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Franke KB, Montarello NJ, Nelson AJ, Marathe JA, Wong DT, Tavella R, Arstall M, Zeitz C, Worthley MI, Beltrame JF, Psaltis PJ. Tandem lesions associate with angiographic progression of coronary artery stenoses. IJC HEART & VASCULATURE 2024; 52:101417. [PMID: 38725440 PMCID: PMC11079457 DOI: 10.1016/j.ijcha.2024.101417] [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: 12/11/2023] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
Background Although the clinical factors associated with progression of coronary artery disease have been well studied, the angiographic predictors are less defined. Objectives Our objective was to study the clinical and angiographic factors that associate with progression of coronary artery stenoses. Methods We conducted a retrospective analysis of consecutive patients undergoing multiple, clinically indicated invasive coronary angiograms with an interval greater than 6 months, between January 2013 and December 2016. Lesion segments were analysed using Quantitative Coronary Angiography (QCA) if a stenosis ≥ 20 % was identified on either angiogram. Stenosis progression was defined as an increase ≥ 10 % in stenosis severity, with progressor groups analysed on both patient and lesion levels. Mixed-effects regression analyses were performed to evaluate factors associated with progression of individual stenoses. Results 199 patients were included with 881 lesions analysed. 108 (54.3 %) patients and 186 (21.1 %) stenoses were classified as progressors. The median age was 65 years (IQR 56-73) and the median interval between angiograms was 2.1 years (IQR 1.2-3.0). On a patient level, age, number of lesions and presence of multivessel disease at baseline were each associated with progressor status. On a lesion level, presence of a stenosis downstream (OR 3.07, 95 % CI 2.04-4.63, p < 0.001) and circumflex artery stenosis location (OR 1.81, 95 % CI 1.21-2.7, p = 0.004) were associated with progressor status. Other lesion characteristics did not significantly impact progressor status or change in stenosis severity. Conclusion Coronary lesions which have a downstream stenosis may be at increased risk of stenosis progression. Further research into the mechanistic basis of this finding is required, along with its implications for plaque vulnerability and clinical outcomes.
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Affiliation(s)
- Kyle B. Franke
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nicholas J. Montarello
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J. Nelson
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Jessica A. Marathe
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | | | - Rosanna Tavella
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Margaret Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Christopher Zeitz
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Matthew I. Worthley
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - John F. Beltrame
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Peter J. Psaltis
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
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2
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Roberto M, Hoepli A, Cattaneo M, Radovanovic D, Rickli H, Erne P, Pedrazzini GB, Moccetti M. Patients With AMI and Severely Reduced LVEF, a Well-Defined, Still Extremely Vulnerable Population (Insights from AMIS Plus Registry). Am J Cardiol 2023; 200:190-201. [PMID: 37348272 DOI: 10.1016/j.amjcard.2023.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/23/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
Left ventricular ejection fraction (LVEF) represents one of the strongest predictors of both in-hospital and long-term prognosis in acute myocardial infarction (AMI). Temporal trends data coming from real-world experiences focused on patients with AMI with severely reduced LVEF (i.e., <30%) are lacking. In a total of 48,543 screened patients with AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry between 2005 and 2020, data on LVEF were available for 23,510 patients. Study patients were classified according to LVEF as patients with AMI with or without severely reduced LVEF (i.e., patients with LVEF <30% and ≥30%, respectively). Overall, 1,657 patients with AMI (7%) displayed severely reduced LVEF. The prevalence of severe LVEF reduction constantly decreased over the study period (from 11% to 4%, p <0.001). In the subgroup of patients with severely reduced LVEF, a significant increase in revascularization rate was observed (from 61% to 84%, p <0.001); however, in-hospital mortality did not significantly decrease and remained well above 20% over the study period (from 23% to 26%, p = 0.65). At discharge, prescription of optimal cardioprotective therapy (defined as an association of renin-angiotensin-aldosterone-system inhibitors, β-blocker, and mineral corticoid receptor antagonist) remained low across the study period (from 17% in 2011 to 20%, p = 0.96). In conclusion, patients with AMI with severely reduced LVEF remain a fragile subgroup of patients with an in-hospital mortality that did not significantly decrease and remained well above 20% over the study period. Moreover, access at discharge to optimal cardioprotective therapy remains suboptimal. Efforts are, therefore, needed to improve prognosis and access to guidelines-directed therapies in this fragile population.
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Affiliation(s)
- Marco Roberto
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland; Cardiology Department, Clinique Le Noirmont, Le Noirmont, Switzerland.
| | - André Hoepli
- AMIS Plus Data Centre, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Mattia Cattaneo
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Centre, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hans Rickli
- Cardiology Department, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Paul Erne
- AMIS Plus Data Centre, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Marco Moccetti
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
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3
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Akodad M, Meunier PA, Padovani C, Cayla G, Zitouni W, Macia JC, Robert P, Steinecker M, Roubille F, Leclercq F. Identification of Low- versus High-Risk Acute Coronary Syndrome for a Selective ECG Monitoring Strategy. J Clin Med 2023; 12:4604. [PMID: 37510718 PMCID: PMC10380550 DOI: 10.3390/jcm12144604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND While admission of patients with acute coronary syndromes (ACS) in cardiology intensive care unit (CICU) is usual, in-hospital major outcomes in lower risk patients may be evaluated after early coronary angiography according to the European guidelines. METHODS Consecutive ACS patients were prospectively included after coronary angiography evaluation within 24 h and percutaneous coronary intervention (PCI), when required. Patients were classified as high- or low-risk according to hemodynamics, rhythmic state, ischemic and bleeding risks. Major in-hospital outcomes were assessed. RESULTS From January to June 2021, 277 patients were enrolled (62.8% with ST-segment elevation myocardial infarction (STEMI) (n = 174); 37.2% with non-NSTEMI (NSTEMI) (n = 103). PCI was required for 260 patients (93.9%). Seventy-four patients (26.7%) were classified as low-risk (n = 47 NSTEMI; n= 27 STEMI) and 203 patients (73.3%) as high-risk of events. All patients were monitored in CICU. While 38 patients (18.7%) from the high-risk group reached the primary endpoint, mainly related to rhythmic or conduction disorder (n = 24, 11.8%) or unstable hemodynamics (n = 17; 8.4%), only 1 patient (1.3%) in the low-risk group had one major outcome (no fatal bleeding); p < 0.01. The negative predictive value of our patient stratification for the absence of major in-hospital outcome was 100% (CI95%: 100-100%) for STEMI and 97.9% [CI95%: 93.2-100%] for NSTEMI patients. CONCLUSIONS Stratification of ACS patients after early coronary angiography and most of the time PCI, identify a population with very low risk of in-hospital events (1/4 of all ACS and 1/2 of NSTEMI) who may probably not require ECG monitoring and/or CICU admission. (NCT04378504).
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Affiliation(s)
- Mariama Akodad
- South Paris Cardiovascular Institute, Jacques Cartie Hospital, 91300 Massy, France
| | - Pierre-Alain Meunier
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Caroline Padovani
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nîmes, 30900 Nîmes, France
| | - Wassim Zitouni
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Jean-Christophe Macia
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Pierre Robert
- Department of Cardiology, University Hospital of Nîmes, 30900 Nîmes, France
| | - Matthieu Steinecker
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, 34295 Montpellier, France
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Kurup R, Wijeysundera HC, Bagur R, Ybarra LF. Complete Versus Incomplete Percutaneous Coronary Intervention-Mediated Revascularization in Patients With Chronic Coronary Syndromes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 47:86-92. [PMID: 36266152 DOI: 10.1016/j.carrev.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023]
Abstract
Multivessel coronary artery disease (CAD) is associated with worse outcomes across the spectrum of clinical presentations. The prognostic implications of completeness of revascularization in CAD patients, especially those with chronic coronary syndromes (CCS), remain highly debated. This is largely due to the use of non-standardized definitions for complete revascularization (CR) and incomplete revascularization (ICR) within previously published studies, lack of randomized clinical data, varying revascularization methods and heterogenous study populations. In particular, the utility and effectiveness of PCI-mediated CR for CCS remains unknown. In this review, we discuss the various definitions used for CR vs. ICR, highlight the rationale for pursuing CR and summarise the current literature regarding the effects of PCI-mediated CR on clinical outcomes in patients with CCS.
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Affiliation(s)
- Rahul Kurup
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Rodrigo Bagur
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Luiz F Ybarra
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
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5
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Greer PJ, Lee PJ, Paragomi P, Stello K, Phillips A, Hart P, Speake C, Lacy-Hulbert A, Whitcomb DC, Papachristou GI. Severe acute pancreatitis exhibits distinct cytokine signatures and trajectories in humans: a prospective observational study. Am J Physiol Gastrointest Liver Physiol 2022; 323:G428-G438. [PMID: 36098405 PMCID: PMC9621712 DOI: 10.1152/ajpgi.00100.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
Severe acute pancreatitis (SAP) is associated with substantial morbidity and mortality. Several cytokines have been identified to have pathophysiological significance in SAP, but studies characterizing their early trajectories are lacking. Here we characterize the early trajectories of seven key cytokines associated with SAP and compare them with non-SAP subjects. Five proinflammatory cytokines (angiopoietin-2, interleukin-6, interleukin-8, monocyte chemoattractant protein-1, resistin) and two anti-inflammatory cytokines (hepatocyte growth factor, and soluble tumor necrosis factor-α receptor-1A) were measured in a prospective cohort of acute pancreatitis subjects (2012-2016) at the time of enrollment and then every 24 h for 5 days or until discharge. The cytokines' levels and trajectories were calibrated based on date of pain onset and were compared between healthy controls and three severity categories (mild, moderate, and severe). The cohort (n = 170) consisted of 27 healthy controls, 65 mild, 38 moderate, and 40 SAP. From day 1 of symptom onset, SAP subjects exhibited significantly higher levels of both pro- and anti-inflammatory cytokines compared with non-SAP and healthy subjects. But in SAP subjects, all proinflammatory cytokines' levels trended downward after day 2 (except for a flat slope for angiopoeitin-2) whereas for non-SAP subjects, the trajectory was upward: this trajectory difference between SAP versus non-SAP subjects resulted in narrowing of the differences initially seen on day 1 for proinflammatory cytokines. For anti-inflammatory cytokines, the trajectories were uniformly upward for both SAP and non-SAP subjects. Proinflammatory cytokine response is an early and time-sensitive event in SAP that should be accounted for when designing future biomarker studies and/or therapeutic trials.NEW & NOTEWORTHY In this study, we showed that the proinflammatory cytokine response in SAP is an early event, with subsequent downregulation of proinflammatory cytokines beginning at day 1 of symptom onset. Our findings underscore the importance of enrolling subjects very early in the disease course when conducting studies to investigate early immune events of SAP; this current study also serves as an important reference for the design of future biomarker studies and therapeutic trials in SAP.
