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Kurniawan RB, Saputra PBT, Haq AUDU, Purwati DD, Wungu CDK, Susilo H, Alsagaff MY, Amin IM, Oktaviono YH. Characteristics of calcified nodule attributable to culprit lesion in acute coronary syndrome: A systematic review and meta-analysis. iScience 2024; 27:110351. [PMID: 39092174 PMCID: PMC11292520 DOI: 10.1016/j.isci.2024.110351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/01/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Abstract
The presence of calcified nodule (CN) is a significant characteristic of atherothrombosis in acute coronary syndrome (ACS). However, its characteristics continue to be understudied. This review aimed to further investigate these characteristics. This study found that CN was a distinctive feature of an atheromatous plaque, representing 6.3% of ACS. CN was more common in NSTE-ACS than in STEMI patients (9.4% vs. 6.6%). CN was also chiefly observed in the left anterior descendant artery (48%), followed by the right coronary (40.4%) and left circumflex (14.5%) arteries. Higher prevalence of hypertension (78.8%), diabetes mellitus (50.8%), multivessel disease (71.7%), and kidney disease (26.43%) were noted in CN compared to non-CN patients. CN-associated ACS also 6-fold increased the risk of target lesion revascularization compared to those without CN.
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Affiliation(s)
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Indah Mohd Amin
- Center of Preclinical Science Studies, Faculty of Dentistry, Universiti Teknologi MARA, Selangor Darul Ehsan, Malaysia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Dong H, Liu Z, Chen H, Ba J, Shi R, Jin Q, Shao X, Tian T, Yin J, Chang L, Deng Y. Association between glycemia and multi-vessel lesion in participants undergoing coronary angiography: a cross-sectional study. Front Cardiovasc Med 2024; 11:1435246. [PMID: 39087073 PMCID: PMC11288860 DOI: 10.3389/fcvm.2024.1435246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Background This study aims to elucidate the association between glycemia and the occurrence of multi-vessel lesions in participants undergoing coronary angiography. Methods We analyzed 2,533 patients with coronary artery disease who underwent coronary angiography. Of these, 1,973 patients, identified by the endpoint of multi-vessel lesions, were examined using univariate and multivariate logistic regression analyses to determine the relationship between glycemia levels and multi-vessel lesion occurrence. Results The analysis included 1,973 participants, among whom 474 patients were identified with coronary multi-vessel lesions. Univariate logistic regression analysis demonstrated a positive correlation between glycemia and the occurrence of coronary multi-vessel lesions (OR 1.04; 95% CI 1.01-1.08; p = 0.02). The adjusted model indicated that for each unit increase in glycemia, the risk of developing coronary multi-vessel lesions increased by 4%, showing a significant correlation (p < 0.05). Subgroup analyses revealed that the impact of glycemia on multi-vessel lesions in patients with PCI varied according to gender, age, and smoking status, with the effect being more pronounced in men, older patients, and smokers. Conclusion Our findings establish a significant association between glycemia and the incidence of multi-vessel lesions, particularly pronounced in male patients, individuals over 45, and smokers.
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Affiliation(s)
- Hezeng Dong
- College of Traditional Chinese Medicine, Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Zhaozheng Liu
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Hao Chen
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Jin Ba
- College of Traditional Chinese Medicine, Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Rui Shi
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Qu Jin
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Xiao Shao
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Tenghui Tian
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Jinzhu Yin
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Liping Chang
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Yue Deng
- Cardiology Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
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Wang H, Ma A, Wang T. Nomogram to Predict Outcomes After Staged Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. Int J Gen Med 2024; 17:1713-1722. [PMID: 38706752 PMCID: PMC11067940 DOI: 10.2147/ijgm.s457236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Objective Approximately 50% of ST-segment elevation myocardial infarction (STEMI) patients have multivessel coronary artery disease (MVD). The management strategy for these patients remains controversial. This study aimed to develop predictive models and nomogram of outcomes in STEMI patients with MVD for better identification and classification. Methods The least absolute shrinkage and selection operator (LASSO) method was used to select the features most significantly associated with the outcomes. A Cox regression model was built using the selected variables. One nomogram was computed from each model, and individual risk scores were obtained by applying the nomograms to the cohort. After regrouping patients based on nomogram risk scores into low- and high-risk groups, we used the Kaplan-Meier method to perform survival analysis. Results The C-index of the major adverse cardiovascular event (MACE)-free survival model was 0·68 (95% CI 0·62-0·74) and 0·65 [0·62-0·68]) at internal validation, and that of the overall survival model was 0·75 (95% CI 0·66-0·84) and (0·73 [0·65-0·81]). The predictions of both models correlated with the observed outcomes. Low-risk patients had significantly lower probabilities of 1-year or 3-year MACEs (4% versus 11%, P= 0.003; 7% versus 15%, P=0.01, respectively) and 1-year or 3-year all-cause death (1% versus 3%, P=0.048; 2% versus 7%, respectively, P=0.001) than high-risk patients. Conclusion Our nomograms can be used to predict STEMI and MVD outcomes in a simple and practical way for patients who undergo primary PCI for culprit vessels and staged PCI for non-culprit vessels.
