. [PMID: 39202606 PMCID: PMC11356482 DOI: 10.3390/medicina60081323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024]
Abstract
The development of percutaneous coronary intervention (PCI) has been one of the greatest advances in cardiology and has changed clinical practice for patients with coronary artery disease (CAD). Despite continuous improvements in operators' experience, techniques, and the development of new-generation devices, significant challenges remain in improving the efficacy of PCI, including calcification, bifurcation, multivascular disease, stent restenosis, and stent thrombosis, among others. The present review aims to provide an overview of the current status of knowledge of endovascular revascularization in CAD, including relevant trials, therapeutic strategies, and new technologies addressing particular scenarios that can impact the prognosis of this vulnerable population.
Collapse
Affiliation(s)
- Leslie Marisol Lugo-Gavidia
- Mexican Academic Consortium for Clinical Data Acquisition SC, Sinaloa 80230, Mexico
- Dobney Hypertension Centre, Medical School, University of Western Australia, Perth 6000, Australia
| | - Marco Antonio Alcocer-Gamba
- Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro 76180, Mexico
- Instituto de Corazón de Querétaro, Santiago de Querétaro 76180, Mexico
- Centro de Estudios Clínicos de Querétaro, Santiago de Querétaro 76180, Mexico
| | - Araceli Martinez-Cervantes
- Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro 76180, Mexico
- Centro de Estudios Clínicos de Querétaro, Santiago de Querétaro 76180, Mexico
| |
Collapse
|
18
|
Szymanski TW, Rockhold MR, Lacoste JL. Temporal Effect of CYP3A4/5 Induction on Ticagrelor's Pharmacodynamic Effects: A Case Series. J Pharm Pract 2024:8971900241273095. [PMID: 39147699 DOI: 10.1177/08971900241273095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Ticagrelor is contraindicated in combination with cytochrome P450 3A4 and 3A5 enzyme (CYP3A4/5) inducers due to increased clearance, causing diminished antiplatelet effects. The emergent nature of acute coronary syndromes (ACS) may preclude scrutinization of home medications before P2Y12 inhibitor administration. The purpose of this case series is to establish the temporal impact of CYP3A4/5 enzyme induction on ticagrelor's pharmacodynamic effect by utilizing VerifyNow platelet aggregation studies. This was a retrospective case series of three patients who were taking a CYP3A4/5-inducing medication and loaded with ticagrelor for ACS. The duration of ticagrelor's antiplatelet effect was dramatically shortened in the presence of background CYP3A4/5 induction. The offset of antiplatelet effect, defined by platelet reactivity units (PRU), was 10-24 hours in the presence of CYP3A4/5 enzyme induction compared to the anticipated 36-48 hours. This was consistent across CYP3A4/5-inducing medications including carbamazepine, phenobarbital, and phenytoin. This study demonstrates rapid return of platelet function after a ticagrelor loading dose in the presence of CYP3A4/5-inducing medications. Monitoring of PRU every 6-12 hours with subsequent loading with clopidogrel or prasugrel should be considered. Larger scale studies are warranted to confirm these results.
Collapse
|
19
|
Pereira NL, Cresci S, Angiolillo DJ, Batchelor W, Capers Q, Cavallari LH, Leifer D, Luzum JA, Roden DM, Stellos K, Turrise SL, Tuteja S. CYP2C19 Genetic Testing for Oral P2Y12 Inhibitor Therapy: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e129-e150. [PMID: 38899464 PMCID: PMC11300169 DOI: 10.1161/cir.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
There is significant variability in the efficacy and safety of oral P2Y12 inhibitors, which are used to prevent ischemic outcomes in common diseases such as coronary and peripheral arterial disease and stroke. Clopidogrel, a prodrug, is the most used oral P2Y12 inhibitor and is activated primarily after being metabolized by a highly polymorphic hepatic cytochrome CYP2C219 enzyme. Loss-of-function genetic variants in CYP2C219 are common, can result in decreased active metabolite levels and increased on-treatment platelet aggregation, and are associated with increased ischemic events on clopidogrel therapy. Such patients can be identified by CYP2C19 genetic testing and can be treated with alternative therapy. Conversely, universal use of potent oral P2Y12 inhibitors such as ticagrelor or prasugrel, which are not dependent on CYP2C19 for activation, has been recommended but can result in increased bleeding. Recent clinical trials and meta-analyses have demonstrated that a precision medicine approach in which loss-of-function carriers are prescribed ticagrelor or prasugrel and noncarriers are prescribed clopidogrel results in reducing ischemic events without increasing bleeding risk. The evidence to date supports CYP2C19 genetic testing before oral P2Y12 inhibitors are prescribed in patients with acute coronary syndromes or percutaneous coronary intervention. Clinical implementation of such genetic testing will depend on among multiple factors: rapid availability of results or adoption of the concept of performing preemptive genetic testing, provision of easy-to-understand results with therapeutic recommendations, and seamless integration in the electronic health record.
Collapse
|
20
|
Ko D, Evans PT, Lin KJ, Pande AN, Cervone A, Lee SB, Cheng S, Tsacogianis T, Glynn RJ, Kim DH. Frailty and Clinical Outcomes of Ticagrelor Versus Clopidogrel in Older Adults With Acute Myocardial Infarction. J Am Heart Assoc 2024; 13:e034529. [PMID: 39056329 DOI: 10.1161/jaha.124.034529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Ticagrelor is recommended over clopidogrel in acute coronary syndrome based on the results of the PLATO (Study of Platelet Inhibition and Patient Outcomes) trial. We aimed to emulate PLATO in older adults with and without frailty and with acute coronary syndrome treated with percutaneous coronary intervention. METHODS AND RESULTS We created a new-user cohort of Medicare fee-for-service beneficiaries aged ≥65 years hospitalized for acute coronary syndrome from 2014 to 2018 and initiated ticagrelor or clopidogrel following percutaneous coronary intervention. Frailty was defined using a validated claims-based frailty index ≥0.25. Coprimary outcomes were major adverse cardiovascular events and major bleeding. Follow-up began on the date of first outpatient prescription for ticagrelor or clopidogrel and ended on the earliest date for an outcome event, death, discontinuation of the index drug, or disenrollment from Medicare. The study included 42 843 older adults; 23% were frail. After propensity score matching, the rates of major adverse cardiovascular events per 100 person-years comparing ticagrelor versus clopidogrel groups were 7.8 and 7.3 in the frail cohort (hazard ratio [HR], 1.07 [95% CI, 0.84-1.36]) and 3.7 and 4.2 in the nonfrail cohort (HR, 0.87 [95% CI, 0.75-1.02]). The corresponding rates of major bleeding were 4.3 and 3.8 in the frail cohort (HR, 1.12 95% CI, [0.80-1.56]) and 2.2 and 1.8 in the nonfrail cohort (HR, 1.22 [95% CI, 0.98-1.51]). CONCLUSIONS There was a trend toward a modest reduction in risk of major adverse cardiovascular events and a trend toward a modest increase in risk of major bleeding with ticagrelor compared with clopidogrel in the nonfrail cohort. There was insufficient evidence for the benefit of ticagrelor in frail older adults.