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Affiliation(s)
- Phil J Greer
- Ariel Precision Medicine, Pittsburgh, Pennsylvania
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Pedram Paragomi
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kim Stello
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna Phillips
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Phil Hart
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Adam Lacy-Hulbert
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - David C Whitcomb
- Ariel Precision Medicine, Pittsburgh, Pennsylvania
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Physiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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6
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Wang KL, Roobottom C, Smith JE, Goodacre S, Oatey K, O’Brien R, Storey RF, Curzen N, Keating L, Kardos A, Felmeden D, Thokala P, Mills NL, Newby DE, Gray AJ. Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:570-579. [PMID: 35642464 PMCID: PMC9302931 DOI: 10.1093/ehjacc/zuac057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 12/28/2022]
Abstract
Aims To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. Methods and results In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome—death or subsequent Type 1 or 4b myocardial infarction—but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P < 0.001), non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001) testing, coronary revascularization (47 vs. 15%; P < 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). Conclusion Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome.
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Affiliation(s)
- Kang Ling Wang
- Centre for Cardiovascular Science, University of Edinburgh , Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB , UK
- School of Medicine, National Yang Ming Chiao Tung University , Taipei , Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Carl Roobottom
- Department of Radiology, University Hospitals Plymouth NHS Trust , Plymouth , UK
| | - Jason E Smith
- Emergency Department, University Hospitals Plymouth NHS Trust , Plymouth , UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield , Sheffield , UK
| | - Katherine Oatey
- Edinburgh Clinical Trials Unit, University of Edinburgh , Edinburgh , UK
| | - Rachel O’Brien
- Department of Emergency Medicine, Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield , Sheffield , UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton , Southampton , UK
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Liza Keating
- Department of Emergency Medicine, Royal Berkshire NHS Foundation Trust , Reading , UK
| | - Attila Kardos
- Translational Cardiovascular Research Group, Milton Keynes University Hospital NHS Foundation Trust , Milton Keynes , UK
- Faculty of Medicine and Health Science, University of Buckingham , Buckingham , UK
| | - Dirk Felmeden
- Department of Cardiology, Torbay and South Devon NHS Foundation Trust , Torquay , UK
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield , Sheffield , UK
| | - Nicholas L Mills
- Centre for Cardiovascular Science, University of Edinburgh , Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB , UK
- Usher Institute, University of Edinburgh , Edinburgh , UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh , Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB , UK
| | - Alasdair J Gray
- Department of Emergency Medicine, Royal Infirmary of Edinburgh , Edinburgh , UK
- Usher Institute, University of Edinburgh , Edinburgh , UK
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7
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Okkonen M, Havulinna AS, Ukkola O, Huikuri H, Pietilä A, Koukkunen H, Lehto S, Mustonen J, Ketonen M, Airaksinen J, Kesäniemi YA, Salomaa V. Risk factors for major adverse cardiovascular events after the first acute coronary syndrome. Ann Med 2021; 53:817-823. [PMID: 34080496 PMCID: PMC8183550 DOI: 10.1080/07853890.2021.1924395] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
AIMS To evaluate risk factors for major adverse cardiac event (MACE) after the first acute coronary syndrome (ACS) and to examine the prevalence of risk factors in post-ACS patients. METHODS We used Finnish population-based myocardial infarction register, FINAMI, data from years 1993-2011 to identify survivors of first ACS (n = 12686), who were then followed up for recurrent events and all-cause mortality for three years. Finnish FINRISK risk factor surveys were used to determine the prevalence of risk factors (smoking, hyperlipidaemia, diabetes and blood pressure) in post-ACS patients (n = 199). RESULTS Of the first ACS survivors, 48.4% had MACE within three years of their primary event, 17.0% were fatal. Diabetes (p = 4.4 × 10-7), heart failure (HF) during the first ACS attack hospitalization (p = 6.8 × 10-15), higher Charlson index (p = 1.56 × 10-19) and older age (p = .026) were associated with elevated risk for MACE in the three-year follow-up, and revascularization (p = .0036) was associated with reduced risk. Risk factor analyses showed that 23% of ACS survivors continued smoking and cholesterol levels were still high (>5mmol/l) in 24% although 86% of the patients were taking lipid lowering medication. CONCLUSION Diabetes, higher Charlson index and HF are the most important risk factors of MACE after the first ACS. Cardiovascular risk factor levels were still high among survivors of first ACS.
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Affiliation(s)
- Marjo Okkonen
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Aki S. Havulinna
- Finnish Institute for Health and Welfare, Helsinki, Finland
- FIMM: Institute for Molecular Medicine Finland, Helsinki, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Arto Pietilä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heli Koukkunen
- Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Seppo Lehto
- University of Eastern Finland, Kuopio, Finland
| | | | | | - Juhani Airaksinen
- University of Turku and Heart Center Turku University Hospital, Turku, Finland
| | - Y. Antero Kesäniemi
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
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8
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Akboğa MK, Yılmaz S, Yalçın R. Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation. Anatol J Cardiol 2021; 25:789-795. [PMID: 34734812 PMCID: PMC8575397 DOI: 10.5152/anatoljcardiol.2021.03982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic value of preprocedural CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, previous stroke or transient ischemic attack (TIA) (doubled), vascular disease, age 65-74 years, female gender] score in predicting high SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and in-hospital mortality for non-atrial fibrillation (AF) patients presenting with non-ST elevation myocardial infarction (NSTEMI). The CHA2DS2-VASc score used to determine thromboembolic risks in AF was recently reported to predict major adverse clinical outcomes in patients with the acute coronary syndrome, irrespective of AF. METHODS A total of 906 patients with a diagnosis of NSTEMI who underwent coronary angiography were retrospectively enrolled and divided into three groups according to their SYNTAX scores (low, intermediate, and high). The CHA2DS2-VASc score of each patient was calculated. RESULTS SYNTAX score had a significant positive correlation with the CHA2DS2-VASc score (r=0.320; p<0.001) in the Spearman correlation analysis. The CHA2DS2-VASc score [Odds ratio, 1.445; 95% confidence interval (CI), 1.268-1.648, p<0.001], left ventricular ejection fraction, creatinine, C-reactive protein, and high-density and low-density lipoprotein cholesterol levels were demonstrated to be independent predictors of high SYNTAX score. The CHA2DS2-VASc score [Hazard ratio (HR), 1.867; 95% CI: 1.462-2.384; p<0.001], the SYNTAX score (HR, 1.049; p=0.003), and age (HR, 1.057; p=0.002) were independently associated with higher risk of in-hospital mortality in a multiple Cox-regression model. Kaplan-Meier survival curves stratified by the CHA2DS2-VASc score (<4 vs. ≥4) also showed that higher CHA2DS2-VASc scores were associated with higher in-hospital mortality. CONCLUSIONS In non-AF patients with NSTEMI, CHA2DS2-VASc and SYNTAX scores are useful for prognosis assessment and can be used to identify patients at higher risk for in-hospital mortality.
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Affiliation(s)
- Mehmet Kadri Akboğa
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | - Samet Yılmaz
- Department of Cardiology, Faculty of Medicine, Pamukkale University; Denizli-Turkey
| | - Rıdvan Yalçın
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
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9
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Iqbal MB, Moore PT, Nadra IJ, Robinson SD, Fretz E, Ding L, Fung A, Aymong E, Chan AW, Hodge S, Webb J, Sheth T, Jolly SS, Mehta SR, Sathananthan J, Wood DA, Della Siega A. Complete revascularization in stable multivessel coronary artery disease: A real world analysis from the British Columbia Cardiac Registry. Catheter Cardiovasc Interv 2021; 99:627-638. [PMID: 33660326 DOI: 10.1002/ccd.29564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND More than half of patients undergoing percutaneous coronary intervention (PCI) have multivessel disease (MVD). The prognostic significance of PCI in stable patients has recently been debated, but little data exists about the potential benefit of complete revascularization (CR) in stable MVD. We investigated the prognostic benefit of CR in patients undergoing PCI for stable disease. METHODS We compared CR versus incomplete revascularization (IR) in 8,436 patients with MVD. The primary outcome was all-cause mortality at 5 years. RESULTS A total of 1,399 patients (17%) underwent CR during the index PCI procedure for stable disease. CR was associated with lower mortality (6.2 vs. 10.7%, p < .001) and lower repeat revascularization at 5 years (12.7 vs. 18.4%, p < .001). Multivariable-adjusted analyses indicated that CR was associated with lower mortality (HR = 0.73, 95% CI: 0.58-0.91, p = .005) and repeat revascularization at 5 years (HR = 0.78, 95% CI: 0.66-0.93, p = .005). These findings were also confirmed in propensity-matched cohorts. Subgroup analyses indicated that CR conferred survival in older patients, male patients, absence of renal disease, greater angina (CCS Class III-IV) and heart failure (NYHA Class III-IV) symptoms, and greater burden of coronary disease. In sensitivity analyses where patients with subsequent repeat revascularization events were excluded, CR remained a strong predictor for lower mortality (HR = 0.69, 95% CI: 0.54-0.89, p = .004). CONCLUSIONS In this study of stable patients with MVD, CR was an independent predictor of long-term survival. This benefit was specifically seen in higher risk patient groups and indicates that CR may benefit selected stable patients with MVD.