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Affiliation(s)
- Huaigen Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Aiqun Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Shaanxi Key Laboratory of Molecular Cardiology (Xi’an Jiaotong University), Xi’an, Shaanxi, People’s Republic of China
| | - Tingzhong Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Shaanxi Key Laboratory of Molecular Cardiology (Xi’an Jiaotong University), Xi’an, Shaanxi, People’s Republic of China
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Hu J, Hao G, Xu J, Wang X, Chen M. Deep learning-based coronary artery calcium score to predict coronary artery disease in type 2 diabetes mellitus. Heliyon 2024; 10:e27937. [PMID: 38496873 PMCID: PMC10944251 DOI: 10.1016/j.heliyon.2024.e27937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
Background Coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM) patients often presents diffuse lesions, with extensive calcification, and it is time-consuming to measure coronary artery calcium score (CACS). Objectives To explore the predictive ability of deep learning (DL)-based CACS for obstructive CAD and hemodynamically significant CAD in T2DM. Methods 469 T2DM patients suspected of CAD who accepted CACS scan and coronary CT angiography between January 2013 and December 2020 were enrolled. Obstructive CAD was defined as diameter stenosis ≥50%. Hemodynamically significant CAD was defined as CT-derived fractional flow reserve ≤0.8. CACS was calculated with a fully automated method based on DL algorithm. Logistic regression was applied to determine the independent predictors. The predictive performance was evaluated with area under receiver operating characteristic curve (AUC). Results DL-CACS (adjusted odds ratio (OR): 1.005; 95% CI: 1.003-1.006; P < 0.001) was significantly associated with obstructive CAD. DL-CACS (adjusted OR:1.003; 95% CI: 1.002-1.004; P < 0.001) was also an independent predictor for hemodynamically significant CAD. The AUCs, sensitivities, specificities, positive predictive values and negative predictive values of DL-CACS for obstructive CAD and hemodynamically significant CAD were 0.753 (95% CI: 0.712-0.792), 75.9%, 66.5%, 74.8%, 67.8% and 0.769 (95% CI: 0.728-0.806), 80.7%, 62.1%, 59.6% and 82.3% respectively. It took 1.17 min to perform automated measurement of DL-CACS in total, which was significantly less than manual measurement of 1.73 min (P < 0.001). Conclusions DL-CACS, with less time-consuming, can accurately and effectively predict obstructive CAD and hemodynamically significant CAD in T2DM.
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Affiliation(s)
- Jingcheng Hu
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guangyu Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jialiang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Meng Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Chen M, Hao G, Hu S, Chen C, Tao Q, Xu J, Geng Y, Wang X, Hu C. Lesion-specific pericoronary adipose tissue CT attenuation improves risk prediction of major adverse cardiovascular events in coronary artery disease. Br J Radiol 2024; 97:258-266. [PMID: 38263819 DOI: 10.1093/bjr/tqad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To determine whether lesion-specific pericoronary adipose tissue CT attenuation (PCATa) is superior to PCATa around the proximal right coronary artery (PCATa-RCA) and left anterior descending artery (PCATa-LAD) for major adverse cardiovascular events (MACE) prediction in coronary artery disease (CAD). METHODS Six hundred and eight CAD patients who underwent coronary CTA from January 2014 to December 2018 were retrospectively included, with clinical risk factors, plaque features, lesion-specific PCATa, PCATa-RCA, and PCATa-LAD collected. MACE was defined as cardiovascular death, non-fatal myocardial infarction, unplanned revascularization, and hospitalization for unstable angina. Four models were established, encapsulating traditional factors (Model A), traditional factors and PCATa-RCA (Model B), traditional factors and PCATa-LAD (Model C), and traditional factors and lesion-specific PCATa (Model D). Prognostic performance was evaluated with C-statistic, area under receiver operator characteristic curve (AUC), and net reclassification index (NRI). RESULTS Lesion-specific PCATa was an independent predictor for MACE (adjusted hazard ratio = 1.108, P < .001). The C-statistic increased from 0.750 for model A to 0.762 for model B (P = .078), 0.773 for model C (P = .046), and 0.791 for model D (P = .005). The AUC increased from 0.770 for model A to 0.793 for model B (P = .027), 0.793 for model C (P = .387), and 0.820 for model D (P = .019). Compared with model A, the NRIs for models B, C, and D were 0.243 (-0.323 to 0.792, P = .392), 0.428 (-0.012 to 0.835, P = .048), and 0.708 (0.152-1.016, P = .001), respectively. CONCLUSIONS Lesion-specific PCATa improves risk prediction of MACE in CAD, which is better than PCATa-RCA and PCATa-LAD. ADVANCES IN KNOWLEDGE Lesion-specific PCATa was superior to PCATa-RCA and PCATa-LAD for MACE prediction.
