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Piccolo R, Leone A, Avvedimento M, Simonetti F, Ippolito D, Angellotti D, Verde N, Manzi L, Cirillo P, Serafino LD, Fortunato G, Franzone A, Esposito G. Impact of biomarker type on periprocedural myocardial infarction in patients undergoing elective PCI. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:680-690. [PMID: 36385164 DOI: 10.1093/ehjqcco/qcac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/08/2023]
Abstract
BACKGROUND Periprocedural myocardial infarction (MI) according to the Society for Cardiovascular Angiography and Interventions (SCAI) criteria has prognostic relevance among patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether the type of cardiac biomarker used for the diagnosis of periprocedural MI plays a role in terms of event frequency and outcomes. OBJECTIVES To compare the characteristics of SCAI periprocedural MI based on creatine kinase-myocardial band fraction (CK-MB) vs. high-sensitivity cardiac troponin (hs-cTn) in patients undergoing elective PCI. METHODS AND RESULTS Between 2017 and 2021, periprocedural MI was assessed in a prospective study. The primary clinical outcome of interest was all-cause death at 1-year follow-up. A total of 1010 patients undergoing elective PCI were included. SCAI periprocedural MI based on CK-MB vs. hs-cTnI occurred in 1.8 and 13.5% of patients, respectively. hs-cTnI periprocedural MI in the absence of concomitant CK-MB criteria was associated with lower rates of ancillary criteria, including angiographic, ECG, and cardiac imaging criteria. At 1-year follow-up, periprocedural MI defined by CK-MB (adjusted hazard ratio, HR, 4.27, 95% confidence intervals, CI, 1.23-14.8; P = 0.022) but not hs-cTnI (adjusted HR 2.04, 95% CI 0.94-4.45; P = 0.072) was associated with a higher risk of all-cause death. Hs-cTnI periprocedural MI was not predictive of death unless accompanied by CK-MB criteria (adjusted HR 4.64, 95% CI 1.32-16.31; P = 0.017). CONCLUSION In the setting of elective PCI, using hs-cTn instead of CK-MB resulted in a substantial increase in SCAI periprocedural MI events, which were not prognostically relevant in the absence of concurrent CK-MB elevations.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Ippolito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, 80131 Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Heuts S, Gollmann-Tepeköylü C, Denessen EJS, Olsthoorn JR, Romeo JLR, Maessen JG, van ‘t Hof AWJ, Bekers O, Hammarsten O, Pölzl L, Holfeld J, Bonaros N, van der Horst ICC, Davidson SM, Thielmann M, Mingels AMA. Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications. Eur Heart J 2023; 44:100-112. [PMID: 36337034 PMCID: PMC9897191 DOI: 10.1093/eurheartj/ehac604] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
The use of biomarkers is undisputed in the diagnosis of primary myocardial infarction (MI), but their value for identifying MI is less well studied in the postoperative phase following coronary artery bypass grafting (CABG). To identify patients with periprocedural MI (PMI), several conflicting definitions of PMI have been proposed, relying either on cardiac troponin (cTn) or the MB isoenzyme of creatine kinase, with or without supporting evidence of ischaemia. However, CABG inherently induces the release of cardiac biomarkers, as reflected by significant cTn concentrations in patients with uncomplicated postoperative courses. Still, the underlying (patho)physiological release mechanisms of cTn are incompletely understood, complicating adequate interpretation of postoperative increases in cTn concentrations. Therefore, the aim of the current review is to present these potential underlying mechanisms of cTn release in general, and following CABG in particular (Graphical Abstract). Based on these mechanisms, dissimilarities in the release of cTnI and cTnT are discussed, with potentially important implications for clinical practice. Consequently, currently proposed cTn biomarker cut-offs by the prevailing definitions of PMI might warrant re-assessment, with differentiation in cut-offs for the separate available assays and surgical strategies. To resolve these issues, future prospective studies are warranted to determine the prognostic influence of biomarker release in general and PMI in particular.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Ellen J S Denessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Jamie L R Romeo
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Arnoud W J van ‘t Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Otto Bekers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ola Hammarsten
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Iwan C C van der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Alma M A Mingels