Collapse
Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife Boston MA
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Peter T Evans
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
- Division of General Internal Medicine, Department of Medicine Massachusetts General Hospital Boston MA
| | - Ashvin N Pande
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Alexander Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Susan Cheng
- Department of Cardiology Cedars-Sinai Medical Center Los Angeles CA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife Boston MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
- Division of Gerontology, Department of Medicine Beth Israel Deaconess Medical Center Boston MA
| |
Collapse
|
21
|
Teira Calderón A, Sans-Roselló J, Fernández-Peregrina E, Sanz Sánchez J, Bosch-Peligero E, Sánchez-Ceña J, Sorolla Romero J, Valcárcel-Paz D, Jiménez-Kockar M, Diez Gil JL, Asmarats L, Millan-Álvarez X, Vilchez-Tschischke JP, Martinez-Rubio A, Garcia-Garcia HM. Impact of the use of plaque modification techniques on coronary microcirculation using an angiography-derived index of microcirculatory resistance. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1671-1682. [PMID: 38848005 DOI: 10.1007/s10554-024-03152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/23/2024] [Indexed: 09/15/2024]
Abstract
Many lesions in patients undergoing percutaneous coronary intervention (PCI) exhibit significant calcification. Several techniques have been developed to improve outcomes in this setting. However, their impact on coronary microcirculation remains unknown. The aim of this study is to evaluate the influence of plaque modification techniques on coronary microcirculation across patients with severely calcified coronary artery disease. In this multicenter retrospective study, consecutive patients undergoing PCI with either Rotablation (RA) or Shockwave-intravascular-lithotripsy (IVL) were included. Primary endpoint was the impairment of coronary microvascular resistances assessed by Δ angiography-derived index of microvascular resistance (ΔIMRangio) which was defined as the difference in IMRangio value post- and pre-PCI. Secondary endpoints included the development of peri procedural PCI complications (flow-limiting coronary dissection, slow-flow/no reflow during PCI, coronary perforation, branch occlusion, failed PCI, stroke and shock developed during PCI) and 12-month follow-up adverse events. 162 patients were included in the analysis. Almost 80% of patients were male and the left descending anterior artery was the most common treated vessel. Both RA and IVL led to an increase in ΔIMRangio (22.3 and 10.3; p = 0.038, respectively). A significantly higher rate of PCI complications was observed in patients with ΔIMRangio above the median of the cohort (21.0% vs. 6.2%; p = 0.006). PCI with RA was independently associated with higher ΔIMRangio values (OR 2.01, 95% CI: 1.01-4.03; p = 0.048). Plaque modification with IVL and RA during PCI increases microvascular resistance. Evaluating the microcirculatory status in this setting might help to predict clinical and procedural outcomes and to optimize clinical results.
Collapse
Affiliation(s)
| | - Jordi Sans-Roselló
- Department of Cardiology, Parc Taulí Hospital Universitari, Parc Taulí, 1, 08208, Sabadell, Spain.
| | - Estefanía Fernández-Peregrina
- Section of Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Eduardo Bosch-Peligero
- Section of Interventional Cardiology, Department of Cardiology, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Juan Sánchez-Ceña
- Section of Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Daniel Valcárcel-Paz
- Section of Interventional Cardiology, Department of Cardiology, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Marcelo Jiménez-Kockar
- Section of Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Lluís Asmarats
- Section of Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Millan-Álvarez
- Section of Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jean Paul Vilchez-Tschischke
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Antonio Martinez-Rubio
- Department of Cardiology, Parc Taulí Hospital Universitari, Parc Taulí, 1, 08208, Sabadell, Spain
| | - Héctor M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, EB 521,110 Irving St NW, Washington, DC, 20010, USA
| |
Collapse
|
22
|
Woods E, Bennett J, Chandrasekhar S, Newman N, Rizwan A, Siddiqui R, Khan R, Khawaja M, Krittanawong C. Efficacy of Diagnostic Testing of Suspected Coronary Artery Disease: A Contemporary Review. Cardiology 2024:1-22. [PMID: 39013364 DOI: 10.1159/000539916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) is a highly prevalent condition which can lead to myocardial ischemia as well as acute coronary syndrome. Early diagnosis of CAD can improve patient outcomes through guiding risk factor modification and treatment modalities. SUMMARY Testing for CAD comes with increased cost and risk; therefore, physicians must determine which patients require testing, and what testing modality will offer the most useful data to diagnose patients with CAD. Patients should have an initial risk stratification for pretest probability of CAD based on symptoms and available clinical data. Patients with a pretest probability less than 5% should receive no further testing, while patients with a high pretest probability should be considered for direct invasive coronary angiography. In patients with a pretest probability between 5 and 15%, coronary artery calcium score and or exercise electrocardiogram can be obtained to further risk stratify patients to low-risk versus intermediate-high-risk. Intermediate-high-risk patients should be tested with coronary computed tomography angiography (preferred) versus positron emission tomography or single photon emission computed tomography based on their individual patient characteristics and institutional availability. KEY MESSAGES This comprehensive review aimed to describe the available CAD testing modalities, detail their risks and benefits, and propose when each should be considered in the evaluation of a patient with suspected CAD.
Collapse
Affiliation(s)
- Edward Woods
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Josiah Bennett
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Noah Newman
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Affan Rizwan
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Rehma Siddiqui
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Rabisa Khan
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Muzamil Khawaja
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, New York, USA
| |
Collapse
|
23
|
Zhang X, Du Y, Zhang T, Zhao Z, Guo Q, Ma X, Shi D, Zhou Y. Prognostic significance of triglyceride-glucose index in acute coronary syndrome patients without standard modifiable cardiovascular risk factors. Cardiovasc Diabetol 2024; 23:270. [PMID: 39044255 PMCID: PMC11267681 DOI: 10.1186/s12933-024-02345-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND A significant percentage of patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) are being identified. Nonetheless, the prognostic influence of the TyG index on adverse events in this type of patient remains unexplored. The aim of this study was to assess the prognostic value of the TyG index among ACS patients without SMuRFs for predicting adverse outcomes. METHODS This study involved 1140 consecutive patients who were diagnosed with ACS without SMuRFs at Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35 to 66 months after discharge. The objective of this study was to examine major adverse cardiac and cerebrovascular events (MACCE), which included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, as well as ischemia-driven revascularization. RESULTS During the median follow-up period of 48.3 months, 220 (19.3%) MACCE events occurred. The average age of the participants was 59.55 ± 10.98 years, and the average TyG index was 8.67 ± 0.53. In the fully adjusted model, when considering the TyG index as either a continuous/categorical variable, significant associations with adverse outcomes were observed. Specifically, for each 1 standard deviation increase in the TyG index within the highest TyG index group, there was a hazard ratio (HR) of 1.245 (95% confidence interval CI 1.030, 1.504) for MACCE and 1.303 (95% CI 1.026, 1.653) for ischemia-driven revascularization (both P < 0.05), when the TyG index was analyzed as a continuous variable. Similarly, when the TyG index was examined as a categorical variable, the HR (95% CI) for MACCE in the highest TyG index group was 1.693 (95% CI 1.051, 2.727) (P < 0.05) in the fully adjusted model, while the HR (95% CI) for ischemia-driven revascularization was 1.855 (95% CI 0.998, 3.449) (P = 0.051). Additionally, the TyG index was found to be associated with a poor prognosis among the subgroup. CONCLUSION The TyG index is correlated with poor prognosis in patients with ACS without SMuRFs, suggesting that it may be an independent predictive factor of adverse events among these individuals.