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Affiliation(s)
- M Bilal Iqbal
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter T Moore
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Imad J Nadra
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Simon D Robinson
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Fretz
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Lillian Ding
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Anthony Fung
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Eve Aymong
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Albert W Chan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Vancouver, British Columbia, Canada
| | - Steven Hodge
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - John Webb
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tej Sheth
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Nanna MG, Peterson ED, Chiswell K, Overton RA, Nelson AJ, Kong DF, Navar AM. The incremental value of angiographic features for predicting recurrent cardiovascular events: Insights from the Duke Databank for Cardiovascular Disease. Atherosclerosis 2021; 321:1-7. [PMID: 33582446 DOI: 10.1016/j.atherosclerosis.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Identifying patient subgroups with cardiovascular disease (CVD) at highest risk for recurrent events remains challenging. Angiographic features may provide incremental value in risk prediction beyond clinical characteristics. METHODS We included all cardiac catheterization patients from the Duke Databank for Cardiovascular Disease with significant coronary artery disease (CAD; 07/01/2007-12/31/2012) and an outpatient follow-up visit with a primary care physician or cardiologist in the same health system within 3 months post-catheterization. Follow-up occurred for 3 years for the primary major adverse cardiovascular event endpoint (time to all-cause death, myocardial infarction [MI], or stroke). A multivariable model to predict recurrent events was developed based on clinical variables only, then adding angiographic variables from the catheterization. Next, we compared discrimination of clinical vs. clinical plus angiographic risk prediction models. RESULTS Among 3366 patients with angiographically-defined CAD, 633 (19.2%) experienced cardiovascular events (death, MI, or stroke) within 3 years. A multivariable model including 18 baseline clinical factors and initial revascularization had modest ability to predict future atherosclerotic cardiovascular disease events (c-statistic = 0.716). Among angiographic predictors, number of diseased vessels, left main stenosis, left anterior descending stenosis, and the Duke CAD Index had the highest value for secondary risk prediction; however, the clinical plus angiographic model only slightly improved discrimination (c-statistic = 0.724; delta 0.008). The net benefit for angiographic features was also small, with a relative integrated discrimination improvement of 0.05 (95% confidence interval: 0.03-0.08). CONCLUSIONS The inclusion of coronary angiographic features added little incremental value in secondary risk prediction beyond clinical characteristics.
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Affiliation(s)
- Michael G Nanna
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Duke University Medical Center, Department of Medicine, Durham, NC, USA.
| | - Eric D Peterson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Robert A Overton
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Adam J Nelson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - David F Kong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Duke University Medical Center, Department of Medicine, Durham, NC, USA
| | - Ann Marie Navar
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Long-Term Outcomes of Complete Revascularization With Percutaneous Coronary Intervention in Acute Coronary Syndromes. JACC Cardiovasc Interv 2021; 13:1557-1567. [PMID: 32646697 DOI: 10.1016/j.jcin.2020.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/25/2020] [Accepted: 04/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the long-term outcomes of patients with acute coronary syndromes (ACS) with multivessel disease undergoing percutaneous coronary intervention (PCI). BACKGROUND Controversy exists regarding the benefit of multivessel PCI across the spectrum of ACS. METHODS A total of 9,094 patients with ACS and multivessel disease (≥70% stenosis in 2 or more major epicardial vessels) undergoing PCI from the Alberta COAPT (Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies) registry (April 1, 2007, to March 31, 2013) were reviewed. Comparisons were made between patients who underwent complete revascularization and those with incomplete revascularization. Complete revascularization was defined as multivessel PCI with a residual angiographic jeopardy score ≤10%. Associations between revascularization status and all-cause death or new myocardial infarction (primary composite endpoint) and all-cause death, new myocardial infarction, or repeat revascularization (secondary composite endpoint) were evaluated. RESULTS Of the study cohort, 66.0% underwent complete revascularization. Compared with incomplete revascularization, the primary composite endpoint occurred less frequently with complete revascularization (event rate within 5 years 15.4% vs. 22.2%; inverse probability-weighted hazard ratio [IPW-HR]: 0.78; 95% confidence interval [CI]: 0.73 to 0.84; p < 0.0001). The secondary composite endpoint was less likely to occur with complete revascularization (event rate within 5 years 23.3% vs. 37.5%; IPW-HR: 0.61; 95% CI: 0.58 to 0.65; p < 0.0001). Complete revascularization was associated with a reduction in all-cause death (IPW-HR: 0.79; 95% CI: 0.73 to 0.86; p = 0.0004), new myocardial infarction (IPW-HR: 0.76; 95% CI: 0.69 to 0.84; p < 0.0001), and repeat revascularization (IPW-HR: 0.53; 95% CI: 0.49 to 0.57; p < 0.0001). CONCLUSIONS Results from this large contemporary registry of patients with ACS and PCI for multivessel disease suggest that complete revascularization occurs commonly and is associated with improved clinical outcomes (including survival) within 5 years.
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12
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Immediate versus deferred percutaneous coronary intervention for patients with acute coronary syndrome: A meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0234655. [PMID: 32614851 PMCID: PMC7332029 DOI: 10.1371/journal.pone.0234655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/31/2020] [Indexed: 11/19/2022] Open
Abstract
Inconsistent results exist regarding the treatment effectiveness of immediate versus deferred percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the efficacy and safety of immediate versus deferred PCI in ACS patients. PubMed, EMBASE, and Cochrane Library electronic databases were systematically searched from their inception up to August 2019. Random-effects models were employed to calculate pooled relative risks (RRs) and weight mean differences (WMDs) with 95% confidence intervals (CIs). A total of 10 randomized controlled trials (RCTs) that recruited 3350 patients were selected for inclusion in the final meta-analysis. Four trials included patients with non-ST elevation ACS (NSTEACS), whereas the remaining six trials included patients with ST elevation myocardial infarction (STEMI). There were no significant differences between immediate versus deferred PCI for the risk of major adverse cardiovascular events (NSTEACS patients: RR, 0.76, 95%CI, 0.33-1.75, P = 0.513; STEMI patients: RR, 1.24, 95%CI, 0.80-1.92, P = 0.335), myocardial infarction (NSTEACS patients: RR, 0.88, 95%CI, 0.27-2.81, P = 0.826; STEMI patients: RR, 0.86, 95%CI, 0.43-1.74, P = 0.678), all-cause mortality (NSTEACS patients: RR, 0.85, 95%CI, 0.38-1.88, P = 0.686; STEMI patients: RR, 1.16, 95%CI, 0.82-1.66, P = 0.407), target vessel revascularisation (NSTEACS patients: RR, 1.26, 95%CI, 0.29-5.43, P = 0.756; STEMI patients: RR, 1.01, 95%CI, 0.51-1.97, P = 0.988), or major bleeding (NSTEACS patients: RR, 0.99, 95%CI, 0.64-1.54, P = 0.972; STEMI patients: RR, 0.90, 95%CI, 0.45-1.77, P = 0.753). Although patients who underwent immediate PCI may experience increased incidences of cardiac death (RR, 1.19, 95%CI, 0.69-2.07, P = 0.525) and no or slow reflow (RR, 1.60, 95%CI, 0.91-2.84, P = 0.105), these increases were not statistically significant. We noted that immediate versus deferred PCI was associated with a reduced incidence of myocardial brush grade 3 (RR, 0.70, 95%CI, 0.56-0.88, P = 0.002); however, no significant differences were observed between immediate and deferred PCI for TIMI III flow (RR, 0.98, 95%CI, 0.93-1.03, P = 0.453), complete ST-segment resolution (RR, 0.93, 95%CI, 0.75-1.17, P = 0.548), and ejection fraction (WMD, -1.05, 95%CI, -2.58 to 0.49, P = 0.182). The findings of this study suggested that deferred PCI did not yield significant benefits for clinical endpoints. Further large-scale RCTs should be conducted to verify the findings of this study.
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13
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Kul S, Konus AH, Dursun I, Turan T, Cirakoglu OF, Sahin S, Karal H, Akyuz AR. Anterior Tragal Crease Is Associated With SYNTAX Score in Non-ST-Segment Elevation Myocardial Infarction. Angiology 2020; 71:793-798. [PMID: 32347104 DOI: 10.1177/0003319720920143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to investigate the relation between anterior tragal crease (ATC) and coronary artery lesion complexity and severity assessed using the SYNTAX score (SXscore) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 121 patients with a first-time diagnosis of NSTEMI were consecutively enrolled. ATC was defined as ≥1 crease that was close to the tragus and descended anteriorly. SXscore was calculated using the SXscore algorithm. The SXscore was higher in the ATC-positive group than in the ATC-negative group (11.85 ± 8.20 vs 7.52 ± 6.38, P = .003). In the univariate analysis, hemoglobin (male: 11.7-17.4 g/dL, female: 11.7-16.1 g/dL; P = .006), diabetes mellitus (P = .031), current smoking (P = .022), and presence of ATC (P = .022) were significantly associated with increased SXscore. Multivariate analysis revealed ATC (95% confidence interval [CI]: 1.313-7.800, P = .011), current smoking (95% CI: 2.034-13.893, P = .001), and hemoglobin (95% CI: 0.433-0.822, P = .002) as independent determinants of increased SXscore. Anterior tragal crease is easily detected by physical examination. Presence of ATC in patients with NSTEMI may be a warning signal of complexity and severity of coronary artery disease (CAD).
