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Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Krljanac G, Simic D, Matic D. Long-Term Prognostic Impact of Stress Hyperglycemia in Non-Diabetic Patients Treated with Successful Primary Percutaneous Coronary Intervention. J Pers Med 2024; 14:591. [PMID: 38929812 PMCID: PMC11204510 DOI: 10.3390/jpm14060591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND stress hyperglicemia (SH) is common in patients with ST-elevation myocardial infraction (STEMI). The aims of this study were to analyze the impact of SH on the incidence of all-cause mortality and major adverse cardiovascular events (MACE-cardiovascular death, nonfatal reinfarction, target vessel revascularization, and stroke) in STEMI patients without diabetes mellitus (DM) who have been treated successfully with primary PCI (pPCI). METHOD we analyzed 2362 STEMI patients treated with successful pPCI (post-procedural flow TIMI = 3) and without DM and cardiogenic shock at admission. Stress hyperglycemia was defined as plasma glucose level above 7.8 mmol/L at admission. The follow-up period was 8 years. RESULTS incidence of SH was 26.9%. Eight-year all-cause mortality and MACE rates were significantly higher in patients with SH, as compared to patients without SH (9.7% vs. 4.2%, p < 0.001, and 15.7% vs. 9.4%, p < 0.001). SH was an independent predictor of short- and long-term all-cause mortality (HR 2.19, 95%CI 1.16-4.18, and HR 1.99, 95%CI 1.03-3.85) and MACE (HR 1.49, 95%CI 1.03-2.03, and HR 1.35, 95%CI 1.03-1.89). CONCLUSION despite successful revascularization, SH at admission was an independent predictor of short-term and long-term (up to eight years) all-cause mortality and MACE, but its negative prognostic impact was stronger in short-term follow-up.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Sanja Stankovic
- Emergency Center, Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Damjan Simic
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Dragan Matic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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Savic L, Mrdovic I, Asanin M, Stankovic S, Krljanac G, Lasica R, Simic D. Sudden cardiac death in long-term follow-up in patients treated with primary percutaneous coronary intervention. SCAND CARDIOVASC J 2023; 57:2176919. [PMID: 36776111 DOI: 10.1080/14017431.2023.2176919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Objective. Most studies analyzing predictors of sudden cardiac death (SCD) after acute myocardial infarction included only high-risk patients or index reperfusion had not been performed in all patients. The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of unselected patients with ST-elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (pPCI). Method. we analysed 3114 STEMI patients included included in the University Clinical Center of Serbia STEMI Register. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge. Results. During 6-year follow-up, lethal outcome was registered in 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e. 0.8% of the patients analyzed. The independent predictors for the occurrence of SCD during 6-year follow-up were EF < 45% (HR 3.07, 95% 1.87-5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37-5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12-2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23-2.97). Conclusion. There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. Predictors of SCD occurence during long-term follow-up in analyzed patients are clinical variables that are easily recorded during index hospitalization and include: EF ≤45%, post-procedural flow TIMI < 3, Killip class >1, and reduced baseline kidney function.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Damjan Simic
- Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
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Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Matic D, Simic D, Krljanac G. Prognostic Impact of Non-Cardiac Comorbidities on Long-Term Prognosis in Patients with Reduced and Preserved Ejection Fraction following Acute Myocardial Infarction. J Pers Med 2023; 13:1110. [PMID: 37511723 PMCID: PMC10381839 DOI: 10.3390/jpm13071110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND We aimed to analyze the prevalence and long-term prognostic impact of non-cardiac comorbidities in patients with reduced and preserved left-ventricular ejection fraction (EF) following ST-elevation myocardial infarction (STEMI). METHOD A total of 3033 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) were divided in two groups: reduced EF < 50% and preserved EF ≥ 50%. The follow-up period was 8 years. RESULTS Preserved EF was present in 1726 (55.4%) patients and reduced EF was present in 1389 (44.5%) patients. Non-cardiac comorbidities were more frequent in patients with reduced EF compared with patients with preserved EF (38.9% vs. 27.4%, respectively, p < 0.001). Lethal outcome was registered in 240 (17.2%) patients with reduced EF and in 40 (2.3%) patients with preserved EF, p < 0.001. Diabetes and chronic kidney disease (CKD) were independent predictors for 8-year mortality in patients with preserved EF. In patients with reduced EF, CKD was independently associated with 8-year mortality. CONCLUSION In patients who had reduced EF, the prevalence of non-cardiac comorbidities was higher than in patients who had preserved EF after STEMI. Only diabetes mellitus and CKD were independently associated with 8-year mortality in analyzed patients.