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Affiliation(s)
- Meng Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Guangyu Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Can Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Qing Tao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Jialiang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Yayuan Geng
- Department of Research and Development, ShuKun Technology Co., Ltd, Beijing 100102, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
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Andishmand A, Emami Meybodi M, Namayandeh SM, Mohammadi HR, Andishmand M, Zarbakhsh MA, Azimi zade M. Comparison between myocardial infarction with non-obstructive coronaries (MINOCA) and myocardial infarct patients with coronary artery disease (MI-CAD): A single-center retrospective cohort study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:109-114. [PMID: 38463910 PMCID: PMC10921117 DOI: 10.22088/cjim.15.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/11/2023] [Accepted: 03/28/2023] [Indexed: 03/12/2024]
Abstract
Background The coronary angiography results in a group of patients with myocardial infarction (MI) are normal or near-normal; which is diagnosed as myocardial infarction with non-obstructive coronary arteries (MINOCA). This study aimed to compare the mortality rate and risk factors between MINOCA and myocardial infarction with obstructive coronary artery (MI-CAD). Methods This retrospective cohort study was conducted from January 1, 2018, to December 31, 2019. A total of 679 patients admitted to Afshar Hospital in Yazd with a diagnosis of ST-elevation myocardial infarction (STEMI) from 2018-2019 who underwent primary Percutaneous Coronary Intervention (PCI) were enrolled in the study. Demographic, and clinical variables, ECG finding and one-year mortality, were extracted using MI registry data from the Yazd Cardiac Research Center. Results The estimated frequency of MINOCA was 4.6%. Patients with MINOCA (47.14±6.2) were younger than patients with MI-CAD (57.61±9.1) (P <0.0001). MINOCA patients (47.4±9.47) had a considerably greater left ventricular ejection fraction (LVEF) than MI-CAD patients (43.5±6.8) (P =0.018). The majority site of MI in MINOCA patients was located in the non-anterior wall (p <0.0001). A comparison of MINOCA and MI-CAD patients' one-year mortality revealed no significant difference (P =0.07). Conclusion The prevalence of patients with MINOCA in Yazd was similar to other communities. Although these patients probably do not have a better prognosis, despite being younger and having better LV systolic function and lower CAD risk factors.
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Affiliation(s)
- Abbas Andishmand
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Emami Meybodi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Hamid Reza Mohammadi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojtaba Andishmand
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Zarbakhsh
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Marzieh Azimi zade
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Rawat A, Nazly S, Kumar J, Khan TJ, Kaur K, Kaur G, Batool S, Khan A. Comparison of Immediate Versus Staged Complete Revascularisation in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease: A Meta-Analysis of Randomized and Non-randomized Studies. Cureus 2023; 15:e43968. [PMID: 37746472 PMCID: PMC10515466 DOI: 10.7759/cureus.43968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Acute myocardial infarction is a critical medical condition that poses a significant health burden, leading to substantial morbidity. Despite advancements in medical care, managing this condition is challenging for patients and society. The preferred approach appears to be comprehensive multivessel revascularization, yet the optimal timing remains uncertain. This study aims to compare immediate complete revascularisation and stage complete vascularization in patients presenting with acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD). The Preferred Reporting of Systematic Reviews and Meta-analysis (PRISMA) guidelines conducted the present meta-analysis. A comprehensive literature search was conducted using online databases, including PubMed, and EMBASE from 2010 onwards, to identify articles that compared cardiovascular outcomes between patients undergoing immediate and staged complete revascularization. We also searched Google Scholar for additional studies relevant to the present meta-analysis. The primary outcome assessed in this study was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and revascularization. A total of 15 studies fulfilled pre-defined eligibility criteria and were included in the final analysis. Our analysis shows that staged revascularization is associated with improved outcomes in patients with ACS and multivessel CAD, including all-cause mortality and cardiovascular mortality, without increasing the risk of major adverse cardiovascular events, myocardial infarction, and the need for unplanned revascularization.