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Affiliation(s)
- Selim Kul
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ali Hakan Konus
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ihsan Dursun
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Turhan Turan
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Omer Faruk Cirakoglu
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Sinan Sahin
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Huseyin Karal
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ali Riza Akyuz
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
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Yahud E, Tzuman O, Fink N, Goldenberg I, Goldkorn R, Peled Y, Lev E, Asher E. Trends in long-term prognosis according to left ventricular ejection fraction after acute coronary syndrome. J Cardiol 2020; 76:303-308. [PMID: 32334901 DOI: 10.1016/j.jjcc.2020.03.012] [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: 01/21/2020] [Revised: 02/27/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
AIMS Our aim was to investigate trends in prognosis among survivors of acute coronary syndrome according to left ventricular ejection fraction during a 16-year period. METHODS Data were derived from the Acute Coronary Syndrome Israeli Survey during the years 2000-2016. Patients aged 18 years and older were included in the analysis (N=11,725). Patients were classified into two groups based on their left ventricular ejection fraction: preserved (≥50%) and reduced (<50%) and also according to their acute coronary syndrome onset (2000-2006 early period vs. 2008-2016 late period). Endpoints were all-cause mortality rates at one and three years after the index event. RESULTS Preserved left ventricular ejection fraction was present in 5047/11,725 (43%) of patients. As expected, patients with preserved left ventricular ejection fraction had lower 1 and 3-year mortality rates as compared with reduced left ventricular ejection fraction regardless of the acute coronary syndrome period onset (6% vs. 19%, p<0.001). Nevertheless, in the late period the prevalence of reduced left ventricular ejection fraction decreased significantly, becoming equal to preserved left ventricular ejection fraction [2761 (50.5%) vs. 2713 (49.5%) respectively, p=0.3]. Moreover, prognosis during the late period as compared with the early period was improved only in patients with reduced left ventricular ejection fraction (HR 0.79; 95% CI 0.70-0.89, p=0.0001). CONCLUSION The prevalence of reduced left ventricular ejection fraction has decreased and prognosis has improved during the past several years but is still much worse than the prognosis of preserved left ventricular ejection fraction.
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Affiliation(s)
- Ella Yahud
- Cardiology Division, Assuta Ashdod University Hospital, Ashdod, Israel.
| | - Oran Tzuman
- Cardiology Division, Assaf Harofeh Hospital, Beer Ya'akov, Israel
| | - Noam Fink
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Ronen Goldkorn
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Peled
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Eli Lev
- Cardiology Division, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Elad Asher
- Heart Institute, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
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15
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Effect of Body Mass Index on Ischemic and Bleeding Events in Patients Presenting With Acute Coronary Syndromes (from the START-ANTIPLATELET Registry). Am J Cardiol 2019; 124:1662-1668. [PMID: 31585697 DOI: 10.1016/j.amjcard.2019.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023]
Abstract
The protective effect of obesity on mortality in acute coronary syndromes (ACS) patients remains debated. We aimed at evaluating the impact of obesity on ischemic and bleeding events as possible explanations to the obesity paradox in ACS patients. For the purpose of this substudy, patients enrolled in the START-ANTIPLATELET registry were stratified according to body mass index (BMI) into 3 groups: normal, BMI <25 kg/m2; overweight, BMI: 25 to 29.9 kg/m2; obese, BMI ≥30 kg/m2. The primary end point was net adverse clinical end points (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. In n = 1,209 patients, n = 410 (33.9%) were normal, n = 538 (44.5%) were overweight and n = 261 (21.6%) were obese. Compared to the normal weight group, obese and overweight patients had a higher prevalence of cardiovascular risk factors but were younger, with a better left ventricular ejection fraction and lower PRECISE-DAPT score. At 1-year follow-up net adverse clinical endpoints was more frequently observed in normal than in overweight and obese patients (15.1%, 8.6%, and9.6%, respectively; p = 0.004), driven by a significantly higher rate of all-cause death (6.3%, 2.6%, and 3.8%, respectively; p = 0.008), whereas no significant differences were noted in terms of myocardial infarction, stroke, and major bleeding. When correcting for confounding variables, BMI loses its power in independently predicting outcomes, failing to confirm the obesity paradox in a real-world ACS population. In conclusion, our study conflicts the obesity paradox in real-world ACS population, and suggest that the reduced rate of adverse events and mortality in obese patients may be explained by relevant differences in the clinical risk profile and medications rather than BMI per se.
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16
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Ma X, Hou F, Tian J, Zhou Z, Ma Y, Cheng Y, Du Y, Shen H, Hu B, Wang Z, Liu Y, Zhao Y, Zhou Y. Aortic Arch Calcification Is a Strong Predictor of the Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7659239. [PMID: 31485445 PMCID: PMC6702823 DOI: 10.1155/2019/7659239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the correlation of the extent of aortic arch calcification (AAC) detectable on chest X-rays with the severity of coronary artery disease (CAD) as evaluated by the SYNTAX score (SS) in patients with acute coronary syndrome (ACS). METHODS A total of 1,418 patients (344 women; 59 ± 10 years) who underwent coronary angiography for ACS and were treated with coronary revascularization were included in the present study; chest X-rays were performed on admission. The AAC extent was divided into four grades (0-3). SS was calculated based on each patient's coronary angiographic findings. The relationship between the AAC extent and SS was assessed. RESULTS The AAC extent was positively correlated with SS (ρ = 0.639, P < 0.001). In the multivariate analysis, compared with grade 0, odds ratios (ORs) of AAC grades 1, 2, and 3 in predicting SS >22 were 12.95 (95% CI, 7.85-21.36), 191.76 (95% CI, 103.17-356.43), and 527.81 (95% CI, 198.24-1405.28), respectively. Receiver operating characteristic curve analysis yielded a strong predictive ability of the AAC extent for SS >22 (area under curve = 0.840, P < 0.001). Absence of AAC had a sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of 46.7%, 95.9%, 94.1%, 56.4%, and 67.3%, respectively, for SS ≤22. AAC grades ≥2 had a sensitivity of 66.3%, specificity of 89.2%, positive prognostic value of 81.5%, negative prognostic value of 78.6%, and accuracy of 79.6% for the correct identification of SS >22. CONCLUSIONS The extent of AAC detectable on chest X-rays might provide valuable information in predicting CAD severity in ACS patients.
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Affiliation(s)
- Xiaoteng Ma
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Fangjie Hou
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Jing Tian
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yue Ma
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Yujing Cheng
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Yu Du
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Hua Shen
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Bin Hu
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Zhijian Wang
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Yuyang Liu
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Yingxin Zhao
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, 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, Beijing 100029, China
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Marenzi G, Cosentino N, Genovese S, Campodonico J, De Metrio M, Rondinelli M, Cornara S, Somaschini A, Camporotondo R, Demarchi A, Milazzo V, Moltrasio M, Rubino M, Marana I, Grazi M, Lauri G, Bonomi A, Veglia F, De Ferrari GM, Bartorelli AL. Reduced Cardio-Renal Function Accounts for Most of the In-Hospital Morbidity and Mortality Risk Among Patients With Type 2 Diabetes Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Diabetes Care 2019; 42:1305-1311. [PMID: 31048409 DOI: 10.2337/dc19-0047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/08/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (DM) have higher in-hospital mortality than those without. Since cardiac and renal functions are the main variables associated with outcome in STEMI, we hypothesized that this prognostic disparity may depend on a higher rate of cardiac and renal dysfunction in DM patients. RESEARCH DESIGN AND METHODS We retrospectively analyzed 5,152 STEMI patients treated with primary angioplasty. Left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were evaluated at hospital admission. The primary end point was in-hospital mortality. A composite of in-hospital mortality, cardiogenic shock, and acute kidney injury was the secondary end point. RESULTS There were 879 patients (17%) with DM. The incidence of LVEF ≤40% (30% vs. 22%), eGFR ≤60 mL/min/1.73 m2 (27% vs. 18%), or both (12% vs. 6%) was higher (P < 0.001 for all comparisons) in DM patients. In-hospital mortality was higher in DM patients than in non-DM patients (6.1% vs. 3.5%; P = 0.002), with an unadjusted odds ratio (OR) of 1.81 (95% CI 1.31-2.49; P < 0.001). However, DM was no longer associated with an increased mortality risk after adjustment for cardiac and renal function (OR 1.03, 95% CI 0.68-1.56; P = 0.89). A similar behavior was observed for the secondary end point, with an unadjusted OR for DM of 1.52 (95% CI 1.25-1.85; P < 0.001) and an OR after adjustment for cardiac and renal function of 1.07 (95% CI 0.85-1.36; P = 0.53). CONCLUSIONS The study indicates that the increased in-hospital mortality and morbidity of DM patients with STEMI is mainly driven by their underlying cardio-renal dysfunction.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Stefano Genovese
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Monica De Metrio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Maurizio Rondinelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Stefano Cornara
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Valentina Milazzo
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Moltrasio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mara Rubino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Ivana Marana
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Grazi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianfranco Lauri
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Ma X, Wang Z, Wang J, Liu F, Zhang D, Yang L, Liu X, Zhou Y. Admission Heart Rate Is Associated With Coronary Artery Disease Severity and Complexity in Patients With Acute Coronary Syndrome. Angiology 2019; 70:774-781. [PMID: 30813736 DOI: 10.1177/0003319719832376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We evaluated the relationship between admission heart rate (HR) and coronary artery disease severity and complexity in patients with acute coronary syndrome (ACS). A total of 884 patients (mean age 59 [11] years, 24.7% female) who underwent coronary angiography for ACS and were treated with primary or selective percutaneous coronary intervention were included in this cross-sectional study. The measurement of admission HR was based on the first available resting electrocardiogram after admission. The SYNTAX score (SS) was calculated. Patients with an SS ≤ 22 (n = 538) were classified as the low SS group and those with an SS > 22 (n = 346) were classified as the intermediate-to-high SS group. Admission HR was greater in the intermediate-to-high SS group compared with the low SS group (75 [10] bpm vs 67 [8] bpm, P < .001). Admission HR was positively and significantly correlated with the SS (r = 0.475, P < .001). After multivariate analysis, admission HR (per 1 standard deviation, ie, 10 bpm) remained an independent predictor of intermediate-to-high SS (odds ratio: 3.135, 95% confidence interval: 2.538-3.873, P < .001). Admission HR is independently and positively associated with the SS. Thus, elevated admission HR may be useful to identify patients with ACS with a high coronary atherosclerotic plaque burden.