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands
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Li ZF, Zhang S, Shi HW, Zhang WJ, Sui YG, Li JJ, Dou KF, Qian J, Wu NQ. The Prognostic Value of Cardiac Troponin I in Patients with or without Three-Vessel Disease Undergoing Complete Percutaneous Coronary Intervention. J Clin Med 2022; 11:jcm11133896. [PMID: 35807181 PMCID: PMC9267560 DOI: 10.3390/jcm11133896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
Postprocedural cardiac troponin I (cTnI) elevation commonly occurs in patients undergoing percutaneous coronary intervention (PCI); however, its prognostic value remains controversial. This study aimed to investigate the prognostic value of peak postprocedural cTnI in cardiac patients with or without three-vessel disease (TVD) undergoing complete PCI. A total of 1237 consecutive patients (77% males, mean age 58 ± 10 years) with normal baseline cTnI levels were enrolled, 439 patients (77% males, 59 ± 10 years) with TVD, and 798 patients (77% males, 57 ± 10 years) with single- or double-vessel disease (non-TVD). The primary outcome was the occurrence of major adverse cardiovascular events (MACE), defined as a composite of non-fatal MI, non-fatal stroke, unplanned revascularization, re-hospitalization due to heart failure or severe arrhythmias, and all-cause death. During the median follow-up of 5.3 years, a total of 169 patients (13.7%) developed MACE, including 73 (16.6%) in the TVD group and 96 (12.0%) in the non-TVD group (p = 0.024). After adjustment, the multivariate Cox analysis showed that hypertension (HR 1.50; 95% CI: 1.01–2.20; p = 0.042), TVD (HR 1.44; 95% CI: 1.03–2.02; p = 0.033), and cTnI ≥ 70× URL (HR 2.47; 95% CI: 1.28–4.78, p = 0.007) were independently associated with increased MACE during long-term follow-up. Further subgroup analyses showed that cTnI ≥ 70× URL was an independent predictor of MACE in TVD patients (HR 3.32, 95% CI: 1.51–7.34, p = 0.003), but not in non-TVD patients (HR 1.01, 95%CI: 0.24–4.32, p = 0.991). In conclusion, elevation of post-PCI cTnI ≥ 70× URL is independently associated with a high risk of MACE during long-term follow-up in patients with TVD, but not in those with non-TVD.
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Yamaguchi M, Hoshino M, Sugiyama T, Kanaji Y, Nagamine T, Misawa T, Hada M, Araki M, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Association of near-infrared spectroscopy-defined lipid rich plaque with lesion morphology and peri-coronary inflammation on computed tomography angiography. Atherosclerosis 2022; 346:109-116. [DOI: 10.1016/j.atherosclerosis.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/24/2021] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
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Zhou Y, Chen Z, Chen A, Ma J, Dai C, Lu D, Wu Y, Li S, Chen J, Liu M, Li C, Lu H, Qian J, Ge J. Association between the magnitude of periprocedural myocardial injury and prognosis in patients undergoing elective percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:871-880. [PMID: 34962992 PMCID: PMC9670329 DOI: 10.1093/ehjqcco/qcab103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022]
Abstract
AIMS This study aimed to investigate the prognostic implications of increased post-procedural cardiac troponin levels in patients undergoing elective percutaneous coronary intervention (PCI) and to define the threshold of prognostically relevant periprocedural myocardial injury (PMI). METHODS AND RESULTS A total of 3249 patients with normal baseline troponin levels referred for elective PCI were enrolled and followed up for a median period of 20 months. The primary endpoint was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial injury (MI), and ischaemic stroke. Post-PCI high-sensitivity cardiac troponin T (hs-cTnT) >99% upper reference limit (URL) occurred in 78.3% of the patients and did not increase the risk of MACEs [adjusted hazard ratio (adHR) 1.00, 95% confidence interval (CI) 0.58-1.74, P = 0.990], nor did 'major PMI', defined as post-PCI hs-cTnT >5× URL (adHR 1.30, 95% CI 0.76-2.23, P = 0.340). Post-PCI troponin >8× URL, with an incidence of 15.2%, started to show an association with a higher risk of MACEs (adHR 1.89, 95% CI 1.06-3.37, P = 0.032), mainly driven by myocardial infarction (adHR 2.38, 95% CI 1.05-5.38, P = 0.037) and ischaemic stroke (adHR 3.35, 95% CI 1.17-9.64, P = 0.025). CONCLUSION In patients with normal baseline troponin values undergoing elective PCI, PMI defined as hs-cTnT >8× URL after PCI was more appropriate for identifying patients with an increased risk of MACEs, which may help guide clinical practice in this population.