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Dragan Matic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Damjan Simic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
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Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Krljanac G, Rajic D, Simic D. The Impact of Kidney Function on the Slow-Flow/No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention: Registry Analysis. J Interv Cardiol 2022; 2022:5815274. [PMID: 36531287 PMCID: PMC9729026 DOI: 10.1155/2022/5815274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE The objective of this study is to analyze the impact of declining kidney function on the occurrence of the slow-flow/no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI (pPCI), as well as the analysis of the prognostic impact of the slow-flow/no-reflow phenomenon on short- and long-term mortality in these patients. METHODS We analyzed 3,115 consecutive patients. A value of the glomerular filtration rate (eGFR) at the time of admission of eGFR <90 ml/min/m2 was considered a low baseline eGFR. The follow-up period was 8 years. RESULTS The slow-flow/no-reflow phenomenon through the IRA was registered in 146 (4.7%) patients. Estimated GFR of <90 ml/min/m2 was an independent predictor for the occurrence of the slow-flow/no-reflow phenomenon (OR 2.91, 95% CI 1.25-3.95, p < 0.001), and the risk for the occurrence of the slow-flow/no-reflow phenomenon increased with the decline of the kidney function: eGFR 60-89 ml/min/m2: OR 1.94 (95% CI 1.22-3.07, p = 0.005), eGFR 45-59 ml/min/m2: OR 2.55 (95% CI 1.55-4.94, p < 0.001), eGFR 30-44 ml/min/m2: OR 2.77 (95% CI 1.43-5.25, p < 0.001), eGFR 15-29 ml/min/m2: OR 5.84 (95% CI 2.84-8.01, p < 0.001). The slow-flow/no-reflow phenomenon was a strong independent predictor of short- and long-term all-cause mortality: 30-day mortality (HR 2.62, 95% CI 1.78-3.57, p < 0.001) and 8-year mortality (HR 2.09, 95% CI 1.49-2.09, p < 0.001). CONCLUSION Reduced baseline kidney function was an independent predictor for the occurrence of the slow-flow/no-reflow phenomenon, and its prognostic impact started with the mildest decrease in eGFR (below 90 ml/min/m2) and increased with its further decline. The slow-flow/no-reflow phenomenon was a strong independent predictor of mortality in the short- and long-term follow-up of the analyzed patients.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dubravka Rajic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Damjan Simic
- Emergency Hospital & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
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Li S, Lv D, Liu C, Jia Y. Practicability of Bivalirudin plus Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis. Clin Appl Thromb Hemost 2021; 27:10760296211055165. [PMID: 34775846 PMCID: PMC8597062 DOI: 10.1177/10760296211055165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A variety of antithrombotic drugs are used during percutaneous coronary interventions (PCIs). We aimed to investigate the practicability of the use of bivalirudin and GPIs in patients receiving PCI. We searched 7 of 629 relevant records from PubMed, the Cochrane Library, EMBASE, and Web of Science for randomised controlled trials. There were no significant differences in the rates of major adverse cardiac events (MACE) between bivalirudin plus GPI and heparin (all P > .05). Bivalirudin plus planned GPI was similar to bivalirudin monotherapy in terms of the risk of MACE (risk ratio [RR] = 1.07; 95% confidence interval [CI] = .91 − 1.27; P = .55). Bivalirudin plus provisional GPI was associated with lower bleeding risk (RR = .57; 95% CI = .47 − .69; P < .01) compared to using heparin plus GPI. Compared to bivalirudin alone, bivalirudin plus planned GPI evidently increased bleeding risk (RR = 2.20; 95% CI = 1.73 − 2.79; P < .01). Patients receiving bivalirudin or heparin therapy had semblable efficacy endpoints, but those receiving bivalirudin had a significantly lower bleeding risk. For high-risk bleeding patients, bivalirudin plus provisional GPI can have a better antithrombotic effect than heparin, without increasing the bleeding risk.