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Affiliation(s)
- Xiaoteng Ma
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Zhijian Wang
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Jianlong Wang
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Fang Liu
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Dai Zhang
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Lixia Yang
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Xiaoli Liu
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- 1 Department of Cardiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
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Early and long-term outcomes of complete revascularization with percutaneous coronary intervention in patients with multivessel coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:32-41. [PMID: 29743902 PMCID: PMC5939543 DOI: 10.5114/aic.2018.74353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The clinical significance of complete revascularization with percutaneous coronary intervention (CR-PCI) in patients with non-ST-segment acute coronary syndrome (NSTE-ACS) remains uncertain. Aim To evaluate the impact of CR-PCI during index hospitalization on short and long-term incidence of death and composite endpoint among patients with multivessel coronary artery disease (CAD) presenting with NSTE-ACS. Material and methods We analyzed consecutive data of 1,592 patients with multivessel CAD from 2006 to 2014. Patients with prior coronary artery bypass grafting (CABG), cardiogenic shock, treated conservatively or with CABG and scheduled for planned CABG or PCI after discharge were excluded. The 30-day and 12-month composite endpoint was defined as all-cause death, nonfatal myocardial infarction (MI) or ACS-driven unplanned revascularization. Six hundred and ninety-five patients were divided into 2 groups: CR-PCI (n = 137) (CR-PCI during index hospitalization) and IR-PCI (n = 558) (incomplete revascularization). Results Incidence of composite endpoint (3.6% vs. 10.2%; HR = 0.31; 95% CI: 0.12–0.87; p = 0.025) and death (0.7% vs. 5.7%, HR = 0.11; 95% CI: 0.02–0.93; p = 0.043) at 30 days was lower in CR-PCI than in IR-PCI. At 12-month follow-up occurrence of composite endpoint was lower in CR-PCI (14.7%) than in IR-PCI (27.4%, p = 0.0037). Multivariate analysis confirmed that CR PCI was associated with a reduction in 12-month composite endpoint (HR = 0.56; 95% CI: 0.31–0.99; p = 0.046). The 12-month mortality was lower in CR-PCI (7.4% vs. 14.8%; p = 0.031), but it was not confirmed in the multivariate analysis. Conclusions In patients with multivessel CAD and NSTE-ACS, CR-PCI during index hospitalization was independently associated with improved early and long-term prognosis without significant differences in periprocedural outcomes in comparison to IR-PCI.
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Desperak P, Hawranek M, Gąsior P, Desperak A, Lekston A, Gąsior M. Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes. Cardiol J 2017; 26:157-168. [PMID: 28980282 DOI: 10.5603/cj.a2017.0110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/10/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. METHODS 3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. RESULTS After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020). CONCLUSIONS In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.
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Affiliation(s)
- Piotr Desperak
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Michał Hawranek
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Paweł Gąsior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Katowice, Poland
| | - Aneta Desperak
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Andrzej Lekston
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
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21
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Prognostic comparison between creatinine-based glomerular filtration rate formulas for the prediction of 10-year outcome in patients with non-ST elevation acute coronary syndrome treated by percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:689-702. [DOI: 10.1177/2048872617697452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), but which estimation formula provides the best long-term risk stratification in this setting is still unclear. We compared the prognostic performance of four creatinine-based formulas for the prediction of 10-year outcome in a NSTE-ACS population treated by percutaneous coronary intervention. Methods: In 222 NSTE-ACS patients submitted to percutaneous coronary intervention, eGFR was calculated using four formulas: Cockcroft–Gault, re-expressed modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-Epi), and Mayo-quadratic. Predefined endpoints were all-cause death and a composite of cardiovascular death, non-fatal reinfarction, clinically driven repeat revascularisation, and heart failure hospitalisation. Results: The different eGFR values showed poor agreement, with prevalences of renal dysfunction ranging from 14% to 35%. Over a median follow-up of 10.2 years, eGFR calculated by the CKD-Epi and Mayo-quadratic formulas independently predicted outcome, with an increase in the risk of death and events by up to 17% and 11%, respectively, for each decrement of 10 ml/min/1.73 m2. The Cockcroft–Gault and MDRD equations showed a borderline association with mortality and did not predict events. When compared in terms of goodness of fit, discrimination and calibration, the Mayo-quadratic outperformed the other formulas for the prediction of death and the CKD-Epi showed the best performance for the prediction of events (net reclassification improvement values 0.33–0.35). Conclusions: eGFR is an independent predictor of long-term outcome in patients with NSTE-ACS treated by percutaneous coronary intervention. The Mayo-quadratic and CKD-Epi equations might be superior to classic eGFR formulas for risk stratification in these patients.
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22
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Marenzi G, Cosentino N, Marinetti A, Leone AM, Milazzo V, Rubino M, De Metrio M, Cabiati A, Campodonico J, Moltrasio M, Bertoli S, Cecere M, Mosca S, Marana I, Grazi M, Lauri G, Bonomi A, Veglia F, Bartorelli AL. Renal replacement therapy in patients with acute myocardial infarction: Rate of use, clinical predictors and relationship with in-hospital mortality. Int J Cardiol 2017; 230:255-261. [DOI: 10.1016/j.ijcard.2016.12.130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
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Perelshtein Brezinov O, Klempfner R, Zekry SB, Goldenberg I, Kuperstein R. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study. Medicine (Baltimore) 2017; 96:e6226. [PMID: 28248882 PMCID: PMC5340455 DOI: 10.1097/md.0000000000006226] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There are limited data regarding factors affecting outcomes among acute coronary syndrome (ACS) patients presenting with varying degrees of left ventricle (LV) dysfunction. We aimed to identify factors associated with mortality according to LV ejection fraction (LVEF) at 1st admission in ACS patients.A total of 8983 ACS patients prospectively enrolled in the Acute Coronary Syndrome Israeli Survey (2000-2010) were categorized according to their LVEF at admission: severe LV dysfunction (LVEF < 30% [n = 845]), mild-moderate LV dysfunction (LVEF 30%-49% [n = 4470]); preserved LV function (LVEF ≥ 50% [n = 3659]). Multivariable Cox proportional hazards regression modeling was used to assess the risk factors for 1-year mortality according to LVEF on admission.Over the past decade there was a gradual decline in the proportion of patients admitted with low LVEF. Mortality rates were highest among patients with severe LV dysfunction (36%), intermediate among those with mild-moderate LV dysfunction (10%), and lowest among those with preserved LV function (4%, P < 0.001). We recognized different risk factors for mortality according to LVEF at admission. Admission clinical features (syncope, anterior myocardial infarction, and ST elevation myocardial infarction [STEMI]) predicted mortality risk in patients with severe LV dysfunction (all P < 0.05), whereas the presence of comorbidities (hypertension, diabetes mellitus, chronic renal failure, and peripheral arterial disease) predicted mortality risk in patients with more preserved LV function. Age and admission Killip class ≥II were consistent predictors in all LVEF subsets.LVEF at admission is a strong predictor of mortality in ACS, and prognostic factors differ according to LVEF during admission. In patients with severe LV dysfunction signs of clinical instability are related to 1-year mortality; in patients with a more preserved LV function the prognosis is related to the presence of co-morbidities.
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Affiliation(s)
- Olga Perelshtein Brezinov
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sagit Ben Zekry
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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24
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Lindholm D, James SK, Bertilsson M, Becker RC, Cannon CP, Giannitsis E, Harrington RA, Himmelmann A, Kontny F, Siegbahn A, Steg PG, Storey RF, Velders MA, Weaver WD, Wallentin L. Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non–ST-Elevation Acute Coronary Syndrome. Clin Chem 2017; 63:573-584. [DOI: 10.1373/clinchem.2016.261271] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/23/2016] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Risk stratification in non–ST-elevation acute coronary syndrome (NSTE-ACS) is currently mainly based on clinical characteristics. With routine invasive management, angiography findings and biomarkers are available and may improve prognostication. We aimed to assess if adding biomarkers [high-sensitivity cardiac troponin T (cTnT-hs), N-terminal probrain-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15)] and extent of coronary artery disease (CAD) might improve prognostication in revascularized patients with NSTE-ACS.
METHODS
In the PLATO (Platelet Inhibition and Patient Outcomes) trial, 5174 NSTE-ACS patients underwent initial angiography and revascularization and had cTnT-hs, NT-proBNP, and GDF-15 measured. Cox models were developed adding extent of CAD and biomarker levels to established clinical risk variables for the composite of cardiovascular death (CVD)/spontaneous myocardial infarction (MI), and CVD alone. Models were compared using c-statistic and net reclassification improvement (NRI).
RESULTS
For the composite end point and CVD, prognostication improved when adding extent of CAD, NT-proBNP, and GDF-15 to clinical variables (c-statistic 0.685 and 0.805, respectively, for full model vs 0.649 and 0.760 for clinical model). cTnT-hs did not contribute to prognostication. In the full model (clinical variables, extent of CAD, all biomarkers), hazard ratios (95% CI) per standard deviation increase were for cTnT-hs 0.93(0.81–1.05), NT-proBNP 1.32(1.13–1.53), GDF-15 1.20(1.07–1.36) for the composite end point, driven by prediction of CVD by NT-proBNP and GDF-15. For spontaneous MI, there was an association with NT-proBNP or GDF-15, but not with cTnT-hs.