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Affiliation(s)
- You Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Zhangwei Chen
- Corresponding authors. Tel: 86 21 64041990 ext. 2728, 86 21 64041990 ext. 2728, 86 21 64041990 ext. 2745, Fax: 86 21 64223006,
| | - Ao Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Jiaqi Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Chunfeng Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Danbo Lu
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Yuan Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Su Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Jinxiang Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Muyin Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - ChenGuang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Hao Lu
- Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China,Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China
| | - Juying Qian
- Corresponding authors. Tel: 86 21 64041990 ext. 2728, 86 21 64041990 ext. 2728, 86 21 64041990 ext. 2745, Fax: 86 21 64223006,
| | - Junbo Ge
- Corresponding authors. Tel: 86 21 64041990 ext. 2728, 86 21 64041990 ext. 2728, 86 21 64041990 ext. 2745, Fax: 86 21 64223006,
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Peripheral Artery Tonometry Reveals Impaired Endothelial Function before Percutaneous Coronary Intervention in Patients with Periprocedural Myocardial Injury. J Interv Cardiol 2021; 2021:5598120. [PMID: 34354549 PMCID: PMC8298173 DOI: 10.1155/2021/5598120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Periprocedural myocardial injury (PMI) is a most common complication of percutaneous coronary intervention (PCI). Microembolization and inflammation underlying PMI could lead to coronary microvascular dysfunction (CMD) and vice versa. Reactive hyperemia index (RHI) assessed by peripheral artery tonometry (PAT) has been considered as a noninvasive method to assess endothelial function and CMD, which could be useful to predict PMI. Methods 268 patients suspected with stable coronary artery disease (CAD) and scheduled for elective coronary angiography were enrolled. RHI was measured by using the Endo-PAT2000™ device before angiography. The association among RHI, PMI, and cardiovascular events was further assessed. Results In this cohort, 189 patients (70.5%) were diagnosed with CAD and 119 patients (44.4%) underwent drug-eluting stent (DES) implantation. Compared with patients without CAD, CAD patients had lower RHI (1.88 ± 0.55 vs. 2.02 ± 0.58, P < 0.05). Patients with PMI had a lower RHI before angiography (1.75 ± 0.37 vs. 1.95 ± 0.50, P < 0.05). Receiver operating characteristic curve analysis of RHI revealed an area under the curve (AUC) of 0.61, with a sensitivity of 62.7% and specificity of 50.0% to predict PMI. Moreover, we found that CAD patients with RHI ≤ 1.81 had a higher incidence of composite cardiac events after stenting (adjusted hazard ratio (HR) 3.31, 95% confidence interval (CI) 1.07–10.22, P < 0.05). Conclusions RHI assessment through PAT could be a promising method to predict PMI before the procedure. RHI is associated with increased risk of long-term adverse cardiac events after DES implantation.
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Zhang W, Dai J, Zheng X, Xu K, Yang X, Shen L, Wang X, Hao Z, Qiu X, Jiang L, Shi H, Shen L, He B. Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e25551. [PMID: 33847683 PMCID: PMC8052047 DOI: 10.1097/md.0000000000025551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI). METHODS In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed. RESULTS Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ± 33.7 vs 93.4 ± 30.9, P = .016; 114.3 ± 34.3 vs 94.7 ± 33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ± 10.5 vs 13.5 ± 5.0, P = .003; 20.2 ± 7.4 vs 15.2 ± 5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ± 30.9 vs 112.1 ± 31.9, P = .739), cTFC (19.4 ± 7.2 vs 19.3 ± 7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate. CONCLUSIONS The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.