Collapse
Affiliation(s)
- Xiaoming Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Tianhao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Zehao Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Qianyun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
| |
Collapse
|
24
|
Zuo L, Tian Z, Zhou B, Hou M, Chen Y, Han P, Ma C, Wu X, Yu D. Perivascular fat attenuation index value and plaque volume increased in non-target lesions of coronary arteries after stenting. Eur Radiol 2024; 34:4233-4242. [PMID: 38057594 DOI: 10.1007/s00330-023-10468-8] [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: 09/09/2023] [Revised: 09/09/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Progression of non-target lesions (NTLs) after stenting has been reported and is associated with the triggering of an inflammatory response. The perivascular fat attenuation index (FAI) may be used as a novel imaging biomarker for the direct quantification of coronary inflammation. OBJECTIVES To investigate whether FAI values can help identify changes in inflammation status in patients undergoing stent implantation, especially in NTLs. METHODS Patients who underwent pre- and post-stenting coronary computed tomography angiography (CCTA) examination between January 2015 and February 2021 were consecutively enrolled. The pre- and post-stenting FAIs of the full coronary arteries were compared in both the non- and stent-implanted coronary arteries. Moreover, local FAI values were measured and compared between the NTLs and target lesions in the stent implantations. We also compared changes in plaque type and volume in NTLs before and after stenting. RESULTS A total of 89 patients (mean age 61 years; male 59) were enrolled. The perivascular FAI values in the full coronary arteries decreased after stenting in both the non- and stent-implanted coronary arteries, similar to those in the target lesions. Conversely, the perivascular FAI values in the NTLs increased after stenting (p < 0.05). In addition, the plaque volumes significantly increased in the NTLs after stenting, regardless of whether they were non-calcified, mixed, or calcified (p < 0.05). CONCLUSION Perivascular FAI values and plaque volumes increased in the NTLs after stenting. Perivascular FAI can be a promising imaging biomarker for monitoring coronary inflammation after stenting and facilitate long-term monitoring in clinical settings. CLINICAL RELEVANCE STATEMENT Perivascular fat attenuation index, a non-invasive imaging biomarker, may help identify coronary arteries with high inflammation in non-target lesions and facilitate long-term monitoring, potentially providing an opportunity for more targeted treatment. KEY POINTS • Perivascular fat attenuation index (FAI) values and plaque volumes increased in the non-target lesions (NTLs) after stenting, suggesting potential focal inflammation progression after stenting. However, stenting along with anti-inflammatory treatment ameliorated inflammation in the full coronary arteries. • Perivascular FAI, a non-invasive imaging biomarker, may help identify coronary arteries with high inflammation in NTLs and facilitate long-term monitoring, potentially providing an opportunity for more targeted treatment.
Collapse
Affiliation(s)
- Liping Zuo
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Ziyu Tian
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Binbin Zhou
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Mingyuan Hou
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Yinghui Chen
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Pei Han
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Chune Ma
- ShuKun (BeiJing) Technology Co., Ltd., Beijing, 100029, China
| | - Xuan Wu
- Shandong Superlink Intelligent Technology Co., Ltd., Jinan, 250000, Shandong, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
25
|
Jamil Y, Sibindi C, Park DY, Frampton J, Damluji AA, Nanna MG. Representation of Older Adults in the ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. JAMA Netw Open 2024; 7:e2421547. [PMID: 38995647 PMCID: PMC11245718 DOI: 10.1001/jamanetworkopen.2024.21547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
This cross-sectional study assesses the generalizability of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) guideline by examining the representation of older adults in studies cited in the guideline.
Collapse
Affiliation(s)
- Yasser Jamil
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cosmas Sibindi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Abdulla A Damluji
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Inova Center of Outcomes Research, Falls Church, Virginia
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
26
|
Razzouk L. The Beaten Path: Use of the Radial Artery as a Bypass Graft After Instrumentation. Circ Cardiovasc Interv 2024; 17:e014194. [PMID: 38973452 DOI: 10.1161/circinterventions.124.014194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- Louai Razzouk
- Department of Interventional Cardiology, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine
| |
Collapse
|
27
|
Nishi T, Kume T, Ueno M, Kobayashi Y, Uemura S. Resolution of spontaneous coronary artery dissection involving the left main coronary artery. Cardiovasc Interv Ther 2024; 39:316-317. [PMID: 38520632 DOI: 10.1007/s12928-024-00996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Takeshi Nishi
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Masahiko Ueno
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| |
Collapse
|
28
|
Wu Y, Wagner WD. Syndecan-4 Functionalization Reduces the Thrombogenicity of Engineered Vascular Biomaterials. Ann Biomed Eng 2024; 52:1873-1882. [PMID: 37071281 PMCID: PMC11169030 DOI: 10.1007/s10439-023-03199-w] [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: 11/03/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
Blood-biomaterial compatibility is essential for tissue repair especially for endovascular biomaterials where small-diameter vessel patency and endothelium formation is crucial. To address this issue, a composite biomaterial termed PFC fabricated from poly (glycerol sebacate), silk fibroin, and collagen was used to determine if functionalization with syndecan-4 (SYN4) would reduce thrombogenesis through the action of heparan sulfate. The material termed, PFC_SYN4, has structure and composition similar to native arterial tissue and has been reported to facilitate the binding and differentiation of endothelial colony-forming cells (ECFCs). In this study, the hemocompatibility of PFC_SYN4 was evaluated and compared with non-functionalized PFC, electrospun collagen, ePTFE, and bovine pericardial patch (BPV). Ultrastructurally, platelets were less activated when cultured on PFC and PFC_SYN4 compared to collagen where extensive platelet degranulation was observed. Quantitatively, 31% and 44% fewer platelets adhered to PFC_SYN4 compared to non-functionalized PFC and collagen, respectively. Functionalization of PFC resulted in reduced levels of complement activation compared to PFC, collagen, and BPV. Whole blood clotting times indicated that PFC_SYN4 was less thrombogenic compared with PFC, collagen, and BPV. These results suggest that syndecan-4 functionalization of blood-contacting biomaterials provides a novel solution for generating a reduced thrombogenic surface.
Collapse
Affiliation(s)
- Yidi Wu
- Department of Plastic & Reconstructive Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - William D Wagner
- Department of Plastic & Reconstructive Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA.
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, 391 Technology Way, Winston-Salem, NC, USA.
| |
Collapse
|
29
|
Aytekin A, Scalamogna M, Coughlan JJ, Lahu S, Ndrepepa G, Menichelli M, Mayer K, Wöhrle J, Bernlochner I, Witzenbichler B, Hochholzer W, Sibbing D, Angiolillo DJ, Hemetsberger R, Tölg R, Valina C, Müller A, Kufner S, Liebetrau C, Xhepa E, Hapfelmeier A, Sager HB, Joner M, Richardt G, Laugwitz KL, Neumann FJ, Schunkert H, Schüpke S, Kastrati A, Cassese S. Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel. Clin Res Cardiol 2024; 113:1060-1069. [PMID: 38740722 PMCID: PMC11219404 DOI: 10.1007/s00392-024-02454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The ISAR-REACT 5 trial compared the efficacy and safety of ticagrelor and prasugrel in patients with ACS managed invasively. The present study sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of urgent revascularization in acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS This post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. The primary endpoint for this analysis was the incidence of urgent revascularization at 12-month follow-up. Secondary outcome was the pattern of urgent revascularization procedures (namely, urgent target vessel/non-target vessel revascularization - TVR/NTVR). Among 3,377 ACS patients who underwent PCI, 1,676 were assigned to ticagrelor and 1,701 to prasugrel before PCI. After 12 months, the incidence of urgent revascularization was higher among patients assigned to ticagrelor as compared to prasugrel (6.8% vs. 5.2%; hazard ratio [HR] = 1.32, 95% confidence interval [CI] 1.00-1.75; p = 0.051), mostly attributable to significantly more urgent NTVR in the ticagrelor group (3.8% vs. 2.4%; HR = 1.62 [1.09-2.41]; p = 0.017). The risk of urgent TVR did not differ between treatment groups (3.3% vs. 3.0%; HR = 1.13 [0.77-1.65]; p = 0.546). CONCLUSIONS In ACS patients treated with PCI, the cumulative rate of urgent revascularizations after 12 months is higher with ticagrelor compared to prasugrel, due to a significant increase in urgent revascularizations involving remote coronary vessels.