CONCLUSIONS
In revascularized patients with NSTE-ACS, the extent of CAD and concentrations of NT-proBNP and GDF-15 independently improve prognostication of CVD/spontaneous MI and CVD alone. This information may be useful for selection of patients who might benefit from more intense and/or prolonged antithrombotic treatment. ClinicalTrials.gov Identifier: NCT00391872
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Affiliation(s)
- Daniel Lindholm
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Maria Bertilsson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung and Vascular Institute, Academic Health Center, Cincinnati, OH
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany
| | | | | | - Frederic Kontny
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Agneta Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Philippe Gabriel Steg
- INSERM-Unité 1148, Paris, France
- Assistance Publique-Hôpitaux de Paris; Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
- NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Matthijs A Velders
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Hambraeus K, Jensevik K, Lagerqvist B, Lindahl B, Carlsson R, Farzaneh-Far R, Kellerth T, Omerovic E, Stone G, Varenhorst C, James S. Long-Term Outcome of Incomplete Revascularization After Percutaneous Coronary Intervention in SCAAR (Swedish Coronary Angiography and Angioplasty Registry). JACC Cardiovasc Interv 2016; 9:207-215. [PMID: 26847112 DOI: 10.1016/j.jcin.2015.10.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to describe current practice regarding completeness of revascularization in patients with multivessel disease undergoing percutaneous coronary intervention (PCI) and to investigate the association of incomplete revascularization (IR) with death, repeat revascularization, and myocardial infarction (MI) in a large nationwide registry. BACKGROUND The benefits of multivessel PCI are controversial. METHODS Between 2006 and 2010 we identified 23,342 patients with multivessel disease in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and merged data with official Swedish health data registries. IR was defined as any nontreated significant (60%) stenosis in a coronary artery supplying >10% of the myocardium. RESULTS Patients with IR (n = 15,165) were older, had more extensive coronary disease, and more often had ST-segment elevation MI at presentation than those with complete revascularization (CR) (n = 8,177). All-cause 1-year mortality, MI, and repeat revascularization were higher in IR than CR: 7.1% versus 3.8%, 10.4% versus 6.0%, and 20.5% versus 8.5%, respectively. Propensity score methodology was used in the adjusted analyses. Adjusted hazard ratio (HR) for the composite of death, MI, or repeat revascularization at 1 year was higher in IR than CR: 2.12 (95% confidence interval [CI]: 1.98 to 2.28; p < 0.0001). Adjusted HR for death and the combination of death/MI were 1.29 (95% CI: 1.12 to 1.49; p = 0.0005) and 1.42 (95% CI: 1.30 to 1.56; p < 0.0001), respectively. CONCLUSIONS Incomplete revascularization at the time of hospital discharge in patients with multivessel disease undergoing PCI is associated with a high risk of recurrent 1-year adverse cardiac events.
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Affiliation(s)
- Kristina Hambraeus
- Department of Cardiology, Falun Hospital, Falun, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
| | - Karin Jensevik
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Roland Carlsson
- PCI Unit, Department of Cardiology, Central Hospital, Karlstad, Sweden
| | | | - Thomas Kellerth
- Department of Cardiology, University Hospital, Örebro, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gregg Stone
- New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York
| | - Christoph Varenhorst
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Moltrasio M, Cosentino N, De Metrio M, Rubino M, Cabiati A, Milazzo V, Discacciati A, Marana I, Bonomi A, Veglia F, Lauri G, Marenzi G. Brain natriuretic peptide in acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 17:803-9. [DOI: 10.2459/jcm.0000000000000353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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CHA2DS2-VASc-HS score in non-ST elevation acute coronary syndrome patients: assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events. Anatol J Cardiol 2016; 16:742-748. [PMID: 27025198 PMCID: PMC5324933 DOI: 10.14744/anatoljcardiol.2015.6593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: We recently described the CHA2DS2-VASc-HS score as a novel predictor of coronary artery disease (CAD) severity in stable CAD patients. We aimed to assess the accuracy of the CHA2DS2-VASc-HS score in the determination of CAD severity and complexity and its availability in the risk stratification of in-hospital major adverse cardiovascular events (MACE) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Methods: We prospectively analyzed the clinical and angiographic data of consecutive NSTE-ACS patients in our clinic. Patients were classified into three tertiles according to their SYNTAX score (SS): tertile 1 had an SS of 0–22; tertile 2 had an SS of 23–32; and tertile 3 had an SS of >32. There were no specific exclusion criteria except for previous coronary artery bypass grafting (CABG) because SS was validated for only native coronary arteries for this study. We used the following analyses: χ2 or Fisher’s exact tests, one-way analysis of variance or Kruskal–Wallis tests, Pearson’s or Spearman’s tests, the receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) or C-statistic, and pairwise comparisons of the ROC curves. Results: A total of 252 patients were enrolled. There were 131 patients in tertile 1, 79 in tertile 2, and 42 in tertile 3. The number of diseased vessels was correlated with the Global Registry for Acute Coronary Events (GRACE) (p<0.001), Thrombolysis in Myocardial Infarction (TIMI) (p<0.001), and CHA2DS2-VASc-HS (p<0.001) scores. In the ROC curve analyses, the cut-off value of the CHA2DS2-VASc-HS score in the prediction of in-hospital MACE was >5 with a sensitivity of 69.6% and specificity of 90.3% (AUC: 0.804, 95%: CI 0.750–0.851, p<0.001). We also compared the diagnostic accuracy of the CHA2DS2-VASc-HS score with the TIMI and GRACE risk scores in the determination of the in-hospital MACE and found no differences. Conclusion: The CHA2DS2-VASc-HS score was positively correlated with the severity and complexity of CAD. We also found that CHA2DS2-VASc-HS was comparable with other risk scores for the risk stratification of the in-hospital MACE of NSTE-ACS patients. Therefore, it may play an important role as a predictive model of NSTE-ACS patients in clinical practice. (Anatol J Cardiol 2016; 16: 742-8)
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Impact of initial glycosylated hemoglobin level on cardiovascular outcomes in prediabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2016; 27:40-6. [DOI: 10.1097/mca.0000000000000305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bettinger N, Palmerini T, Caixeta A, Dressler O, Litherland C, Francese DP, Giustino G, Mehran R, Leon MB, Stone GW, Généreux P. Risk stratification of patients undergoing medical therapy after coronary angiography. Eur Heart J 2015; 37:3103-3110. [DOI: 10.1093/eurheartj/ehv674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
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Correlation of NLRP3 with severity and prognosis of coronary atherosclerosis in acute coronary syndrome patients. Heart Vessels 2015; 31:1218-29. [DOI: 10.1007/s00380-015-0723-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/24/2015] [Indexed: 12/22/2022]
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Saba L, Fellini F, De Filippo M. Diagnostic value of contrast-enhanced cardiac magnetic resonance in patients with acute coronary syndrome with normal coronary arteries. Jpn J Radiol 2015; 33:410-7. [DOI: 10.1007/s11604-015-0440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/14/2015] [Indexed: 01/01/2023]
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Lee SJ, Hong JM, Lee M, Huh K, Choi JW, Lee JS. Cerebral arterial calcification is an imaging prognostic marker for revascularization treatment of acute middle cerebral arterial occlusion. J Stroke 2015; 17:67-75. [PMID: 25692109 PMCID: PMC4325637 DOI: 10.5853/jos.2015.17.1.67] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion. METHODS Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score ≥3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study. RESULTS Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs. LCB 14.6±3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043). CONCLUSIONS Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Manyong Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Kyoon Huh
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
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Waksman R, Lipinski MJ. The Utility of Thrombus Aspiration for NSTEMI. J Am Coll Cardiol 2014; 64:1125-7. [DOI: 10.1016/j.jacc.2014.06.1176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 11/25/2022]
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Lansky AJ, Ng VG, Meller S, Xu K, Fahy M, Feit F, Ohman EM, White HD, Mehran R, Bertrand ME, Desmet W, Hamon M, Stone GW. Impact of nonculprit vessel myocardial perfusion on outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes: analysis from the ACUITY trial (Acute Catheterization and Urgent Intervention Triage Strategy). JACC Cardiovasc Interv 2014; 7:266-75. [PMID: 24650400 DOI: 10.1016/j.jcin.2013.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 08/08/2013] [Accepted: 08/30/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study evaluated the impact of nonculprit vessel myocardial perfusion on outcomes of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients. BACKGROUND ST-segment elevation myocardial infarction patients have decreased perfusion in areas remote from the infarct-related vessel. The impact of myocardial hypoperfusion of regions supplied by nonculprit vessels in NSTE-ACS patients treated with percutaneous coronary intervention (PCI) is unknown. METHODS The angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial included 6,921 NSTE-ACS patients. Complete 3-vessel assessments of baseline coronary TIMI (Thrombolysis In Myocardial Infarction) flow grade and myocardial blush grade (MBG) were performed. We examined the outcomes of PCI-treated patients according to the worst nonculprit vessel MBG identified per patient. RESULTS Among the 3,826 patients treated with PCI, the worst nonculprit MBG was determined in 3,426 (89.5%) patients, including 375 (10.9%) MBG 0/1 patients, 475 (13.9%) MBG 2 patients, and 2,576 (75.2%) MBG 3 patients. Nonculprit MBG 0/1 was associated with worse baseline clinical characteristics. Patients with nonculprit MBG 0/1 versus MBG 3 had increased rates of 30-day (3.0% vs. 0.7%, p < 0.0001) and 1-year (4.4% vs. 1.0%, p < 0.0001) death. Similar results were found among patients with pre-procedural TIMI flow grade 3 in the culprit vessel, where nonculprit vessel MBG 0/1 (hazard ratio: 2.81 [95% confidence interval: 1.63 to 4.84], p = 0.0002) was the strongest predictor of 1-year mortality. CONCLUSIONS Reduced myocardial perfusion in an area supplied by a nonculprit vessel is associated with increased short- and long-term mortality rates in NSTE-ACS patients undergoing PCI. Furthermore, worst nonculprit MBG is able to risk-stratify patients with normal baseline flow of the culprit vessel.