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Affiliation(s)
- Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Baksar Wala, IND
| | - Sumreen Nazly
- Internal Medicine, University Medical & Dental College Faisalabad, Faisalabad, PAK
| | - Jasvant Kumar
- Internal Medicine, Chandka Medical College, Larkana, PAK
| | - Tayyaba J Khan
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Komal Kaur
- Medicine, American University of Antigua, Osburn, ATG
| | - Gurvir Kaur
- Medicine, American University of Antigua, Osburn, ATG
- Medicine, Chino Valley Medical Center, Chino, USA
| | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
| | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
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Carpenter HJ, Ghayesh MH, Zander AC, Psaltis PJ. On the nonlinear relationship between wall shear stress topology and multi-directionality in coronary atherosclerosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107418. [PMID: 36842347 DOI: 10.1016/j.cmpb.2023.107418] [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: 11/02/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE In this paper we investigate twelve multi-directional/topological wall shear stress (WSS) derived metrics and their relationships with the formation of coronary plaques in both computational fluid dynamics (CFD) and dynamic fluid-structure interaction (FSI) frameworks. While low WSS is one of the most established biomechanical markers associated with coronary atherosclerosis progression, alone it is limited. Multi-directional and topological WSS derived metrics have been shown to be important in atherosclerosis related mechanotransduction and near-wall transport processes. However, the relationships between these twelve WSS metrics and the influence of both FSI simulations and coronary dynamics is understudied. METHODS We first investigate the relationships between these twelve WSS derived metrics, stenosis percentage and lesion length through a parametric, transient CFD study. Secondly, we extend the parametric study to FSI, both with and without the addition of coronary dynamics, and assess their correlations. Finally, we present the case of a patient who underwent invasive coronary angiography and optical coherence tomography imaging at two time points 18 months apart. Associations between each of the twelve WSS derived metrics in CFD, static FSI and dynamic FSI simulations were assessed against areas of positive/negative vessel remodelling, and changes in plaque morphology. RESULTS 22-32% stenosis was the threshold beyond which adverse multi-directional/topological WSS results. Each metric produced a different relationship with changing stenoses and lesion length. Transient haemodynamics was impacted by coronary dynamics, with the topological shear variation index suppressed by up to 94%. These changes appear more critical at smaller stenosis levels, suggesting coronary dynamics could play a role in the earlier stages of atherosclerosis development. In the patient case, both dynamics and FSI vs CFD changes altered associations with measured changes in plaque morphology. An appendix of the linear fits between the various FSI- and CFD-based simulations is provided to assist in scaling CFD-based results to resemble the compliant walled characteristics of FSI more accurately. CONCLUSIONS These results highlight the potential for coronary dynamics to alter multi-directional/topological WSS metrics which could impact associations with changes in coronary atherosclerosis over time. These results warrant further investigation in a wider range of morphological settings and longitudinal cohort studies in the future.
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Affiliation(s)
- Harry J Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Mergen H Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Anthony C Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia
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9
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Panuccio G, Salerno N, De Rosa S, Torella D. Timing of Complete Revascularization in Patients with STEMI and Multivessel Disease: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023; 24:58. [PMID: 39077406 PMCID: PMC11273107 DOI: 10.31083/j.rcm2402058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 07/31/2024] Open
Abstract
Background About half of patients with ST-segment Elevation Myocardial Infarction (STEMI) have multivessel coronary artery disease (MVD). Our aim was to provide a quantitative comparison of single-stage complete revascularization during the index revascularization versus deferred staged complete revascularization in STEMI patients with MVD. Methods All studies evaluating patients with STEMI and MVD were included. The primary endpoint was a composite of all-cause death, myocardial infarction and repeat revascularization. Secondary endpoints were cardiovascular death, acute kidney injury and trial defined major bleeding. Results Eight studies and 2256 patients with STEMI and MVD were included. No difference was evident in the rate of the primary composite endpoint among the study group (Risk Ratio 0.95; 95% CI 0.71-1.27, p = 0.74), while meta-regression showed a significant interaction with drug eluting stent (DES) use (Coefficient -0.005; 95% CI -0.01 to -0.001; p = 0.007). Higher rates of cardiovascular (CV) death were found in the immediate complete revascularization group (5.0% vs 2.6%; Risk Ratio 0.39; 95% CI 0.25-0.62; p < 0.01). Conclusions Our analysis documented similar clinical outcomes with either single-stage immediate complete revascularization and delayed staged complete revascularization. Secondary analyses suggest that an increase in cardiovascular death might be expected with single-stage percutaneous coronary intervention (PCI). While new randomized trials on the topic are ongoing, revascularization can be personalized and guided by the acute clinical setting, patients'-related factors and workflow logistics.