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Affiliation(s)
- Weifeng Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Jinjie Dai
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Xiaowen Zheng
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ke Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Xiaoxiao Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Lan Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
- Clinical Research Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiaolei Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ziyong Hao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Xingbiao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Lisheng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Hongyu Shi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
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Hong XL, Li Y, Zhou BQ, Fu GS, Zhang WB. Comparison of rotational atherectomy and modified balloons prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions. Medicine (Baltimore) 2021; 100:e25323. [PMID: 33761735 PMCID: PMC9281966 DOI: 10.1097/md.0000000000025323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119-0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277-0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12-0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329-1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.
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Affiliation(s)
- Xu-Lin Hong
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Ya Li
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Bin-Quan Zhou
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Guo-Sheng Fu
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Wen-Bin Zhang
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
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9
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Liu Y, Wang W, Song J, Zhang K, Wang K, Shao C, Li P, Xu B, Yang M, Chen J, Zheng J, Tang YD. Prognosis of spontaneous myocardial infarction and various definitions of periprocedural myocardial infarction in patients who underwent percutaneous coronary intervention. Int J Cardiol 2021; 333:60-68. [PMID: 33744346 DOI: 10.1016/j.ijcard.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Debate exists on the prognostic significance of spontaneous myocardial infarction (SMI) and periprocedural myocardial infarction (PMI), which could be diagnosed by various definitions. METHODS AND RESULTS A total of 10,724 patients undergoing percutaneous coronary intervention (PCI) were consecutively enrolled and followed up for a median of 2.4 years. We evaluated outcomes of all-cause death, cardiac death, and major adverse cardiovascular events (MACE). Patients were stratified into three groups, including the No MI group, PMI group, and SMI group. PMI was defined based on different diagnostic criteria, including the third and fourth universal myocardial infarction (MI) definitions, the society for cardiovascular angiography and interventions (SCAI) definition, and the independent biomarker definition. Regardless of these definitions, the PMI groups were all associated with a significantly increased MACE risk at one year or 1000 days (all P < 0.05), but not all-cause or cardiac death. The SMI group was associated with a markedly elevated risk of death and MACE, but it showed no significant different risk of MACE to PMI using varying definitions. CONCLUSIONS According to various PMI definitions, PMI and SMI were associated with an increased risk of MACE, but not death for PMI. No significantly different risk of MACE was observed between PMI and SMI.
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Affiliation(s)
- Yupeng Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaihao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiac Catheterization Laboratory, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jilin Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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10
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Zhou Y, Chen Z, Ma J, Chen A, Lu D, Wu Y, Ren D, Zhang C, Dai C, Zhang Y, Qian J, Ge J. Incidence, predictors and clinical significance of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention. J Cardiol 2020; 76:309-316. [DOI: 10.1016/j.jjcc.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 01/09/2023]
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11
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Koskinas KC, Ndrepepa G, Räber L, Karagiannis A, Kufner S, Zanchin T, Hieber J, Hunziker L, Mayer K, Byrne RA, Heg D, Windecker S, Kastrati A. Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions. Circ Cardiovasc Interv 2019; 11:e006752. [PMID: 30545257 DOI: 10.1161/circinterventions.118.006752] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions. METHODS AND RESULTS We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin. CONCLUSIONS In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.
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Affiliation(s)
- Konstantinos C Koskinas
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Lorenz Räber
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Alexios Karagiannis
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland (A.K., D.H.)
| | - Sebastian Kufner
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Thomas Zanchin
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Julia Hieber
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Lukas Hunziker
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Katharina Mayer
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
| | - Robert A Byrne
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (R.A.B., A.K.)
| | - Dik Heg
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland (A.K., D.H.)
| | - Stephan Windecker
- From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.)
| | - Adnan Kastrati
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (R.A.B., A.K.)