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Affiliation(s)
- Alexandra J Lansky
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Vivian G Ng
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie Meller
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ke Xu
- Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Martin Fahy
- Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Frederick Feit
- Division of Cardiology, New York University School of Medicine, New York, New York
| | - E Magnus Ohman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Roxana Mehran
- Division of Cardiology, Mount Sinai Medical Center, New York, New York
| | | | - Walter Desmet
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Martial Hamon
- Department of Cardiology, University Hospital, Normandy, France
| | - Gregg W Stone
- Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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Güngör B, Alper AT, Özcan KS, Ekmekçi A, Karadeniz FÖ, Mutluer FO, Kaya A, Karataş B, Osmonov D, Bolca O. Presence of sigma shaped right coronary artery is an indicator of poor prognosis in patients with inferior myocardial infarction treated with primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2014; 84:965-72. [DOI: 10.1002/ccd.25388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/09/2013] [Accepted: 12/30/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Barış Güngör
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Ahmet Taha Alper
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Ahmet Ekmekçi
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Fatma Özpamuk Karadeniz
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Ferit Onur Mutluer
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Adnan Kaya
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Baran Karataş
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Damirbek Osmonov
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
| | - Osman Bolca
- Department of Cardiology; Siyami Ersek Cardiovascular and Thoracic Surgery Center; 34087 Istanbul Turkey
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Donataccio MP, Puymirat E, Vassanelli C, Blanchard D, le Breton H, Perier MC, Gilard M, Lefèvre T, Barragan P, Mulak G, Danchin N, Spaulding C, Jouven X, Jouven X. Presentation and revascularization patterns of patients admitted for acute coronary syndromes in France between 2004 and 2008 (from the National Observational Study of Diagnostic and Interventional Cardiac Catheterization [ONACI]). Am J Cardiol 2014; 113:243-8. [PMID: 24169017 DOI: 10.1016/j.amjcard.2013.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 11/25/2022]
Abstract
Patients with acute coronary syndrome (ACS) comprise a heterogeneous group. Despite clear guidelines, the management of ACS in clinical practice is variable. We aimed to evaluate clinical characteristics and myocardial revascularization patterns of patients presenting with ACS from a large French nationwide registry. The National Observational Study of Diagnostic and Interventional Cardiac Catheterization is a multicenter registry including all interventional cardiology procedures performed since 2004. Patient demographics and co-morbidities, invasive parameters, treatment options, and procedural techniques were prospectively collected. The present study is focused on data collected between 2004 and 2008. Patients were recruited in 99 hospitals (55% in private clinics, 45% in public institutions). Over a 5-year period, 64,932 patients with ACS were included (mean age 65.7 ± 13.3; 73% men, 31% ST-elevation myocardial infarction [STEMI]). Patients presenting with unstable angina pectoris and non-ST-elevation myocardial infarction weresimilar with regards to clinical presentation and coronary artery disease (CAD) extension. Overall, these patients were older, had a higher cardiovascular risk profile, and had more severe CAD compared with STEMI patients. In-hospital mortality during the first 24 hours was higher in STEMI patients. Patient's characteristics and CAD were highly dependent on the type of ACS. Patients with unstable angina/non-STEMI were older and had a more severe CAD. In-hospital complications were higher in STEMI patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Jouven
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, France; Université Paris Descartes, Paris, France; INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France
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Angeli F, Verdecchia P, Savonitto S, Morici N, De Servi S, Cavallini C. Early invasive versus selectively invasive strategy in patients with non-ST-segment elevation acute coronary syndrome: Impact of age. Catheter Cardiovasc Interv 2014; 83:686-701. [DOI: 10.1002/ccd.25307] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/31/2013] [Accepted: 11/22/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology; Teaching Hospital “S.M. della Misericordia,”; Perugia Italy
| | - Paolo Verdecchia
- Department of Internal Medicine; Hospital of Assisi; Assisi Italy
| | - Stefano Savonitto
- Division of Cardiology; IRCCS “Arcispedale S. Maria Nuova,”; Reggio Emilia Italy
| | - Nuccia Morici
- Department of Cardiology; Hospital “Niguarda Ca' Granda,”; Milano Italy
| | | | - Claudio Cavallini
- Department of Cardiology; Teaching Hospital “S.M. della Misericordia,”; Perugia Italy
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Généreux P, Stone GW, Harrington RA, Gibson CM, Steg PG, Brener SJ, Angiolillo DJ, Price MJ, Prats J, LaSalle L, Liu T, Todd M, Skerjanec S, Hamm CW, Mahaffey KW, White HD, Bhatt DL. Impact of intraprocedural stent thrombosis during percutaneous coronary intervention: insights from the CHAMPION PHOENIX Trial (Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention). J Am Coll Cardiol 2013; 63:619-629. [PMID: 24184169 DOI: 10.1016/j.jacc.2013.10.022] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study sought to evaluate the clinical impact of intraprocedural stent thrombosis (IPST), a relatively new endpoint. BACKGROUND In the prospective, double-blind, active-controlled CHAMPION PHOENIX (Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention) trial, cangrelor significantly reduced periprocedural and 30-day ischemic events in patients undergoing percutaneous coronary intervention (PCI), including IPST. METHODS An independent core laboratory blinded to treatment assignment performed a frame-by-frame angiographic analysis in 10,939 patients for the development of IPST, defined as new or worsening thrombus related to stent deployment at any time during the procedure. Adverse events were adjudicated by an independent, blinded clinical events committee. RESULTS IPST developed in 89 patients (0.8%), including 35 of 5,470 (0.6%) and 54 of 5,469 (1.0%) patients in the cangrelor and clopidogrel arms, respectively (odds ratio: 0.65; 95% confidence interval: 0.42 to 0.99; p = 0.04). Compared to patients without IPST, IPST was associated with a marked increase in composite ischemia (death, myocardial infarction [MI], ischemia-driven revascularization, or new-onset out-of-laboratory stent thrombosis [Academic Research Consortium]) at 48 h and at 30 days (29.2% vs. 4.5% and 31.5% vs. 5.7%, respectively; p < 0.0001 for both). After controlling for potential confounders, IPST remained a strong predictor of all adverse ischemic events at both time points. CONCLUSIONS In the large-scale CHAMPION PHOENIX trial, the occurrence of IPST was strongly predictive of subsequent adverse cardiovascular events. The potent intravenous adenosine diphosphate antagonist cangrelor substantially reduced IPST, contributing to its beneficial effects at 48 h and 30 days. (Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX]; NCT01156571).
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Affiliation(s)
- Philippe Généreux
- Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Gregg W Stone
- Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | | | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ph Gabriel Steg
- Institut National de la Santé et de la Recherche Médicale-Unité 698, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, and Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France, and Royal Brompton Hospital, London, United Kingdom
| | - Sorin J Brener
- Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, Brooklyn, New York
| | | | - Matthew J Price
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, California
| | - Jayne Prats
- The Medicines Company, Parsippany, New Jersey
| | - Laura LaSalle
- Cardiovascular Research Foundation, New York, New York
| | - Tiepu Liu
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, California
| | - Meredith Todd
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, California
| | - Simona Skerjanec
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, California
| | - Christian W Hamm
- University of Giessen and Kerckhoff Heart Center, Bad Nauheim, Germany
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
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Aortic valve sclerosis in acute coronary syndrome patients. Herz 2013; 39:1001-4. [DOI: 10.1007/s00059-013-3936-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 07/17/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Cakar MA, Sahinkus S, Aydin E, Vatan MB, Keser N, Akdemir R, Gunduz H. Relation between the GRACE score and severity of atherosclerosis in acute coronary syndrome. J Cardiol 2013; 63:24-8. [PMID: 24012333 DOI: 10.1016/j.jjcc.2013.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with non-ST-elevation acute coronary syndrome are heterogeneous in terms of clinical presentation and immediate- and long-term risk of death or non-fatal ischemic events. The aim of the present study was to evaluate the relationship between the Global Registry of Acute Coronary Events (GRACE) score and severity of coronary artery disease angiographically evaluated by Gensini score in patients with non-ST-elevation acute coronary syndrome. METHODS A total of 245 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low- (n=97, 39.6%), intermediate- (n=84, 34.3%), and high- (n=64, 26.1%) risk groups. All patients underwent coronary angiography within five days after admission. RESULTS The Gensini scores were 26±29 in the low-risk group, 29±19 in the intermediate-risk group, and 38±23 in the high-risk group (p=0.016). The low-risk group was significantly different from the high-risk group (p=0.013), and the difference from the intermediate-risk group almost reached significance. Normal, noncritical, one and two, or multivessel disease were identified in 15 (6.1%), 31 (12.7%), 75 (30.6%), and 124 (50.6%) patients, respectively. The prevalence of multivessel disease was 28% in the low-risk group, 30% in the intermediate-risk group, and 42% in the high-risk group. The high-risk group was significantly different from the low-risk group (p<0.01). CONCLUSION Our study demonstrates that the GRACE score has significant value for assessing the severity and extent of coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome.
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Affiliation(s)
- Mehmet Akif Cakar
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey.
| | - Salih Sahinkus
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey
| | - Ercan Aydin
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey
| | - Mehmet Bulent Vatan
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey
| | - Nurgul Keser
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey
| | - Ramazan Akdemir
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey
| | - Huseyin Gunduz
- Cardiology Department, Sakarya University Faculty of Medicine, 54100 Sakarya, Turkey
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Study design and baseline characteristics of the national observational study of diagnostic and interventional cardiac catheterization by the French Society of Cardiology. Am J Cardiol 2013; 112:336-42. [PMID: 23664079 DOI: 10.1016/j.amjcard.2013.03.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 02/05/2023]
Abstract
The national observational study of diagnostic and interventional cardiac catheterization (ONACI) is a prospective multicenter registry of the French Society of Cardiology including all interventional cardiology procedures performed from 2004. We aimed to evaluate "real-world" management of patients with coronary artery disease in France from this registry. The present study was focused on data collected from 2004 to 2008. Patient demographics and co-morbidities, invasive parameters, treatment options, and procedural techniques were prospectively collected. Patients were recruited from 99 hospitals (55% of patients were hospitalized in private clinics and 45% in public institutions). During a 5-year period, a total of 298,105 patients underwent coronary angiography and 176,166 patients underwent percutaneous coronary intervention. Diagnosis was acute coronary syndrome in 22%, stable angina or silent ischemia in 23%, and atypical chest pain in 9% of cases. Normal coronary arteries or nonsignificant coronary narrowing were found in 26% of patients. Radial access was increasingly used over the years regardless of the indication. The average number of percutaneous coronary interventions per procedure was 1.5 ± 0.7 (range, 1.3 ± 0.7 to 1.5 ± 0.7) and that of stents per procedure was 1.5 ± 0.8 (range, 1.5 ± 0.8 to 1.6 ± 0.8). Drug-eluting stents were used in 45% (range, 34% to 62%), increasing from 2004 to 2006, and then decreasing after the 2006 controversy. In conclusion, ONACI is one of the largest catheterization registries during this period, providing a detailed and comprehensive global description of the spectrum and management of patients with suspected coronary artery disease undergoing cardiac catheterization.