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Affiliation(s)
- Giuseppe Panuccio
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Nadia Salerno
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
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Vasiljevs D, Kakurina N, Pontaga N, Kokina B, Osipovs V, Sorokins N, Pikta S, Trusinskis K, Lejnieks A. Culprit versus Complete Revascularization during the Initial Intervention in Patients with Acute Coronary Syndrome Using a Virtual Treatment Planning Tool: Results of a Single-Center Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:270. [PMID: 36837471 PMCID: PMC9967361 DOI: 10.3390/medicina59020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
Background and Objectives: The revascularization strategy for percutaneous coronary intervention (PCI) in patients with multivessel (MV) acute coronary syndrome (ACS) remains controversial. Certain gaps in the evidence are related to the optimal timing of non-culprit lesion revascularization and the utility of instantaneous wave-free ratio (iFR) in the management of MV ACS intervention. The major benefits of iFR utilization in MV ACS patients in one-stage complete revascularization are: (1) the possibility to virtually plan the PCI, both the location and the extension of the necessary stenting to achieve the prespecified final hemodynamic result; (2) the opportunity to validate the final hemodynamic result of the PCI, both in culprit artery and all non-culprit arteries and (3) the value of obliviating the uncomfortable, costly, time consuming and sometimes deleterious effects from Adenosine, as there is no requirement for administration. Thus, iFR use fosters the achievement of physiologically appropriate complete revascularization in MV ACS patients during acute hospitalization. Materials and Methods: This pilot study was aimed to test the feasibility of a randomized trial research protocol as well as to assess patient safety signals of co-registration iFR-guided one-stage complete revascularization compared with that of standard staged angiography-guided PCI in de novo patients with MV ACS. This was a single-center, prospective, randomized, open-label clinical trial consecutively screening patients with ACS for MV disease. The intervention strategy of interest was iFR-guided physiologically complete one-stage revascularization, in which the virtual PCI planning of non-culprit lesions and the intervention itself were performed in one stage directly following treatment of the culprit lesion and other critical stenosis of more than ninety percent. Seventeen patients were recruited and completed the 3-month follow-up. Results: Index PCI duration was significantly longer while the volume of contrast media delivered in index PCI was significantly greater in the iFR-guided group than in the angiography-guided group (119.4 ± 40.7 vs. 47 ± 15.5 min, p = 0.004; and 360 ± 97.9 vs. 192.5 ± 52.8 mL, p = 0.003). There were no significant differences in PCI-related major adverse cardiovascular events (MACE) between the groups during acute hospitalization and at 3-months follow-up. One-stage iFR-guided PCI requires fewer PCI attempts until complete revascularization than does angiography-guided staged PCI. Conclusions: Complete revascularization with the routine use of the virtual planning tool in one-stage iFR-guided PCI is a feasible practical strategy in an everyday Cath lab environment following the protocol designed for the study. No statistically significant safety signals were documented in the number of PCI related MACE during the 3-month follow-up.