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Affiliation(s)
- Senjie Li
- 105862Department of Cardiology, The First Hospital of ShanXi Medical University, Taiyuan, Shanxi, China
| | - Dongqing Lv
- 105862Department of Endocrinology, The First Hospital of ShanXi Medical University, Taiyuan, Shanxi, China
| | - Caihong Liu
- 74648ShanXi Medical University, Taiyuan, Shanxi, China
| | - Yongping Jia
- 105862Department of Cardiology, The First Hospital of ShanXi Medical University, Taiyuan, Shanxi, China
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Savic L, Mrdovic I, Asanin M, Stankovic S, Krljanac G, Lasica R, Viduljevic M. Impact of kidney function on the occurrence of new-onset atrial fibrillation in patients with ST-elevation myocardial infarction. Anatol J Cardiol 2021; 25:638-645. [PMID: 34498595 DOI: 10.5152/anatoljcardiol.2021.35332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we aimed to examine the prognostic impact of decreased kidney function at admission on the occurrence of new-onset atrial fibrillation (AF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). METHODS The study enrolled 3,115 consecutive patients with STEMI. Kidney function was assessed by estimation of the glomerular filtration rate (eGFR) at admission. Patients with cardiogenic shock at admission, patients on hemodialysis, and patients with a medical history of previous AF (paroxysmal, persistent, or permanent) were excluded. The follow-up period was six years. RESULTS New-onset AF occurred in 215 (6.9%) patients, 75 (34.9%) patients presented with AF, and 140 (65.1%) patients developed AF after pPCI. The median time of AF occurrence in patients who did not present with AF was 4.5 (interquartile range 1-25) hours after pPCI. New-onset AF was associated with a higher short- and long-term mortality. In the multiple logistic regression analysis, all stages of reduced kidney function were independent predictors for the occurrence of new-onset AF, and negative prognostic impact increased with the deterioration of kidney function: eGFR <90 mL/min/m2, hazard ratio (HR) 1.96, 95% confidence interval (CI) 1.42-2.89, p=0.011; eGFR 60-89 mL/min/m2, HR 1.54, 95% CI 1.13-2.57, p=0.045; eGFR 45-59 mL/min/m2-, HR 2.09, 95% CI 1.24-2.85, p=0.023; eGFR 30-44 mL/min/m2-, HR 2.93, 95% CI 1.64-5.29, p<0.001; eGFR 15-29 mL/min/m2-, HR 5.51, 95% CI 2.67-11.39, p<0.001. CONCLUSION Decreased kidney function was significantly associated with the occurrence of new-onset AF, and its impact increased with the deterioration in kidney function, starting with an eGFR value of 90 mL/min/m2. New-onset AF was an independent predictor of long-term all-cause mortality in the analyzed patients.
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Affiliation(s)
- Lidija Savic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Igor Mrdovic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Milika Asanin
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Ratko Lasica
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
| | - Mihajlo Viduljevic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit and Cardiology Clinic, Belgrade, Serbia
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Guo YZ, Zhao ZW, Li SM, Chen LL. Clinical efficacy and safety of tirofiban combined with conventional dual antiplatelet therapy in ACS patients undergoing PCI. Sci Rep 2021; 11:17144. [PMID: 34433885 PMCID: PMC8387390 DOI: 10.1038/s41598-021-96606-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022] Open
Abstract
Challenges remain for clinicians over balancing the efficacy of active antithrombotic therapy and simultaneous bleeding reduction in patients. The clinical data of 347 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. On the basis of the given tirofiban, the patients were assigned into three different dose groups: high dose group (group H), medium dose group (group M), and low dose group (group L). The tirofiban efficacy was evaluated in terms of major adverse cardiovascular event (MACE) parameters and lab endpoints, including platelet count and function. The tirofiban safety was assessed by the occurrence of bleeding events. The patients were followed up for 1 month after the PCI. No significant difference in MACE events was evident among these groups (p > 0.05). Groups H and M reported an obvious reduction in platelet count (p < 0.05 for both) and an increased platelet inhibition rate (p < 0.05 for both). Group H showed a higher rate of total bleeding events than the other groups (Group H vs. Group M: 34.4% vs. 16.5%; Group H vs. Group L: 34.4% vs. 10.3%; p < 0.05 for both). A proper administration of a low dose of tirofiban may be a superior alternative in treating ACS patients, which can produce a similar favorable clinical outcome and a decrease in bleeding complication.
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Affiliation(s)
- Yong-Zhe Guo
- Department of Cardiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, China
| | - Zi-Wen Zhao
- Department of Cardiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, China
| | - Shu-Mei Li
- Department of Cardiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, China
| | - Liang-Long Chen
- Department of Cardiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, China.