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Taglieri N, Dall’Ara G, Rapezzi C, Saia F, Cinti L, Rosmini S, Alessi L, Vagnarelli F, Moretti C, Palmerini T, Marrozzini C, Montefiori M, Branzi A, Marzocchi A. Predictors of complicated athero-thrombotic lesions in non-ST segment acute coronary syndrome. J Cardiovasc Med (Hagerstown) 2013; 14:430-7. [DOI: 10.2459/jcm.0b013e328356a384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Exactitud pronóstica de las escalas GRACE y TIMI en pacientes llevados a intervencionismo percutáneo por síndrome coronario agudo sin elevación del ST. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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44
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Brener SJ, Cristea E, Kirtane AJ, McEntegart MB, Xu K, Mehran R, Stone GW. Intra-Procedural Stent Thrombosis. JACC Cardiovasc Interv 2013; 6:36-43. [DOI: 10.1016/j.jcin.2012.08.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/27/2012] [Accepted: 08/16/2012] [Indexed: 11/30/2022]
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Aldrovandi A, Cademartiri F, Arduini D, Lina D, Ugo F, Maffei E, Menozzi A, Martini C, Palumbo A, Bontardelli F, Gherli T, Ruffini L, Ardissino D. Computed Tomography Coronary Angiography in Patients With Acute Myocardial Infarction Without Significant Coronary Stenosis. Circulation 2012; 126:3000-7. [DOI: 10.1161/circulationaha.112.117598] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
It is known that a significant number of patients experiencing an acute myocardial infarction have normal coronary arteries or nonsignificant coronary disease at coronary angiography (CA). Computed tomography coronary angiography (CTCA) can identify the presence of plaques, even in the absence of significant coronary stenosis. This study evaluated the role of 64-slice CTCA in detecting and characterizing coronary atherosclerosis in these patients.
Methods and Results—
Consecutive patients with documented acute myocardial infarction but without significant coronary stenosis at CA underwent late gadolinium-enhanced magnetic resonance and CTCA. Only the 50 patients with an area of myocardial infarction identified by late gadolinium-enhanced magnetic resonance were included in the study. All of the coronary segments were assessed for the presence of plaques. CTCA identified 101 plaques against the 41 identified by CA: 61 (60.4%) located in infarct-related arteries (IRAs) and 40 (39.6%) in non-IRAs. In the IRAs, 22 plaques were noncalcified, 17 mixed, and 22 calcified; in the non-IRAs, 5 plaques were noncalcified, 8 mixed, and 27 calcified (
P
=0.005). Mean plaque area was greater in the IRAs than in the non-IRAs (6.1±5.4 mm
2
versus 4.2±2.1 mm
2
;
P
=0.03); there was no significant difference in mean percentage stenosis (33.5%±14.6 versus 31.7%±12.2;
P
=0.59), but the mean remodeling index was significantly different (1.25±0.41 versus 1.08±0.21;
P
=0.01).
Conclusions—
CTCA detects coronary plaques in nonstenotic coronary arteries that are underestimated by CA, and identifies a different distribution of plaque types in IRAs and non-IRAs. It may therefore be valuable for diagnosing coronary atherosclerosis in acute myocardial infarction patients without significant coronary stenosis.
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Affiliation(s)
- Annachiara Aldrovandi
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Filippo Cademartiri
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Daniele Arduini
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Daniela Lina
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Fabrizio Ugo
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Erica Maffei
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Alberto Menozzi
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Chiara Martini
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Alessandro Palumbo
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Federico Bontardelli
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Tiziano Gherli
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Livia Ruffini
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Diego Ardissino
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
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Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, Mehran R, Della Riva D, Fahy M, Xu K, Stone GW. A New Score for Risk Stratification of Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2012; 5:1108-16. [DOI: 10.1016/j.jcin.2012.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
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Segev A, Matetzky S, Danenberg H, Fefer P, Bubyr L, Zahger D, Roguin A, Gottlieb S, Kornowski R. Contemporary use and outcome of percutaneous coronary interventions in patients with acute coronary syndromes: insights from the 2010 ACSIS and ACSIS-PCI surveys. EUROINTERVENTION 2012; 8:465-9. [DOI: 10.4244/eijv8i4a73] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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48
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Benyakorn T, Kuanprasert S, Rerkasem K. A correlation study between ankle brachial pressure index and the severity of coronary artery disease. INT J LOW EXTR WOUND 2012; 11:120-3. [PMID: 22561522 DOI: 10.1177/1534734612446966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies have shown that there was a correlation between low ankle brachial pressure index (ABPI) and the presence of the coronary artery disease (CAD). However, few studies have investigated the correlation between ABPI and the severity of CAD by using a scoring system. The authors aimed to investigate this correlation by using ABPI and CAD diagnosed by coronary angiography (CAG). A total of 213 consecutive patients awaiting CAG in Maharaj Nakorn Chiang Mai Hospital from July 2009 to November 2009 were enrolled in this study. The ABPI was measured before CAG. The severity of CAD was graded on CAG by using SYNTAX scores. The authors found a significantly negative correlation between ABPI and SYNTAX scores (correlation coefficient = -.172, P = .01). The authors concluded that ABPI appeared to correlate negatively with the severity of CAD in the Thai population.
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Palmerini T, Caixeta A, Genereux P, Cristea E, Lansky A, Mehran R, Dangas G, Lazar D, Sanchez R, Fahy M, Xu K, Stone GW. Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. Am Heart J 2012; 163:383-91, 391.e1-5. [PMID: 22424008 DOI: 10.1016/j.ahj.2011.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/07/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND Several prognostic risk scores have been developed for patients with coronary artery disease, but their comparative use in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) has not been examined. We therefore investigated the accuracy of the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score, Clinical Synergy Between PCI With Taxus and Cardiac Surgery score (CSS), New Risk Stratification (NERS) score (NERS), Age, Creatinine, Ejection Fraction (ACEF) score, Global Registry for Acute Coronary Events (GRACE) score, and Thrombolysis in Myocardial Infarction (TIMI) score for risk assessment of 1-year mortality, cardiac mortality, myocardial infarction, target vessel revascularization, and stent thrombosis in patients with NSTEACS undergoing PCI. METHODS The 6 scores were determined in 2,094 patients with NSTEACS treated with PCI enrolled in the angiographic substudy of the ACUITY trial. The prognostic accuracy of the 6 scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. The index of separation and net reclassification improvement (NRI) were also determined. RESULTS Scores incorporating clinical and angiographic variables (CSS and NERS) showed the best tradeoff between discrimination and calibration for most end points, with the best discrimination for all end points and good calibration for most of them. The CSS had the best index of separation for most ischemic endpoints and displayed an NRI for cardiac death and myocardial infarction (MI) compared to the other scores, whereas NERS displayed an NRI for all-cause death and target vessel revascularization. The 3 scores-CSS, NERS, and SYNTAX-were the only scores to have both good discrimination and calibration for cardiac mortality. CONCLUSIONS In patients with NSTEACS undergoing PCI, risk scores incorporating clinical and angiographic variables had the highest predictive accuracy for a broad spectrum of ischemic end points.
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Acharji S, Baber U, Mehran R, Fahy M, Kirtane AJ, Lansky AJ, Stone GW. Prognostic significance of elevated baseline troponin in patients with acute coronary syndromes and chronic kidney disease treated with different antithrombotic regimens: a substudy from the ACUITY trial. Circ Cardiovasc Interv 2012; 5:157-65. [PMID: 22354934 DOI: 10.1161/circinterventions.111.963876] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevation of baseline cardiac troponin in patients presenting with acute coronary syndromes (ACS) confers an adverse prognosis. The prognostic value of troponin elevation in patients with chronic kidney disease (CKD) and ACS is less certain. METHODS AND RESULTS In the ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) trial, 13 819 patients with moderate and high-risk ACS were assigned randomly to receive heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin monotherapy. Among 2179 patients with CKD (creatinine clearance <60 mL/min), baseline troponin elevation was present in 1291 patients (59.2%). Major bleeding and major adverse cardiac events (MACE), including death, myocardial infarction (MI), or unplanned revascularization, were examined according to baseline troponin status and randomization arm. Patients with CKD in whom the baseline troponin level was elevated had significantly higher rates of death, MI, and MACE at 30 days and 1 year compared with CKD patients without elevated baseline troponin. By multivariable analysis, baseline troponin elevation in patients with CKD was an independent predictor of composite death or MI at 30 days (hazard ratio [95% CI]=2.05 [1.48, 2.83], P<0.0001) and 1 year (1.72 [1.36, 2.17], P<0.0001). In CKD patients with baseline troponin elevation, bivalirudin monotherapy compared with heparin plus a GPI significantly reduced the 30-day rates of major bleeding with nonsignificantly different rates of MACE at 30 days and 1 year. CONCLUSIONS In patients with ACS and CKD, baseline troponin elevation is associated with significantly worse short- and long-term clinical outcomes. Bivalirudin monotherapy safely reduces major bleeding in ACS patients with CKD and baseline troponin elevation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.
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