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Affiliation(s)
- Deniss Vasiljevs
- Daugavpils Regional Hospital, 20 Vasarnicu Str., LV-5417 Daugavpils, Latvia
- Department of Internal Diseases, Riga Stradins University, 16 Dzirciema Str., LV-1007 Riga, Latvia
| | - Natalja Kakurina
- Daugavpils Regional Hospital, 20 Vasarnicu Str., LV-5417 Daugavpils, Latvia
| | - Natalja Pontaga
- Daugavpils Regional Hospital, 20 Vasarnicu Str., LV-5417 Daugavpils, Latvia
| | - Baiba Kokina
- Department of Internal Diseases, Riga Stradins University, 16 Dzirciema Str., LV-1007 Riga, Latvia
| | - Vladimirs Osipovs
- Daugavpils Regional Hospital, 20 Vasarnicu Str., LV-5417 Daugavpils, Latvia
| | - Nikolajs Sorokins
- Daugavpils Regional Hospital, 20 Vasarnicu Str., LV-5417 Daugavpils, Latvia
| | - Sergejs Pikta
- Daugavpils Regional Hospital, 20 Vasarnicu Str., LV-5417 Daugavpils, Latvia
| | - Karlis Trusinskis
- Department of Internal Diseases, Riga Stradins University, 16 Dzirciema Str., LV-1007 Riga, Latvia
- Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Str., LV-1002 Riga, Latvia
| | - Aivars Lejnieks
- Department of Internal Diseases, Riga Stradins University, 16 Dzirciema Str., LV-1007 Riga, Latvia
- Riga East Clinical University Hospital, 2 Hipokrata Str., LV-1038 Riga, Latvia
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Chen X, Wu H, Li L, Zhao X, Zhang C, Wang WE. The prognostic utility of GRACE risk score in predictive adverse cardiovascular outcomes in patients with NSTEMI and multivessel disease. BMC Cardiovasc Disord 2022; 22:568. [PMID: 36572851 PMCID: PMC9791745 DOI: 10.1186/s12872-022-03025-6] [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: 06/27/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND GRACE risk score models are capable of predicting all-cause mortality of non-ST elevation myocardial infarction (NSTEMI) patients. However, its utility for evaluating major adverse cardiovascular events (MACE) in NSTEMI patients with multivessel disease (MVD) remains unclear. METHODS AND RESULTS This study was designed as a retrospective cohort study that recruited patients with NSTEMI and multivessel disease between September 2013 and December 2018 in Daping Hospital, Chongqing, China. The primary outcome was a composite outcome that included all-cause mortality, recurrent angina, non-fatal myocardial infarction, coronary re-vascularization, and non-fatal strokes. Of the 827 patients with NSTEMI, 32 did not complete follow-up and 430 were excluded because of single-vessel disease. The remaining 365 NSTEMI patients with MVD had a median follow-up of 3.0 (IQR 2.6-3.3) years, 78 patients experienced outcomes. The GRACE risk score predicted the MACE (hazard ratio 1.014, 95% CI 1.006-1.021, P < 0.001). The GRACE risk score performed well in predicting all-cause mortality (c-statistic 0.72, 95% CI 0.59-0.85, P = 0.001) in MVD but was less powerful in predicting MACE (c-statistic 0.69, 95% CI 0.62-0.75, P < 0.001). When combining the GRACE risk score with the SYNTAX score, and blood urea nitrogen for predicting all-cause mortality and MACE events, the c-statistic value increased to 0.82 and 0.81 (P < 0.001). CONCLUSION In NSTEMI patients with MVD, the GRACE score showed an acceptable predictive value for all-cause mortality, but it was less powerful in predicting MACE. Blood urea nitrogen may be valuable in assessing long-term cardiovascular events in patients with MVD.
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Affiliation(s)
- Xiaokang Chen
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China ,Department of Cardiology, Santai County People’s Hospital (Affiliated Hospital of North Sichuan Medical College in Santai County), Mianyang, 621100 China
| | - Hao Wu
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Liangpeng Li
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Xiaofang Zhao
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Chao Zhang
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Wei Eric Wang
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
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12
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Gager GM, Eyileten C, Postula M, Gasecka A, Jarosz-Popek J, Gelbenegger G, Jilma B, Lang I, Siller-Matula J. Association Between the Expression of MicroRNA-125b and Survival in Patients With Acute Coronary Syndrome and Coronary Multivessel Disease. Front Cardiovasc Med 2022; 9:948006. [PMID: 35872885 PMCID: PMC9304571 DOI: 10.3389/fcvm.2022.948006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMicroRNAs (miRNA, miR) have an undeniable physiological and pathophysiological significance and act as promising novel biomarkers. The aim of the study was to investigate blood-derived miRNAs and their association with long-term all-cause mortality in patients with multivessel disease (MVD) suffering from acute coronary syndrome (ACS).Materials and MethodsThis study was an observational prospective study, which included 90 patients with MVD and ACS. Expression of miR-125a, miR-125b, and miR-223 was analysed by polymerase chain reaction (PCR). Patients were followed-up for a median of 7.5 years. All-cause mortality was considered as the primary endpoint. Adjusted Cox-regression analysis was performed for prediction of events.ResultsElevated expression of miR-125b (>4.6) at the time-point of ACS was associated with increased long-term all-cause mortality (adjusted [adj.] hazard ratio [HR] = 11.26, 95% confidence interval [95% CI]: 1.15–110.38; p = 0.038). The receiver operating characteristic (ROC) analysis showed a satisfactory c-statistics for miR-125b for the prediction of long-term all-cause mortality (area under the curve [AUC] = 0.76, 95% CI: 0.61–0.91; p = 0.034; the negative predictive value of 98%). Kaplan–Meier time to event analysis confirmed an early separation of the survival curves between patients with high vs low expression of miR-125b (p = 0.003). An increased expression of miR-125a and miR-223 was found in patients with non-ST-segment elevation ACS (NSTE-ACS) as compared to those with ST-segment elevation myocardial infarction (STEMI) (p = 0.043 and p = 0.049, respectively) with no difference in the expression of miR-125b between the type of ACS.ConclusionIn this hypothesis generating study, lower values of miR-125b were related to improved long-term survival in patients with ACS and MVD. Larger studies are needed to investigate whether miR-125b can be used as a suitable predictor for long-term all-cause mortality.