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Impact of Multivessel Coronary Artery Disease on Long Term Prognosis in Patients with ST-segment Elevation Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: A significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVD), and they are at high risk for recurrent cardiac events. The aim of the present study was to analyze the impact of MVD on long-term cardiovascular mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Method: This study included 3,115 consecutive STEMI patients hospitalized in the Coronary Care Unit of the Clinical Centre of Serbia, between November 2005 and January 2012. Patients were divided in two groups: MVD and no MVD. MVD disease was defined as stenosis greater than 50% by visual assessment in more than one major coronary artery. Primary PCI was limited to the infarct-related artery (IRA). Cardiovascular mortality was defined as any death from cardiovascular reason (myocardial reinfarction, low-output heart failure, and sudden death). Patients presenting with cardiogenic shock were excluded. Patients were followed-up for 6 years after enrollment. Results: Among 3,115 analyzed patients, 1,352 (43.4%) patients had no MVD and 1,763 (56.6%) had MVD; among patients with MVD, 926 (52.6%) had two-vessel disease and 837 (47.4%) had three-vessel disease. Compared with patients with single-vessel disease, patients with MVD were older, had longer pain duration, and presented more often with heart failure; they were more likely to have previous coronary artery disease, diabetes, hypertension, and chronic kidney disease; post-procedural flow TIMI <3 was more frequently observed in patients with MVD than in patients with no MVD (5.9% vs. 3.1%, p <0.001). Patients with MVD had lower left ventricular ejection fraction than patients with single-vessel disease: 45% (interquartile range [IQR] 40¬–55%) vs. 50% (IQR 43–55%), p <0.001. Revascularization of non-IRA lesions was performed at index hospitalization in 1,075 (61%) patients, and in 602 (34.1%) patients revascularization was performed in the first few months after pPCI (median 1.5 months, IQR 1–2.5 months); coronary artery bypass grafting was performed in 291 (18.4%) patients and PCI (with stent implantation) in 1,368 (81.6%) patients. Six-year cardiovascular mortality was significantly higher in patients with MVD than in patients with single-vessel disease (10.4% vs. 4.6%, p <0.001). In multivariate Cox regression analysis, MVD remained an independent predictor for 6-year cardiovascular mortality (HR 1.55, 95% CI 1.11–2.06, p = 0.041). Conclusion: In STEMI patients treated with pPCI, the presence of MVD remained an independent predictor for higher long-term cardiovascular mortality despite early revascularization of the remaining stenosis in non-IRA.
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Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired, and severely impaired left ventricular systolic function following myocardial infarction. Anatol J Cardiol 2018; 20:21-28. [PMID: 29952358 PMCID: PMC6237792 DOI: 10.14744/anatoljcardiol.2018.47701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The aim of this study was to investigate and compare the prognostic impact of renal dysfunction (RD) at admission in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following ST-elevation myocardial infarction (STEMI). Methods: We included 2436 patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients presenting with cardiogenic shock and those on hemodyalisis were excluded. According to the left ventricular ejection fraction (EF), patients were divided in three groups: preserved left ventricular systolic function – EF >50%, moderately impaired – EF=40%-50% and severely impaired left ventricular systolic function-EF <40%. RD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 at admission. The follow-up period was 6 years. Results: Preserved, moderately impaired and severely impaired systolic function were found in 741 (30.5%), 1367 (56.1%) and 328 (13.4%) patients, respectively. RD was present in 105 (14.2%) patients with preserved systolic function, 247 (18.1%) patients with moderately impaired, and 120 (36.5%) patients with severely impaired systolic function.Regardless of the presence of RD, 6-year mortality rates in patients with preserved, moderately impaired, and severely impaired systolic function were 2.7%, 5.2% and 31.1% respectively. Within each LVEF group, patients with RD had a worse outcome, both in the short- and long-term. In the Mulivariate Cox Analysis, RD remained an independent predictor of 6-year mortality in patients with moderately (HR 2.52, 95% CI 1.54-3.78) and severely impaired systolic function (HR 2.84, 95% CI 1.68-5.34), but not in patients with preserved left ventricular systolic function (HR 0.59, 95% CI 0.14-1.41). Conclusion: Although patients with RD had higher 6-year mortallity following STEMI regardless of LVEF, RD at admission remained a strong independent predictor for 6-year mortality only in patients with moderately and severely impaired left ventricular systolic function.