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12
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Yang HM, Yoon MH, Lim HS, Seo KW, Choi BJ, Choi SY, Hwang GS, Tahk SJ. Lipid-Core Plaque Assessed by Near-Infrared Spectroscopy and Procedure Related Microvascular Injury. Korean Circ J 2019; 49:1010-1018. [PMID: 31456364 PMCID: PMC6813158 DOI: 10.4070/kcj.2019.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/23/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction. We assessed the lipid-core plaque using near-infrared spectroscopy (NIRS) and microvascular dysfunction invasively with the index of microcirculatory resistance (IMR) and evaluated their relationship. Methods This study is pilot retrospective observational study. We analyzed 39 patients who performed NIRS before and after PCI, while fractional flow reserve, thermo-dilution coronary flow reserve (CFR) and IMR were measured after PCI. The maximum value of lipid core burden index (LCBI) for any of the 4-mm segments at the culprit lesion (culprit LCBI4mm) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit LCBI4mm ≥500. Results Mean pre-PCI LCBI was 333±196 and mean post-PCI IMR was 20±14 U. Post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower (3.7±2.2 vs. 2.1±1.0, p=0.029) in the high LCBI group. Pre-PCI LCBI was positively correlated with post-PCI IMR (ρ=0.358, p=0.025) and negatively correlated with post-PCI CFR (ρ=−0.494, p=0.001). The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high LCBI group (9.4% vs. 85.7%, p<0.001). However, there were no significant differences in the incidences of creatine Kinase-MB (9.4% vs. 14.3%, p=0.563) and troponin-I elevation (12.5% vs. 14.3%, p=1.000). Conclusions A large lipid-core plaque at the ‘culprit’ lesion is observed higher incidence of post-PCI microvascular dysfunction after PCI. Prospective study with adequate subject numbers will be needed.
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Affiliation(s)
- Hyoung Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Myeong Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
| | - Hong Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Byoung Joo Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - So Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Gyo Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
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13
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Predictive value of baseline C-reactive protein for periprocedural myocardial infraction of higher risk stratifications: A retrospective cohort clinical study. Anatol J Cardiol 2018; 20:310-317. [PMID: 30297597 PMCID: PMC6287438 DOI: 10.14744/anatoljcardiol.2018.05406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: It is controversial whether preprocedural elevated high sensitivity C-reactive protein (CRP) could increase the incidence of periprocedural myocardial infraction (PMI) of higher risk stratifications. The primary aim of this study was to evaluate whether preoperative elevated CRP level was related to the incidence of PMI in patients who underwent percutaneous coronary intervention (PCI). Methods: A total of 4.426 patients [66 y (59, 75); 72.3% males] with normal preprocedural cardiac enzymes were prospectively divided into two groups; the elevated CRP group was defined as CRP >3 mg/L, which was approximately 30.4% of the patients. The relationship between CRP and the incidence of PMI was established by multivariate logistic regression analysis, and multivariate linear regression analysis was used to assess the correlation between CRP and the severity of myocardial injury. Results: The incidence rates were similar between the two groups with periprocedural myocardial minor necrosis (34.23% versus 32.74%, p=0.607), but significantly differed based on the 2007 (defined as cardiac enzymes >3-fold elevations), 31.25% in high CRP group versus 26.25% in low group [odds ratio (OR) 1.19; p=0.046] and the 2012 universal PMI (defined as cardiac enzymes >5-fold elevations with at least one clinical evidence, such as chest pain, ECG changes or imaging diagnosis of heart ischemia), 19.79% versus 15.35% (OR 1.26, p=0.023); besides, the PMI ratios increased in line with the elevation of CRP (p=0.006 for the 2007 and p=0.011 for the 2012 universal PMI). However, no significant linear relationship was found between CRP and high sensitivity cardiac troponin I peak post-PCI. Conclusion: Elevated baseline CRP was an independent risk factor for the incidence of the 2007 and the 2012 universal PMI rather than minor necrosis. However, CRP may not correlate with the severity of minor myocardial necrosis in patients with PMI.