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Affiliation(s)
- Gloria M. Gager
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
- Genomics Core Facility, Center of New Technologies (CeNT), University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Jarosz-Popek
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jolanta Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Jolanta Siller-Matula,
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Carpenter HJ, Ghayesh MH, Zander AC, Li J, Di Giovanni G, Psaltis PJ. Automated Coronary Optical Coherence Tomography Feature Extraction with Application to Three-Dimensional Reconstruction. Tomography 2022; 8:1307-1349. [PMID: 35645394 PMCID: PMC9149962 DOI: 10.3390/tomography8030108] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary optical coherence tomography (OCT) is an intravascular, near-infrared light-based imaging modality capable of reaching axial resolutions of 10-20 µm. This resolution allows for accurate determination of high-risk plaque features, such as thin cap fibroatheroma; however, visualization of morphological features alone still provides unreliable positive predictive capability for plaque progression or future major adverse cardiovascular events (MACE). Biomechanical simulation could assist in this prediction, but this requires extracting morphological features from intravascular imaging to construct accurate three-dimensional (3D) simulations of patients' arteries. Extracting these features is a laborious process, often carried out manually by trained experts. To address this challenge, numerous techniques have emerged to automate these processes while simultaneously overcoming difficulties associated with OCT imaging, such as its limited penetration depth. This systematic review summarizes advances in automated segmentation techniques from the past five years (2016-2021) with a focus on their application to the 3D reconstruction of vessels and their subsequent simulation. We discuss four categories based on the feature being processed, namely: coronary lumen; artery layers; plaque characteristics and subtypes; and stents. Areas for future innovation are also discussed as well as their potential for future translation.
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Affiliation(s)
- Harry J. Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Mergen H. Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Anthony C. Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Jiawen Li
- School of Electrical Electronic Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, SA 5005, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, SA 5005, Australia
| | - Giuseppe Di Giovanni
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (G.D.G.); (P.J.P.)
| | - Peter J. Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (G.D.G.); (P.J.P.)
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
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14
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Baumann AAW, Tavella R, Air TM, Mishra A, Montarello NJ, Arstall M, Zeitz C, Worthley MI, Beltrame JF, Psaltis PJ. Prevalence and real-world management of NSTEMI with multivessel disease. Cardiovasc Diagn Ther 2022; 12:1-11. [PMID: 35282665 PMCID: PMC8898694 DOI: 10.21037/cdt-21-518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/13/2022] [Indexed: 09/09/2023]
Abstract
BACKGROUND Non-ST elevation myocardial infarction (NSTEMI) has higher post-discharge mortality than ST-elevation myocardial infarction (STEMI). Prognosis worsens in those with multivessel coronary disease (MVD). However, information about the prevalence and extent of MVD in NSTEMI is limited, in turn limiting insights into optimal treatment strategies. This study aimed to define the prevalence and extent of MVD, preferred treatment strategies and the predictors of MVD in a real-world NSTEMI population. METHODS The Coronary Angiogram Database of South Australia (CADOSA) was used to identify consecutive patients presenting to major teaching hospitals with NSTEMI between 2012 and 2016. Obtaining clinical and angiographic details, patients were stratified by the number of significantly diseased vessels (0,1,2,3-VD), defined by a stenosis of ≥70%, or ≥50% in the left main coronary artery. Data was analysed retrospectively. RESULTS The prevalence of MVD (2- or 3-VD) was 42% amongst 3,722 NSTEMI presentations. Multivariate logistic regression modelling showed age, male gender, diabetes, dyslipidaemia and prior myocardial infarction predicted MVD over 1-VD or 0-VD. Percutaneous coronary intervention (PCI) was performed in 42% of patients with MVD. This comprised 61% of 2-VD patients and only 22% of 3-VD patients, with 24% and 66% of each group referred for coronary bypass grafting, respectively. Among MVD patients treated with PCI, 76% had their culprit lesion treated alone in the index admission. CONCLUSIONS In this NSTEMI cohort, over 40% had MVD. Notably, a minority of patients with MVD undergoing PCI received multivessel revascularisation. This real-world practice emphasises that further evaluation is required to determine whether complete revascularisation is beneficial in NSTEMI, as reported for STEMI.