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Hu S, Wang H, Zhu J, Li M, Li H, Gao D, Zhang H. Effect of intra-coronary administration of tirofiban through aspiration catheter on patients over 60 years with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Medicine (Baltimore) 2018; 97:e10850. [PMID: 29794782 PMCID: PMC6393146 DOI: 10.1097/md.0000000000010850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to compare the efficacy and safety of 2 approaches for intra-coronary administration of tirofiban (aspiration catheter versus guiding catheter) in patients over 60 years of age undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). It has been suggested that the administration of tirofiban by intra-coronary injection could promote drug absorption in the diseased region and enhance the inhibition of platelet aggregation, decreasing bleeding rates, but little is known about the comparative efficiency and safety of using guiding catheter versus aspiration catheter for delivery.Eighty-nine patients over 60 years of age with STEMI undergoing PCI were randomly divided into 2 groups according to the injection route for intracoronary administration of tirofiban [guiding catheter (n = 41) and aspiration catheter (n = 48)]. Baseline features, epicardial and myocardial perfusion, major adverse cardiac and cerebrovascular events (MACCEs), and bleeding rate were compared.No differences in age, gender, and history of hypertension, hypercholesterolemia, diabetes, and so on were observed (P > .05). The patients in the aspiration catheter group generally had a higher incidence of cerebral vascular disease. Compared with those in the guiding catheter group, patients in the aspiration catheter group obtained more favorable myocardial perfusion (P < .05). In-hospital and at 3-month and 6-month follow-ups, the MACCE rate and frequency of bleeding events were similar between the 2 groups (P > .05).Intra-coronary delivery of tirofiban through aspiration catheter led to better myocardial perfusion in STEMI patients over 60 years of age undergoing PCI compared with intra-coronary injection of tirofiban through guiding catheter. The 2 delivery routes were associated with similar rates of MACCEs and bleeding events.
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Jia H, Lu C, Sun P. Intracoronary administration of tirofiban during percutaneous coronary intervention facilitates patients with acute coronary syndrome. Oncotarget 2017; 8:107303-107311. [PMID: 29291030 PMCID: PMC5739815 DOI: 10.18632/oncotarget.19179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/30/2017] [Indexed: 11/25/2022] Open
Abstract
We assessed the efficacy and safety of tirofiban intracoronary versus intravenous administration during percutaneous coronary intervention for patients with acute coronary syndrome. The databases of PubMed, Web of Science, China National Knowledge Infrastructure, and WanFang Database were retrieved. A total of 437 articles were found, according to inclusive and exclusive criteria, 13 of which were finally included. Compared with subjects with intravenous administration, those with intracoronary administration were more likely to reach thrombolysis in myocardial infarction trial grade 3 flow (relative risk = 1.17, 95% confidence interval: 1.11–1.22), improve left ventricular ejection fraction (Standardized mean difference = 0.65, 95% confidence interval: 0.20–1.11). Intracoronary administration resulted in a reduced risk of major adverse cardiovascular events at 30-day follow-up (relative risk = 0.47, 95% confidence interval: 0.34–0.65). However, incidence of bleeding complications was not statistically significant between two groups (relative risk = 0.76, 95% confidence interval: 0.55–1.04). Intracoronary administration of tirofiban can be more effective in increasing coronary blood flow and microvascular perfusion, more effective in improving postoperative myocardial reperfusion, more significantly in reducing the incidence of adverse cardiovascular events at 30-day’s follow-up and improving the prognosis after percutaneous coronary intervention without increasing the risk of bleeding.