Collapse
Affiliation(s)
- Alp Aytekin
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | - Maria Scalamogna
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | - J J Coughlan
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland
| | - Shqipdona Lahu
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | - Gjin Ndrepepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | | | - Katharina Mayer
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | - Jochen Wöhrle
- Department of Cardiology, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Isabell Bernlochner
- Klinik Und Poliklinik Für Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Willibald Hochholzer
- Department of Cardiology and Intensive Care Medicine, Klinikum Würzburg Mitte, Würzburg, Germany
| | - Dirk Sibbing
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Klinik der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Rayyan Hemetsberger
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Ralph Tölg
- Department of Cardiology, Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - Christian Valina
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arne Müller
- Klinik Und Poliklinik Für Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | - Christoph Liebetrau
- Heart Center, Campus Kerckhoff of Justus-Liebig-University, Giessen, Germany
| | - Erion Xhepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- School of Medicine, Institute of General Practice and Health Services Research, Munich, Germany
| | - Hendrik B Sager
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Gert Richardt
- Department of Cardiology, Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - Karl-Ludwig Laugwitz
- Klinik Und Poliklinik Für Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Franz Josef Neumann
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Stefanie Schüpke
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany.
| |
Collapse
|
30
|
Chamié D, Pfau S. Complete Revascularization in Acute Myocardial Infarction: The Clock Is Ticking. Circ Cardiovasc Interv 2024; 17:e014284. [PMID: 38973471 DOI: 10.1161/circinterventions.124.014284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- Daniel Chamié
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT (D.C., S.P.)
| | - Steven Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT (D.C., S.P.)
- VA Connecticut, West Haven, CT (S.P.)
| |
Collapse
|
31
|
Mankerious N, Richardt G, Allali A, Geist V, Kastrati A, El-Mawardy M, Rheude T, Sulimov D, Toelg R, Abdel-Wahab M. Lower revascularization rates after high-speed rotational atherectomy compared to modified balloons in calcified coronary lesions: 5-year outcomes of the randomized PREPARE-CALC trial. Clin Res Cardiol 2024; 113:1051-1059. [PMID: 38483633 DOI: 10.1007/s00392-024-02434-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/06/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND In the PREPARE-CALC trial, severely calcified lesion preparation with rotational atherectomy (RA) before biodegradable polymer sirolimus-eluting stent (SES) implantation demonstrated higher procedural success and comparable rates of acute lumen gain and late lumen loss compared to modified balloons (MB) (scoring/cutting). We aimed to analyze the 5-year outcomes of both lesion preparation strategies. METHODS PREPARE-CALC randomly assigned 200 patients 1:1 to MB or RA, followed by SES implantation. The principal endpoint of the current analysis was target vessel failure (TVF) at 5 years. RESULTS At 5 years, MB had comparable rates of TVF to RA (19% vs. 21%, HR 1.14, 95% CI 0.60-2.16, p = 0.687). Subgroup analysis showed a lesion length treatment interaction, favoring MB for short lesions and RA for long ones (p for interaction = 0.042). Target lesion revascularization (TLR) was significantly less common with RA (12 vs. 3%, HR 0.28, 95% CI 0.08-0.98, p = 0.048). In a multivariate analysis, RA was independently protective against TLR (adj. HR 0.17, 95% CI 0.04-0.78, p = 0.022), while ostial lesions were associated with higher TLR independent of treatment strategy (adj. HR 11.3, 95% CI 2.98-42.6, p < 0.001). CONCLUSION In patients with severely calcified coronary lesions, using MB or RA for lesion preparation followed by biodegradable polymer SES implantation was associated with comparable rates of TVF at 5 years. However, a significant reduction of TLR was observed after RA. PREPARE-CALC is the first randomized trial showing potential clinical advantages of RA over MB during long-term follow-up. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov . Unique identifier: NCT02502851.
Collapse
Affiliation(s)
- Nader Mankerious
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Gert Richardt
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Abdelhakim Allali
- Cardiology Department, University Heart Center Lübeck, Lübeck, Germany
| | - Volker Geist
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Tobias Rheude
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | - Dmitriy Sulimov
- Cardiology Department, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Medical Faculty of the Christian-Albrechts University of Kiel, Kiel, Germany
- Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| |
Collapse
|
32
|
Park DY, Hu JR, Campbell G, Goldwag K, Kelsey MD, Altin SE, Gallegos-Kattán C, Nanna MG. Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101859. [PMID: 39131993 PMCID: PMC11307649 DOI: 10.1016/j.jscai.2024.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 08/13/2024]
Abstract
Background Patients with type 2 diabetes mellitus (DM) comprise more than a quarter of all patients undergoing percutaneous coronary intervention and are at higher risk of adverse events. We sought to reexamine the optimal duration of dual antiplatelet therapy (DAPT) postpercutaneous coronary intervention in patients with DM. Methods We systematically included randomized controlled trials comparing any 2 of 1, 3, 6, and 12 months of DAPT that reported major adverse cardiovascular events (MACE), net adverse clinical events (NACE), bleeding, or stent thrombosis in DM, and performed a frequentist network meta-analysis. We also performed a sensitivity analysis of trials that exclusively enrolled patients with acute coronary syndrome. Results In 16 randomized controlled trials comprising 16,376 adults with DM, there was no significant difference in NACE, MACE, stent thrombosis, or major bleeding between pairwise comparisons of 1, 3, 6, and 12 months of DAPT, except for a signal for lower bleeding with 3 months of DAPT compared to 12 (risk ratio, 0.72; 95% CI, 0.51-0.99). Sensitivity analysis of trials that solely included acute coronary syndrome similarly showed no significant difference in MACE between 1, 3, 6, and 12 months of DAPT. Conclusions Our study found no meaningful difference in NACE or MACE between pairwise comparisons of 1, 3, 6, and 12 months of DAPT by study-level meta-analysis of patients with DM, with lower bleeding risk observed with 3 months than with 12 months of DAPT. This finding may provide clinicians greater flexibility to personalize patients' DAPT duration based on other non-DM comorbidities that might affect bleeding or thrombosis risk.
Collapse
Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Greta Campbell
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kiara Goldwag
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michelle D. Kelsey
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - S. Elissa Altin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
33
|
Peng Y, Wei X, Wu F, Fan M, Wang K, Zhou J. Electroacupuncture for slow flow/no-reflow phenomenon in patients with acute myocardial infarction undergoing percutaneous coronary intervention: protocol for a pilot randomized controlled trial. Front Cardiovasc Med 2024; 11:1401269. [PMID: 38957330 PMCID: PMC11218819 DOI: 10.3389/fcvm.2024.1401269] [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: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
Background Slow flow/no-reflow (SF-NR) during percutaneous coronary intervention (PCI) is associated with poor prognosis of patients with acute myocardial infarction (AMI). Currently, effective treatment is not available for SF-NR. Electroacupuncture (EA) has shown significant efficacy as an adjuvant therapy for many cardiovascular diseases by improving microcirculation and reducing ischemia-reperfusion injury. However, its effects on SF-NR in the AMI patients during PCI are not clear. This pilot trial aims to determine the efficacy of intraoperative EA in alleviating SF-NR in AMI patients undergoing PCI. Methods This prospective, single-center, randomized controlled, pilot trial will recruit 60 AMI patients scheduled for PCI at the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, China. The patients will be randomized in a 1:1 ratio into the EA or the control groups. Patients in the control group will undergo standard PCI. Patients in the EA group will undergo intraoperative electroacupuncture while undergoing standard PCI. Incidence of SF-NR is the primary outcome for this study. This study will also assess secondary outcomes including cardiac biomarkers, inflammatory biomarkers, pain and anxiety scores, electrocardiography parameters, traditional Chinese medicine (TCM) symptom score, and major adverse cardiovascular and cerebrovascular events (MACCE). All the included patients will undergo laboratory tests including routine blood tests, levels of electrolytes, as well as liver and renal function tests. Patients will be followed up for 1 month after the procedure. Discussion This pilot trial will provide evidence for the potential benefits of intraoperative EA in improving microvascular perfusion and preventing or alleviating SF-NR during PCI in patients with AMI. If proven effective, intraoperative EA will provide a new and effective strategy against SF-NR and provide evidence for subsequent multicenter trials. Clinical Trial Registration ClinicalTrials.gov, identifier (ChiCTR2300072265). Registered on 8 June 2023.