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14
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Jinnouchi H, Sakakura K, Fujita H. Peri-procedural myocardial infarction is all the same? J Thorac Dis 2018; 10:S3176-S3181. [PMID: 30430028 DOI: 10.21037/jtd.2018.08.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.,CV Path Institute, Gaithersburg, Maryland, USA
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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15
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Monteiro Moreira F, Cristina Dias Cunha Nascimento T, Murata Murakami B, Cristina Bergamasco E, Takao Lopes C, Ribeiro Dos Santos E. Clinical Predictors of Risk for Decreased Cardiac Tissue Perfusion After Percutaneous Coronary Intervention: A Retrospective Cohort Study. Int J Nurs Knowl 2018; 30:162-167. [PMID: 29745449 DOI: 10.1111/2047-3095.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish clinical predictors of risk for decreased cardiac tissue perfusion (DCTP) after percutaneous coronary intervention (PCI). METHODS Data on demographic, anthropometric, clinical, and procedural variables were collected as explanatory from a database of 1,542 adult patients undergoing PCI. A diagnosis of periprocedural myocardial infarction was used to confirm DCTP. A multivariate logistic regression determined the predictors of DCTP. RESULTS The independent predictors of risk for DCTP were age (OR = 1.02, CI 95% = 1.01-1.03, p = .008), multivessel disease (OR = 1.79, CI 95% = 1.30-2.46, p <.001) and intraprocedural lesion complications (OR = 4.56, CI 95% = 3.03-6.87, p <.001). CONCLUSION AND IMPLICATIONS FOR NURSING PRACTICE These results increase the level of evidence of risk for DCTP by refining its risk factors and can support nurses' clinical judgment.
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Affiliation(s)
| | | | | | | | - Camila Takao Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo-SP, Brazil
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16
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Ricottini E, Mangiacapra F, Nusca A, Melfi R, Cavallari I, Miglionico M, Gallo P, Pozzilli P, Di Sciascio G. Relation of Platelet Indexes to Platelet Reactivity and Periprocedural Myocardial Infarction in Patients Who Underwent Percutaneous Coronary Angioplasty. Am J Cardiol 2018; 121:1027-1031. [PMID: 29571721 DOI: 10.1016/j.amjcard.2018.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
No comprehensive data are available on the role of platelet indexes (PI) in the periprocedural risk stratification of patients who underwent percutaneous coronary intervention (PCI). The aim of this study was to investigate the relation of PI to platelet reactivity (PR) and periprocedural myocardial infarction (PMI) in patients receiving PCI. A total of 502 PCI patients had preprocedural measurement of PI and PR, the latter assessed by VerifyNow P2Y12 assay. Study end points were incidence of PMI and high platelet reactivity (HPR) according to tertiles of PI and evaluation of PI in HPR patients. Incidence of PMI in the overall population was 6.6%. Rates of PMI were not different in PI tertiles: platelet count (I: 6.0%, II: 7.1%, III: 6.5%; p = 0.74), mean platelet volume (MPV, I: 6.6%, II: 7.3%, III: 5.8%;p = 0.86), platelet distribution width (I: 7.2%, II: 7.2%, III: 5.8%;p = 0.74), and MPV/P ratio (I: 6.6%, II: 6.0%, III: 7.1%; p = 0.91). The occurrence of PMI was significantly different in PR tertiles (I: 3%, II: 5.4%, III: 11.4%; p = 0.006). Platelet count and MPV/P ratio were significantly different in patients with and without HPR (221.8 ± 58.6 × 103/µL vs207 ± 59.4 × 103/µL, p = 0.008; 51.73 ± 15.17 vs 56.7 ± 18.3, p = 0.002).In conclusion, this study showed no relation between PI and PMI in PCI patients but confirms the association of HPR with increased incidence of PMI; thus, PI seem to be not able to identify patients at higher periprocedural risk, but monitoring PR by a bedside assay remains a useful tool for risk stratification.