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Affiliation(s)
- Helei Jia
- Department of Emergency, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan Province 450002, China
| | - Changqing Lu
- Department of Emergency, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan Province 450002, China
| | - Panli Sun
- Department of Cardiology, Henan Provincial Hospital, Zhengzhou, Henan Province 450000, China
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12
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Kaymaz C. Author's Reply. Anatol J Cardiol 2016; 15:958-9. [PMID: 26904756 PMCID: PMC5336955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey,Address for Correspondence: Dr. Cihangir Kaymaz Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kartal, İstanbul-Turkey Phone: +90 216 459 44 40 Fax: +90 216 500 15 00 E-mail:
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13
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Kaymaz C. Author's Reply. Anatol J Cardiol 2016; 15:956-8. [PMID: 26904755 PMCID: PMC5336953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey,Address for Correspondence: Dr. Cihangir Kaymaz, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kartal, İstanbul-Türkiye Phone: +90 216 459 44 40 E-mail:
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14
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Savic L, Mrdovic I, Asanin M, Stankovic S, Krljanac G, Lasica R. Gender differences in the prognostic impact of chronic kidney disease in patients with left ventricular systolic dysfunction following ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Hellenic J Cardiol 2016; 57:109-15. [DOI: 10.1016/j.hjc.2015.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/04/2015] [Indexed: 12/18/2022] Open
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15
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Henriet T, Secrétan PH, Amrani F, Sadou-Yayé H, Bernard M, Solgadi A, Yagoubi N, Do B. Phototransformation patterns of the antiplatelet drug tirofiban in aqueous solution, relevant to drug delivery and storage. NEW J CHEM 2016. [DOI: 10.1039/c5nj01826a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tirofiban in aqueous solution mostly photodegrades through photosensitized oxidation reactions and the photoproducts formed are not structurally alerting for genotoxicity.
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Affiliation(s)
- Théo Henriet
- Université Paris Sud
- UFR de Pharmacie
- Groupe Matériaux et Santé
- 92296 Châtenay-Malabry
- France
| | | | - Fatma Amrani
- Université Paris Sud
- UFR de Pharmacie
- Groupe Matériaux et Santé
- 92296 Châtenay-Malabry
- France
| | - Hassane Sadou-Yayé
- Université Paris Sud
- UFR de Pharmacie
- Groupe Matériaux et Santé
- 92296 Châtenay-Malabry
- France
| | - Mélisande Bernard
- Université Paris Sud
- UFR de Pharmacie
- Groupe Matériaux et Santé
- 92296 Châtenay-Malabry
- France
| | - Audrey Solgadi
- Université Paris-Sud
- UFR de Pharmacie
- SAMM – Service d'Analyse des Médicaments et Métabolites
- Institut d'Innovation Thérapeutique
- 92296 Châtenay-Malabry
| | - Najet Yagoubi
- Université Paris Sud
- UFR de Pharmacie
- Groupe Matériaux et Santé
- 92296 Châtenay-Malabry
- France
| | - Bernard Do
- Université Paris Sud
- UFR de Pharmacie
- Groupe Matériaux et Santé
- 92296 Châtenay-Malabry
- France
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Li J, Yu S, Qian D, He Y, Jin J. Bivalirudin Anticoagulant Therapy With or Without Platelet Glycoprotein IIb/IIIa Inhibitors During Transcatheter Coronary Interventional Procedures: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1067. [PMID: 26266343 PMCID: PMC4616679 DOI: 10.1097/md.0000000000001067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The safety and effectiveness of using the direct thrombin inhibitor bivalirudin during transcatheter coronary interventional procedures remains uncertain.This study aimed to systematically assess anticoagulation with bivalirudin alone or bivalirudin plus glycoprotein (GP) IIb/IIIa inhibitors (bivalirudin-based anticoagulant therapy) in patients undergoing percutaneous coronary intervention (PCI) procedures by a meta-analysis of randomized controlled trials (RCTs).Systematical searches of the MEDLINE, EMBASE, and Cochrane databases were conducted. RCTs comparing bivalirudin-based anticoagulant therapy with a comparable heparin therapy in patients undergoing PCI were eligible. Risk ratios (RRs) with 95% confidence intervals (CIs) served as summary statistics.A total of 38,096 patients from 17 RCTs were randomized to the bivalirudin group (n = 18,878) or heparin group (n = 19,218) in the meta-analysis. No significant differences in death, myocardial infarction or reinfarction, ischemia-driven revascularization, or in-stent thrombosis were observed between the 2 groups (all P > 0.05). Notably, bivalirudin-based therapy showed a highly significant 34% decrease in the incidence of major bleeding (RR = 0.66; 95% CI 0.54-0.81; P < 0.001) and a 28% reduction in the need for blood transfusion (RR = 0.72; 95% CI 0.56-0.91; P < 0.01). Meta-regression analyses demonstrated that additional administration of GP IIb/IIIa receptor inhibitors (P = 0.01), especially eptifibatide (P = 0.001) and tirofiban (P = 0.002), was likely to increase the major bleeding risk associated with bivalirudin.Bivalirudin, in comparison to heparin, is associated with a markedly lower risk of major bleeding, and the additional use of GP IIb/IIIa inhibitors may weaken this benefit.
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Affiliation(s)
- Jiabei Li
- From the Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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