Collapse
Affiliation(s)
- Yanbin Peng
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuqiang Wei
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Wu
- Department of Cardiovascular Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fan
- Department of Cardiovascular Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Wang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia Zhou
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
34
|
Abukhalil AD, Hamad S, Swaileh ZK, Ghanem AW, Abumadi S, Madia R, Al-Shami NO. Acute Coronary Syndrome: Treatment Strategies and Outcomes in Patients Admitted to a Tertiary Care Hospital in Palestine. Patient Prefer Adherence 2024; 18:1173-1181. [PMID: 38882643 PMCID: PMC11180461 DOI: 10.2147/ppa.s467924] [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: 05/01/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
Background Acute coronary syndrome (ACS) is the leading cause of death worldwide despite advances in treatment and prevention measures. This study aimed to explore ACS treatment strategies (ischemia-guided vs early invasive) and risk factors among patients diagnosed with ACS in a tertiary care hospital in Palestine and to evaluate related outcomes regarding future events and standard clinical guidelines. Methods This retrospective cohort study reviewed patient data from a Palestinian medical hospital. The study included 255 patients ≥ 18 years who were hospitalized between January 2021 and December 2021 and diagnosed with ACS. The data were analyzed using the Statistical Package for Social Science (SPSS). Results 71% of the participants were males. The mean age was 59.59±11.56 years. Smoking, diabetes, and hypertension were the most common risk factors. Unstable angina (UA) was the most prevalent ACS type, accounting for 43.1% (110) of cases, whereas NSTEMI accounted for 39.2% (100) and STEMI accounted for 17.6% (45) of cases. An ischemic-guided strategy approach was used in 71% (181) of the patients. Upon discharge, the most prescribed medication classes were antiplatelets (97.6%), statins (87.1%), PPIs (72.5%), and antihypertensives (71.8%). Treatment strategies were selected according to the clinical guidelines for most ACS types. Conclusion ACS management in Palestine continues to evolve to overcome barriers, decrease patient mortality, and decrease hospital stay. UA and NSTEMI were the most common ACS diagnoses at admission, and the ischemic strategy was the most common modality. The findings of this study call for an increased awareness of CVD risk factors, resource availability, and adherence to clinical guidelines to improve patient outcomes and community health.
Collapse
Affiliation(s)
- Abdallah Damin Abukhalil
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Shahd Hamad
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Zain Khalid Swaileh
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Aseel Wasel Ghanem
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Sarah Abumadi
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Raed Madia
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Ni'meh Own Al-Shami
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| |
Collapse
|
35
|
Watanabe A, Miyamoto Y, Ueyama H, Gotanda H, Tsugawa Y, Kuno T. Percutaneous Microaxial Ventricular Assist Device Versus Intra-Aortic Balloon Pump for Nonacute Myocardial Infarction Cardiogenic Shock. J Am Heart Assoc 2024; 13:e034645. [PMID: 38804220 PMCID: PMC11255633 DOI: 10.1161/jaha.123.034645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/04/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Evidence on the comparative outcomes following percutaneous microaxial ventricular assist devices (pVAD) versus intra-aortic balloon pump for nonacute myocardial infarction cardiogenic shock is limited. METHODS AND RESULTS We included 704 and 2140 Medicare fee-for-service beneficiaries aged 65 to 99 years treated with pVAD and intra-aortic balloon pump, respectively, for nonacute myocardial infarction cardiogenic shock from 2016 to 2020. Patients treated using pVAD compared with those treated using intra-aortic balloon pump were more likely to be concurrently treated with mechanical ventilation, renal replacement therapy, and blood transfusions. We computed propensity scores for undergoing pVAD using patient- and hospital-level factors and performed a matching weight analysis. The use of pVAD was associated with higher 30-day mortality (adjusted odds ratio, 1.92 [95% CI, 1.59-2.33]) but not associated with in-hospital bleeding (adjusted odds ratio, 1.00 [95% CI, 0.81-1.24]), stroke (adjusted odds ratio, 0.91 [95% CI, 0.56-1.47]), sepsis (OR, 0.91 [95% CI, 0.64-1.28]), and length of hospital stay (adjusted mean difference, +0.4 days [95% CI, -1.4 to +2.3]). A quasi-experimental instrumental variable analysis using the cross-sectional institutional practice preferences showed similar patterns, though not statistically significant (adjusted odds ratio, 1.38; 95% CI, 0.28-6.89). CONCLUSIONS Our investigation using the national sample of Medicare beneficiaries showed that the use of pVAD compared with intra-aortic balloon pump was associated with higher mortality in patients with nonacute myocardial infarction cardiogenic shock. Providers should be cautious about the use of pVAD for nonacute myocardial infarction cardiogenic shock, while adequately powered high-quality randomized controlled trials are warranted to determine the clinical effects of pVAD.
Collapse
Affiliation(s)
- Atsuyuki Watanabe
- Department of MedicineMount Sinai Beth IsraelIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Yoshihisa Miyamoto
- Division of Nephrology and EndocrinologyThe University of TokyoTokyoJapan
| | - Hiroki Ueyama
- Division of CardiologyEmory University School of MedicineAtlantaGA
| | - Hiroshi Gotanda
- Division of General Internal MedicineCedars‐Sinai Medical CenterLos AngelesCA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services ResearchDavid Geffen School of Medicine at The University of California, Los AngelesLos AngelesCA
- Department of Health Policy and ManagementUCLA Fielding School of Public Health, Los AngelesLos AngelesCA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
- Division of Cardiology, Jacobi Medical CenterAlbert Einstein College of MedicineNew YorkNY
| |
Collapse
|
36
|
Herron GC, Bates ER. Review of the Ticagrelor Trials Evidence Base. J Am Heart Assoc 2024; 13:e031606. [PMID: 38804216 PMCID: PMC11255623 DOI: 10.1161/jaha.123.031606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Ticagrelor is a platelet P2Y12 receptor inhibitor approved for use in patients with acute coronary syndromes, coronary artery disease, and low-moderate risk acute ischemic stroke or high-risk transient ischemic attack. Clinical trials have evaluated the efficacy and safety of ticagrelor on ischemic and bleeding outcomes for different indications and with varying treatment approaches. As a result, there is a large body of clinical evidence demonstrating different degrees of net clinical benefit compared with other platelet inhibitor drugs based on indication, patient characteristics, clinical presentation, treatment duration, and other factors. We provide a review of the major trials of ticagrelor in the context of other randomized trials of clopidogrel and prasugrel to organize the volume of available information, elevate corroborating and conflicting data, and identify potential gaps as areas for further exploration of optimal antiplatelet treatment.