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Affiliation(s)
- Angus A. W. Baumann
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Department of Medicine, Alice Springs Hospital, Alice Springs, Australia
| | - Rosanna Tavella
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Tracy M. Air
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Aashka Mishra
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
| | - Nicholas J. Montarello
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
| | - Margaret Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Northern Adelaide Local Health Network (NALHN), Adelaide, Australia
| | - Chris Zeitz
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - John F. Beltrame
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Peter J. Psaltis
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, Adelaide, Australia
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Raygan F, Etminan A, Mohammadi H, Akbari H, Nikoueinejad H. Serum Levels of Growth Differentiation Factor-15 as an Inflammatory Marker in Patients with Unstable Angina Pectoris. J Tehran Heart Cent 2022; 16:15-19. [PMID: 35082862 PMCID: PMC8728865 DOI: 10.18502/jthc.v16i1.6595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Growth differentiation factor-15 (GDF-15), a member of transforming growth factors, is a stress-responsive marker whose levels may significantly increase in response to pathological stresses associated with inflammatory tissue injuries such as unstable angina pectoris (USAP). This study evaluated the diagnostic value of GDF-15 in patients with USAP. Methods: The present cross-sectional study recruited 39 patients with USAP criteria and 30 patients with stable angina pectoris (SAP), referred to Shahid Beheshti Hospital, Kashan, Iran. All the patients with USAP had at least 1 coronary artery stenosis (>50%) in angiography. The control group comprised 42 healthy individuals. The serum levels of GDF-15 were measured in all the participants by ELISA. Also analyzed were the relationship between GDF-15 levels and thrombolysis in myocardial infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE) risk scores in the patients with USAP to determine the severity of the disease. Result: The study population consisted of 111 subjects, 62 women and 49 men, divided into 3 groups of USAP (n=39, mean age=60.07±14.10 y), SAP (n=30, mean age=67.56±9.88 y), and control (n=42, mean age=61.21±7.76 y). The mean serum level of GDF-15 in the USAP group was significantly different from the other 2 groups (P<0.001), while no significant difference was observed in this regard between the SAP and control groups (P=0.797). No correlation was found between the mean GDF-15 serum level and the GRACE (P=0.816) and TIMI (P=0.359) risk scores in the USAP group. Conclusion: The mean serum level of GDF-15 exhibited a rise in our patients with USAP. GDF-15 may be a diagnostic biomarker of USAP and its severity.
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Affiliation(s)
- Fariba Raygan
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Aniseh Etminan
- Students' Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hanieh Mohammadi
- Students' Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hassan Nikoueinejad
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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16
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Management of Culprit and Non-Culprit Lesions in Acute Coronary Syndrome. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Multivessel coronary artery disease, defined by the presence of a significant stenosis (≥50% diameter) in two or more epicardial coronary vessels, usually occurs in more than 50% of patients with ST-segment elevation myocardial infarction. The latest guidelines indicate revascularization of the non-culprit artery with a recommendation of class IIB. However, the management of non-culprit lesions in patients with acute coronary syndrome is still a matter of debate. This article presents the most recent concepts related to the management of culprit and non-culprit coronary lesions, based on advanced imaging approaches, in order to identify high-risk patients and prevent further acute coronary syndromes.
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17
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Ahmed F, Khan MS, Ali Shah SD, Jalbani J, Ali Shah A, Shaikh GA. Frequency of Three-Vessel Disease Among Patients With Non-ST Segment Elevation Myocardial Infarction. Cureus 2020; 12:e11634. [PMID: 33381357 PMCID: PMC7757756 DOI: 10.7759/cureus.11634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA). Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05). Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.
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