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Abstract
Evidence-based medicine (EBM) provides clinicians with beneficial information. Nonetheless, study findings are often arbitrary, speculative or provisional. The current state of misleading evidence exists in all applications, including those for guideline recommendations. We conductedan appraisal of the American College of Cardiologyand European Society of Cardiology Guidelines for revascularisation of complex coronary anatomy to determine the veracity of the evidence that recommendations were based on. Study-specific critical appraisals were conducted by the authors on the 5-year Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and future revascularisation evaluation in patients with diabetes mellitus: optimal management of multivessel disease (FREEDOM) Trials. Each appraisal was performed according the standard EBM practices. A thorough design and analytic critique was performed for each study and the results presented and explained. The guideline recommendations were reviewed in terms of the veracity of the evidence cited. The relative difference in major adverse cardiac and cerebrovascular event (MAACE) rates between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are not the 30% level reported by the SYNTAX Trial but closer to 11% difference when study limitations are factored in. Similarly, the 30% effect size in MAACE rates between procedures from the FREEDOM Trial is closer to a non-significant 5% relative difference when limitations are adjusted for. Based on the actual findings of each study, outcomes from procedures by CABG or PCI for multivessel revascularisation are similar and contradict the conclusions of the study authors as well as the recommendations. These recommendations fail to inform current clinical practice.
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Affiliation(s)
- David R Dobies
- Cardiology Department, Regional Cardiology Associates, Grand Blanc, Michigan, USA
| | - Kimberly R Barber
- Research Department, Ascension/Genesys Regional Research, Grand Blanc, Michigan, USA
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Effect of Remote Ischemic Preconditioning on Perioperative Cardiac Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of 16 Randomized Trials. Cardiol Res Pract 2017; 2017:6907167. [PMID: 29062582 PMCID: PMC5618784 DOI: 10.1155/2017/6907167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background The main objective of this meta-analysis was to investigate whether remote ischemic preconditioning (RIPC) reduces cardiac and renal events in patients undergoing elective cardiovascular interventions. Methods and Results We systematically searched articles published from 2006 to 2016 in PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. Sixteen RCTs of 2435 patients undergoing elective PCI were selected. Compared with control group, RIPC could significantly reduce the incidence of perioperative myocardial infarction (OR = 0.64; 95% CI: 0.48–0.86; P = 0.003) and acute kidney injury (OR = 0.56; 95% CI: 0.322–0.99; P = 0.049). Metaregression analysis showed that the reduction of PMI by RIPC was enhanced for CAD patients with multivessel disease (coef.: −0.05 [−0.09; −0.01], P = 0.022). There were no differences in the changes of cTnI (P = 0.934) and CRP (P = 0.075) in two groups. Conclusion Our meta-analysis of RCTs demonstrated that RIPC can provide cardiac and renal protection for patients undergoing elective PCI, while no beneficial effect on reducing the levels of cTnI and CRP after PCI was reported.
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Xia J, Xu J, Hu S, Hao H, Yin C, Xu D. Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6months follow-up. Clin Chim Acta 2017. [PMID: 28624498 DOI: 10.1016/j.cca.2017.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. METHODS From May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. RESULTS The occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85-5.38; P=0.01). CONCLUSIONS The trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up.