Collapse
Affiliation(s)
| | - Eric R. Bates
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| |
Collapse
|
37
|
Choi KH, Park TK, Song YB, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Yang JH, Choi SH, Gwon HC, Hahn JY, Nam CW. Intravascular Imaging and Angiography Guidance in Complex Percutaneous Coronary Intervention Among Patients With Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417613. [PMID: 38913377 PMCID: PMC11197449 DOI: 10.1001/jamanetworkopen.2024.17613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/18/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Data are limited regarding the effects of intravascular imaging guidance during complex percutaneous coronary intervention (PCI) in patients with diabetes. Objective To compare the clinical outcomes of intravascular imaging-guided vs angiography-guided complex PCI in patients with or without diabetes. Design, Setting, and Participants This prespecified secondary analysis of a subgroup of patients in RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention), an investigator-initiated, open-label multicenter trial, analyzed enrolled patients who underwent complex PCI at 20 sites in Korea from May 2018 through May 2021. Eligible patients were randomly assigned in a 2:1 ratio to undergo either the intravascular imaging-guided PCI or angiography-guided PCI. Data analyses were performed from June 2023 to April 2024. Interventions Percutaneous coronary intervention was performed either under the guidance of intravascular imaging or angiography alone. Main Outcomes and Measures The primary end point was target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. Results Among the 1639 patients included in the analysis (mean [SD] age, 65.6 [10.2] years; 1300 males [79.3%]), 617 (37.6%) had diabetes. The incidence of TVF was significantly higher in patients with diabetes than patients without diabetes (hazard ratio [HR], 1.86; 95% CI, 1.33-2.60; P < .001). Among patients without diabetes, the intravascular imaging-guided PCI group had a significantly lower incidence of TVF compared with the angiography-guided PCI group (4.7% vs 12.2%; HR, 0.41 [95% CI, 0.25-0.67]; P < .001). Conversely, in patients with diabetes, the risk of TVF was not significantly different between the 2 groups (12.9% vs 12.3%; HR, 0.97 [95% CI, 0.60-1.57]; P = .90). There was a significant interaction between the use of intravascular imaging and diabetes for the risk of TVF (P for interaction = .02). Among patients with diabetes, only those with good glycemic control (hemoglobin A1c level ≤7.5%) and who achieved stent optimization by intravascular imaging showed a lower risk of future ischemic events (HR, 0.31; 95% CI, 0.12-0.82; P = .02). Conclusions and Relevance In this secondary analysis of a subgroup of patients in the RENOVATE-COMPLEX-PCI trial, intravascular imaging guidance reduced the risk of TVF compared with angiography guidance in patients without diabetes (but not in patients with diabetes) during complex PCI. In patients with diabetes undergoing complex PCI, attention should be paid to stent optimization using intravascular imaging and glycemic control to improve outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03381872.
Collapse
Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyeong Ho Yun
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | - Hyo-Suk Ahn
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Yong Hwan Park
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil-Sang Song
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Incheon St Mary’s Hospital, Seoul, Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea
| | - Yun-Hyeong Cho
- Division of Cardiology, Department of Internal Medicine, Hanyang University Myongji Hospital, Goyang, Korea
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kook-Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| |
Collapse
|
38
|
Lawton J. Improving Outcomes for Women After Coronary Artery Bypass Grafting. JAMA Netw Open 2024; 7:e2414287. [PMID: 38861263 DOI: 10.1001/jamanetworkopen.2024.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Affiliation(s)
- Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
39
|
Arshad N, Sukmawati I, Wickramarachchi U, Banerjee S, Cader FA. Routine Functional Testing or Standard Care in High-Risk Patients after Percutaneous Coronary Intervention. Curr Cardiol Rep 2024; 26:497-503. [PMID: 38722493 DOI: 10.1007/s11886-024-02064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW This review aimed to collate the available evidence on outcomes following routine functional stress testing vs standard of care (i.e. symptom-guided stress testing) in high-risk patients following percutaneous coronary intervention (PCI). RECENT FINDINGS The most recent pragmatic POST-PCI trial provided randomized evidence showing that routine functional stress testing post-PCI did not lead to a reduction in 2-year ischemic cardiovascular events or all-cause mortality, as compared to a symptom-guided standard-of-care approach. This was also true for sub-analyses including multivessel or left main disease, diabetics, as well as following imaging or physiology guided PCI. In the absence of a change in their clinical or functional status suggestive of stent failure, post-PCI routine periodic stress testing in stable patients on guideline-directed medical therapy is currently not recommended by American clinical practice guidelines. While evidence on the cost-effectiveness of routine stress testing strategy is scarce, physician, payer, and policy-level interventions to reduce inappropriate use of routine functional testing need to be addressed.
Collapse
Affiliation(s)
- Nouman Arshad
- Kettering General Hospital, Rothwell Road, Kettering, NN16 8UZ, UK
| | - Indah Sukmawati
- Siloam Hospitals Lippo Village - Universitas Pelita Harapan, Tangerang, Indonesia
| | - Upul Wickramarachchi
- Lanka Hospitals, Colombo, Sri Lanka
- Faculty of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | |
Collapse
|
40
|
Gunaga S, Fourtounis JV, Swan KW, Butler SP, Al Hage A. Multi-organ Thromboembolic Crisis: A Case Report of Concomitant Stroke, Myocardial Infarction, and Pulmonary Embolism. Cureus 2024; 16:e63288. [PMID: 39070318 PMCID: PMC11283252 DOI: 10.7759/cureus.63288] [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] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Management of acute coronary syndrome (ACS), cerebrovascular accident (CVA), and pulmonary embolism (PE) necessitates prompt intervention, as delayed treatment may lead to severe consequences. Each of these conditions presents significant challenges and carries a high risk of morbidity and mortality. We present the case of an 86-year-old female with a history of stage 4 urothelial carcinoma metastasized to the lungs, who presented to the emergency department (ED) with acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), and bilateral PE. We propose the term "multi-organ thromboembolic crisis" (MOTEC) to streamline the communication and management approach for patients experiencing critical thromboembolic events affecting multiple organ systems.
Collapse
Affiliation(s)
- Satheesh Gunaga
- Emergency Medicine, Henry Ford Wyandotte Hospital/Envision Healthcare/Michigan State University College of Osteopathic Medicine, Wyandotte, USA
| | | | - Kirby W Swan
- Emergency Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, USA
| | - Seth P Butler
- Emergency Medicine, University at Buffalo, Buffalo, USA
| | - Abe Al Hage
- Emergency Medicine, Henry Ford Wyandotte Hospital/Envision Healthcare/Michigan State University College of Osteopathic Medicine, Wyandotte, USA
| |
Collapse
|
41
|
Tern PJW, Yeo KK, Tan JWC, Chin CT, Tan RS, Yap J. Role of anticoagulation in non-ST-elevation myocardial infarction: a contemporary narrative review. Expert Rev Cardiovasc Ther 2024; 22:203-215. [PMID: 38739469 DOI: 10.1080/14779072.2024.2354243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Anticoagulants play a vital role as part of the antithrombotic therapy of myocardial infarction and are complementary to antiplatelet therapies. In the acute setting, the rationale for their use is to antagonize the ongoing clotting cascade including during percutaneous coronary intervention. Anticoagulation may be an important part of the longer-term antithrombotic strategy especially in patients who have other existing indications (e.g. atrial fibrillation) for their use. AREAS COVERED In this narrative review, the authors provide a contemporary summary of the anticoagulation strategies of patients presenting with NSTEMI, both in terms of anticoagulation during the acute phase as well as suggested antithrombotic regimens for patients who require long-term anticoagulation for other indications. EXPERT OPINION Patients presenting with non-ST-elevation myocardial infarction (NSTEMI) should be initiated on anticoagulation (e.g. heparin/low molecular weight heparin) for the initial hospitalization period for those medically managed or until percutaneous coronary intervention. Longer term management of NSTEMI for patients with an existing indication for long-term anticoagulation should comprise triple antithrombotic therapy of anticoagulant (preferably DOAC) with aspirin and clopidogrel for up to 1 month (typically 1 week or until hospital discharge), followed by DOAC plus clopidogrel for up to 1 year, and then DOAC monotherapy thereafter.
Collapse
Affiliation(s)
- Paul Jie Wen Tern
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
42
|
Thériault-Lauzier P, Fearon WF. Is There a Role for Physiology-Guided PCI of Nonculprit Lesions in Patients With STEMI? Circ Cardiovasc Interv 2024; 17:e014253. [PMID: 38785074 DOI: 10.1161/circinterventions.124.014253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Pascal Thériault-Lauzier
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA (P.T.-L., W.F.F.)
- Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (P.T.-L.)
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA (P.T.-L., W.F.F.)
- Cardiology Section, Palo Alto VA Medical Center, CA (W.F.F.)
| |
Collapse
|
43
|
Faulder TI, Prematunga K, Moloi SB, Faulder LE, Jones R, Moxon JV. Agreement of Fractional Flow Reserve Estimated by Computed Tomography With Invasively Measured Fractional Flow Reserve: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e034552. [PMID: 38726901 PMCID: PMC11179792 DOI: 10.1161/jaha.124.034552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/21/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Fractional flow reserve (FFR) is the ratio of blood pressure measured distal to a stenosis and pressure proximal to a stenosis. FFR can be estimated noninvasively using computed tomography (CT) although the usefulness of this technique remains controversial. This meta-analysis evaluated the agreement of FFR estimated by CT (FFR-CT) with invasively measured FFR. The study also evaluated the diagnostic accuracy of FFR-CT, defined as the ability of FFR-CT to classify lesions as hemodynamically significant (invasive FFR ≤0.8) or insignificant (invasive FFR >0.8). METHODS AND RESULTS Forty-three studies reporting on 7291 blood vessels from 5236 patients were included. A moderate positive linear relationship between FFR-CT and invasively measured FFR was observed (Spearman correlation coefficient: 0.67). Agreement between the 2 measures increased as invasively measured FFR values approached 1. The overall diagnostic accuracy, sensitivity and specificity of FFR-CT were 82.2%, 80.9%, and 83.1%, respectively. Diagnostic accuracy of 90% could be demonstrated for FFR-CT values >0.90 and <0.49. The diagnostic accuracy of off-site tools was 79.4% and the diagnostic accuracy of on-site tools was 84.1%. CONCLUSIONS The agreement between FFR-CT and invasive FFR is moderate although agreement is highest in vessels with FFR-CT >0.9. Diagnostic accuracy varies widely with FFR-CT value but is above 90% for FFR-CT values >0.90 and <0.49. Furthermore, on-site and off-site tools have similar performance. Ultimately, FFR-CT may be a useful adjunct to CT coronary angiography as a gatekeeper for invasive coronary angiogram.
Collapse
Affiliation(s)
- Thomas I Faulder
- College of Medicine and Dentistry James Cook University Townsville QLD Australia
| | | | - Soniah B Moloi
- Department of Cardiology Townsville University Hospital Townsville QLD Australia
| | - Lauren E Faulder
- College of Medicine and Dentistry University of Adelaide Adelaide SA Australia
| | - Rhondda Jones
- Graduate Research School James Cook University Townsville QLD Australia
- Tropical Australian Academic Health Centre James Cook University Townsville QLD Australia
| | - Joseph V Moxon
- College of Medicine and Dentistry James Cook University Townsville QLD Australia
- The Australian Institute of Tropical Health and Medicine James Cook University Townsville QLD Australia
| |
Collapse
|
44
|
Abdelfattah OM, Kumfa P, Allencherril J. Coronary Embolism in ST-Segment-Elevation Myocardial Infarction and Atrial Fibrillation: Not One Size Fits All. J Am Heart Assoc 2024; 13:e035372. [PMID: 38742541 PMCID: PMC11179833 DOI: 10.1161/jaha.124.035372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Omar M Abdelfattah
- Division of Cardiovascular Medicine University of Texas Medical Branch Galveston TX USA
| | - Paul Kumfa
- Division of Cardiovascular Medicine University of Texas Medical Branch Galveston TX USA
| | - Joseph Allencherril
- Division of Cardiovascular Medicine University of Texas Medical Branch Galveston TX USA
| |
Collapse
|
45
|
Wang G, Xia M, Liang C, Pu F, Liu S, Jia D. Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1362893. [PMID: 38784168 PMCID: PMC11112025 DOI: 10.3389/fcvm.2024.1362893] [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: 12/29/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Background Elevated lipoprotein (a) level was recognized as an independent risk factor for significant adverse cardiovascular events in acute coronary syndrome (ACS) patients. Despite this recognition, the consensus in the literature regarding the prognostic significance of elevated lipoprotein (a) in ACS was also limited. Consequently, we conducted a thorough systematic review and meta-analysis to evaluate the prognostic relevance of elevated lipoprotein (a) level in individuals diagnosed with ACS. Methods and results A thorough literature review was conducted by systematically searching PubMed, Embase, and Cochrane databases until September 2023. This review specifically examined cohort studies exploring the prognostic implications of elevated lipoprotein (a) level in relation to major adverse cardiovascular events (MACE), including death, stroke, non-fatal myocardial infarction (MI), and coronary revascularization, in patients with ACS. The meta-analysis utilized aggregated multivariable hazard ratios (HR) and their respective 95% confidence intervals (CI) to evaluate prognostic implications between high and low lipoprotein (a) levels [the cut-off of high lipoprotein (a) level varies from 12.5 to 60 mg/dl]. Among 18,168 patients in the identified studies, elevated lipoprotein (a) was independently associated with increased MACE risk (HR 1.26; 95% CI: 1.17-1.35, P < 0.00001) and all-cause mortality (HR 1.36; 95% CI: 1.05-1.76, P = 0.02) in ACS patients. In summary, elevated lipoprotein (a) levels independently forecast MACE and all-cause mortality in ACS patients. Assessing lipoprotein (a) levels appears promising for risk stratification in ACS, offering valuable insights for tailoring secondary prevention strategies. Systematic Review Registration PROSPERO (CRD42023476543).
Collapse
Affiliation(s)
- Guochun Wang
- The Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Maoyin Xia
- The Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Cai Liang
- The Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Feng Pu
- The Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Sitai Liu
- Department of General Practice, Sichuan Mianyang 404 Hospital, The Second Affiliated Hospital of North Sichuan Medical College, Mianyang, Sichuan, China
| | - Dongxia Jia
- Department of General Practice, Sichuan Mianyang 404 Hospital, The Second Affiliated Hospital of North Sichuan Medical College, Mianyang, Sichuan, China
| |
Collapse
|
46
|
Kwon W, Choi KH, Lee SH, Hong D, Shin D, Kim HK, Park KH, Choo EH, Kim CJ, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Joh HS, Kyu Park T, Yang JH, Song YB, Choi SH, Jeong MH, Gwon HC, Hahn JY, Lee JM. Clinical Value of Single-Projection Angiography-Derived FFR in Noninfarct-Related Artery. Circ Cardiovasc Interv 2024; 17:e013844. [PMID: 38771911 DOI: 10.1161/circinterventions.123.013844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The Murray law-based quantitative flow ratio (μFR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesions with μFR >0.80 in the setting of AMI. METHODS μFR and QFR were analyzed for non-IRA lesions of patients with AMI enrolled in the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients With Acute Myocardial Infarction), consisting of fractional flow reserve (FFR)-guided percutaneous coronary intervention and angiography-guided percutaneous coronary intervention groups. The diagnostic accuracy of μFR was compared with QFR and FFR. Patients were classified by the non-IRA μFR value of 0.80 as a cutoff value. The primary outcome was a vessel-oriented composite outcome, a composite of cardiac death, non-IRA-related myocardial infarction, and non-IRA-related repeat revascularization. RESULTS μFR and QFR analyses were feasible in 443 patients (552 lesions). μFR showed acceptable correlation with FFR (R=0.777; P<0.001), comparable C-index with QFR to predict FFR ≤0.80 (μFR versus QFR: 0.926 versus 0.961, P=0.070), and shorter total analysis time (mean, 32.7 versus 186.9 s; P<0.001). Non-IRA with μFR >0.80 and deferred percutaneous coronary intervention had a significantly lower risk of vessel-oriented composite outcome than non-IRA with performed percutaneous coronary intervention (3.4% versus 10.5%; hazard ratio, 0.37 [95% CI, 0.14-0.99]; P=0.048). CONCLUSIONS In patients with multivessel AMI, μFR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR ≤0.80. Deferred non-IRA with μFR >0.80 showed a lower risk of vessel-oriented composite outcome than revascularized non-IRA. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.
Collapse
Affiliation(s)
- Woochan Kwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC (D.S.)
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea (H.K.K., K.H.P.)
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea (H.K.K., K.H.P.)
| | - Eun Ho Choo
- Seoul St. Mary's Hospital, The Catholic University of Korea, South Korea (E.H.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, South Korea (C.J.K.)