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Affiliation(s)
- Jinggang Xia
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ji Xu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Shaodong Hu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hengjian Hao
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chunlin Yin
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Dong Xu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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Impact of Institutional and Operator Volume on Short-Term Outcomes of Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2017; 10:918-927. [DOI: 10.1016/j.jcin.2017.02.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022]
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Seto AH, Kern MJ. Breaking the code: What is the best post-PCIMI definition? Catheter Cardiovasc Interv 2017; 89:857-859. [DOI: 10.1002/ccd.27049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Arnold H. Seto
- Division of Cardiology, Department of Medicine; Veterans Affairs Long Beach Healthcare System; Long Beach California
| | - Morton J. Kern
- Division of Cardiology, Department of Medicine; Veterans Affairs Long Beach Healthcare System; Long Beach California
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Zhang D, Li Y, Yin D, He Y, Chen C, Song C, Yan R, Zhu C, Xu B, Dou K. Risk stratification of periprocedural myocardial infarction after percutaneous coronary intervention: Analysis based on the SCAI definition. Catheter Cardiovasc Interv 2017; 89:534-540. [PMID: 28191726 DOI: 10.1002/ccd.26939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Dong Zhang
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Yiping Li
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Dong Yin
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Yuan He
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Changzhe Chen
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Chenxi Song
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Ruohua Yan
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Chen'gang Zhu
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Bo Xu
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Kefei Dou
- From State Key Laboratory of Cardiovascular Disease, Department of Cardiology; Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
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Abstract
Acute coronary syndrome (ACS) encompasses a pathophysiological spectrum of cardiovascular diseases, all of which have significant morbidity and mortality. ACS was once considered an acute condition; however, new treatment strategies and improvements in biomarker assays have led to ACS being an acute and chronic disease. Cardiac troponin is the preferred biomarker for the diagnosis of myocardial infarction, and there is considerable interest and efforts toward development and implementation of high-sensitivity cardiac troponin (hs-cTn) assays worldwide. Analytical and clinical performance characteristics of hs-cTn assays as well as testing limitations are important for laboratorians and clinicians to understand in order to utilize testing appropriately. Furthermore, expanding the clinical utility of hs-cTn into other cohorts such as asymptomatic community dwelling populations, heart failure, and chronic kidney disease populations supports novel opportunities for improved short- and long-term prognosis.
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24
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Stone GW. Periprocedural Myocardial Infarction. JACC Cardiovasc Interv 2016; 9:2229-2231. [DOI: 10.1016/j.jcin.2016.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 11/16/2022]
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Sakakura K, Inohara T, Kohsaka S, Amano T, Uemura S, Ishii H, Kadota K, Nakamura M, Funayama H, Fujita H, Momomura SI. Incidence and Determinants of Complications in Rotational Atherectomy. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004278. [DOI: 10.1161/circinterventions.116.004278] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
Abstract
Background—
The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI).
Methods and Results—
The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02–1.05), impaired kidney function (OR 1.59, 95% CI 1.15–2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21–2.35), emergent PCI (OR 4.02, 95% CI 1.66–8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43–3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36–0.89).
Conclusions—
The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).
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Affiliation(s)
- Kenichi Sakakura
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Taku Inohara
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Shun Kohsaka
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Tetsuya Amano
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Shiro Uemura
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Hideki Ishii
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Kazushige Kadota
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Masato Nakamura
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Hiroshi Funayama
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Hideo Fujita
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
| | - Shin-ichi Momomura
- From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.)
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Ollila A, Vikatmaa L, Virolainen J, Vikatmaa P, Leppäniemi A, Albäck A, Salmenperä M, Pettilä V. Perioperative Myocardial Infarction in Non-Cardiac Surgery Patients: A Prospective Observational Study. Scand J Surg 2016; 106:180-186. [DOI: 10.1177/1457496916673585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials. Material and Methods: We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment. Results: Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery—19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non–perioperative myocardial infarction patients ( p < 0.001). Perioperative risk calculator predicted perioperative myocardial infarction with an area under curve of 0.73 (95% confidence interval: 0.64–0.81). Conclusion: Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.
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Affiliation(s)
- A. Ollila
- Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L. Vikatmaa
- Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J. Virolainen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P. Vikatmaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A. Leppäniemi
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A. Albäck
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M. Salmenperä
- Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - V. Pettilä
- Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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27
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Safety and Efficacy of Same-Day Discharge Following Elective Percutaneous Coronary Intervention, Including Evaluation of Next Day Troponin T Levels. Heart Lung Circ 2015; 24:368-76. [DOI: 10.1016/j.hlc.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 12/22/2022]
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