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, South Korea (S.G.A.)
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.)
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, South Korea (S.Y.L.)
| | - Sang Don Park
- Inha University Hospital, Incheon, South Korea (S.D.P.)
| | - Hyun-Jong Lee
- Sejong General Hospital, Bucheon, South Korea (H.-J.L.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea (M.G.K., J.-S.K.)
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., C.-W.N.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., C.-W.N.)
| | - Hyun Sung Joh
- Seoul National University Boramae Medical Center, Seoul National University College of Medicine, South Korea (H.S.J.)
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| |
Collapse
|
47
|
Ning B, Ge T, Wu Y, Wang Y, Zhao M. Role of Brain-Derived Neurotrophic Factor in Anxiety or Depression After Percutaneous Coronary Intervention. Mol Neurobiol 2024; 61:2921-2937. [PMID: 37946008 DOI: 10.1007/s12035-023-03758-1] [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: 08/17/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Anxiety or depression after percutaneous coronary intervention (PCI) is one of the key clinical problems in cardiology that need to be solved urgently. Brain-derived neurotrophic factor (BDNF) may be a potential biomarker for the pathogenesis and treatment of anxiety or depression after PCI. This article reviews the correlation between BDNF and cardiovascular system and nervous system from the aspects of synthesis, release and action site of BDNF, and focuses on the latest research progress of the mechanism of BDNF in anxiety or depression after PCI. It includes the specific mechanisms by which BDNF regulates the levels of inflammatory factors, reduces oxidative stress damage, and mediates multiple signaling pathways. In addition, this review summarizes the therapeutic potential of BDNF as a potential biomarker for anxiety or depression after PCI.
Collapse
Affiliation(s)
- Bo Ning
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
| | - Teng Ge
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
| | - Yongqing Wu
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
| | - Yuting Wang
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
- Affiliated Hospital, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
| | - Mingjun Zhao
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, 712046, China.
- Affiliated Hospital, Shaanxi University of Chinese Medicine, Xianyang, 712046, China.
- Shaanxi Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Cardiovascular Diseases, Xianyang, 712046, China.
| |
Collapse
|
48
|
Zheng X, Wu H, Zhang M, Yao B. Clinical significance of R-wave amplitude in lead V 1 and inferobasal myocardial infarction in patients with inferior wall myocardial infarction. Ann Noninvasive Electrocardiol 2024; 29:e13114. [PMID: 38563240 PMCID: PMC10985631 DOI: 10.1111/anec.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 02/10/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To assess electrocardiogram (ECG) for risk stratification in inferior ST-elevation myocardial infarction (STEMI) patients within 24 h. METHODS Three hundred thirty-four patients were divided into four ECG-based groups: Group A: R V1 <0.3 mV with ST-segment elevation (ST↑) V7-V9, Group B: R V1 <0.3 mV without ST↑ V7-V9, Group C: R V1 ≥0.3 mV with ST↑ V7-V9, and Group D: R V1 ≥0.3 mV without ST↑ V7-V9. RESULTS Group A demonstrated the longest QRS duration, followed by Groups B, C, and D. ECG signs for right ventricle (RV) infarction were more common in Groups A and B (p < .01). ST elevation in V6, indicative of left ventricle (LV) lateral injury, was more higher in Group C than in Group A, while the ∑ST↑ V3R + V4R + V5R, representing RV infarction, showed the opposite trend (p < .05). The estimated LV infarct size from ECG was similar between Groups A and C, yet Group A had higher creatine kinase MB isoform (CK-MB; p < .05). Cardiac troponin I (cTNI) was higher in Groups A and C than in B and D (p < .05 and p = .16, respectively). NT-proBNP decreased across groups (p = .20), with the highest left ventricular ejection fraction (LVEF) observed in Group D (p < .05). Group A notably demonstrated more cardiac dysfunction within 4 h post-onset. CONCLUSIONS For inferior STEMI patients, concurrent R V1 <0.3 mV with ST↑ V7-V9 suggests prolonged ventricular activation and notable myocardial damage. RV infarction's dominance over LV lateral injury might explain these observations.
Collapse
Affiliation(s)
- Xiao‐Bin Zheng
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| | - Hai‐Yan Wu
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| | - Ming Zhang
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| | - Bing‐Qi Yao
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| |
Collapse
|
49
|
Fong AYY, Said A, Oon YY, Koh KT, Ho KH, Shu FEP, Tan CT, Bhavnani CD, Lee SWH, Liu KT, Cham YL, Ong TK. A Comparison of 2 Paclitaxel-Coated Balloon Systems in Treatment of De Novo Coronary Artery Lesions. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101295. [PMID: 39132464 PMCID: PMC11308760 DOI: 10.1016/j.jscai.2024.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 08/13/2024]
Abstract
Background In percutaneous coronary intervention (PCI) of de novo lesions, drug-coated balloons (DCB) have been shown to be a promising strategy to improve clinical outcomes of patients with small vessel disease. Evidence of this strategy in PCI of de novo coronary lesions in a real-world setting is limited. The objective of this study was to compare the 12-month outcomes of 2 paclitaxel-coated balloon systems for the treatment of all de novo coronary artery lesions. Methods All patients who were treated for de novo coronary artery stenosis with either SeQuent Please or In.Pact Falcon DCB at a single center from January 2014 to December 2018 were included. The primary end point was the composite of cardiac death, nonfatal myocardial infarction, and target vessel revascularization (3-point major adverse cardiovascular events) at 12 months. Results A total of 496 patients with 623 lesions, of which 144 were treated with SeQuent Please and 352 were treated with In.Pact Falcon were included in the study. Baseline patient, lesion and procedural characteristics at baseline were similar between groups. At 12-month follow-up, 3-point major adverse cardiovascular event outcomes were similar (4.2% vs 2.3% respectively; P = .272). Deaths due to cardiovascular events were few and similar between groups (2.7% vs 1.1% respectively; P = .20). Conclusions Both paclitaxel DCB systems have similar efficacy and safety outcomes, suggesting that both may be an appropriate treatment choice for patients with de novo lesions. However, a larger randomized controlled study is needed to confirm these findings.
Collapse
Affiliation(s)
- Alan Yean Yip Fong
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
- Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Asri Said
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Yen Yee Oon
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | - Keng Tat Koh
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | - Kian Hui Ho
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | - Francis Eng Pbeng Shu
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | - Chen Ting Tan
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | - Chandan Deepak Bhavnani
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | | | - Kien Ting Liu
- National Heart Association of Malaysia, Kuala Lumpur, Malaysia
| | - Yee Ling Cham
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia, Kota Samarahan, Malaysia
| |
Collapse
|
50
|
Cheng AM, Doll JA. When to Consider Coronary Revascularization for Stable Coronary Artery Disease. Med Clin North Am 2024; 108:517-538. [PMID: 38548461 DOI: 10.1016/j.mcna.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Revascularization is an effective adjunct to medical therapy for some patients with chronic coronary disease. Despite numerous randomized trials, there remains significant uncertainty regarding if and how to revascularize many patients. Coronary artery bypass grafting is a class I indication for patients with significant left main stenosis or multivessel disease with ejection fraction ≤ 35%. For other patients, clinicians must carefully consider the potential benefits of symptom improvement and reduction of future myocardial infarction or CV death against the risk and cost of revascularization. Although guidelines provide a framework for these decisions, each individual patient will have distinct coronary anatomy, clinical factors, and preferences.
Collapse
Affiliation(s)
- Andrew M Cheng
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Section of Cardiology, VA Puget Sound Health Care System, 1660 South Columbian Way S111-CARDIO, Seattle, WA 98108, USA
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Section of Cardiology, VA Puget Sound Health Care System, 1660 South Columbian Way S111-CARDIO, Seattle, WA 98108, USA.
| |
Collapse
|