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Shimono H, Tokushige A, Kanda D, Ohno A, Hayashi M, Fukuyado M, Akao M, Kawasoe M, Arikawa R, Otsuji H, Chaen H, Okui H, Oketani N, Ohishi M. Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention. Heart Vessels 2023; 38:1205-1217. [PMID: 37285031 PMCID: PMC10465392 DOI: 10.1007/s00380-023-02276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607-1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan-Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86-9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.
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Affiliation(s)
- Hirokazu Shimono
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Akihiro Tokushige
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus School of Medicine, Nishihara, Okinawa, Japan.
| | - Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ayaka Ohno
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Masao Hayashi
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mana Fukuyado
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mitsumasa Akao
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mariko Kawasoe
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Ryo Arikawa
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideaki Otsuji
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideto Chaen
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideki Okui
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Naoya Oketani
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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2
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Lemos PA, Franken M, Mariani J, Caixeta A, Almeida BO, Pitta FG, Prado GFA, Garzon S, Ramalho F, Albuquerque G, Gomes IM, de Oliveira IS, Valle L, Galastri L, Affonso BB, Nasser F, Garcia RG. Safety and effectiveness of introducing a robotic-assisted percutaneous coronary intervention program in a tertiary center: a prospective study. Cardiovasc Diagn Ther 2022; 12:67-76. [PMID: 35282671 PMCID: PMC8898692 DOI: 10.21037/cdt-21-442] [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: 07/17/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2024]
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (PCI) is a novel technology that permits remote operation of interventional devices. However, little is known about the safety and effectiveness of introducing a robotic PCI program in a hospital already experienced in traditional coronary angioplasty. METHODS Prospective single-arm survey to assess the safety and effectiveness of robotic-assisted PCI in comparison to pre-defined performance goals. The study cohort comprised all consecutive cases treated with robotic PCI since its introduction. The safety primary endpoint was a composite of (I) overall death or (II) non-fatal adverse events related to target vessel complications (stent thrombosis, myocardial infarction, vessel perforation or cardiac tamponade, or repeat invasive treatment) during the index hospitalization. The efficacy primary endpoint was robotic-assisted procedural success, a composite of (I) successful dilatation of the target lesion and (II) successful robotic assistance, defined as absent non-planned manual conversion. RESULTS A total of 83 patients and 112 lesions were prospectively enrolled. The rate of angiographic success was 99.1%. From these, 97 lesions (86.6%) were treated with only robotic PCI or with hybrid according to the pre-interventional plan. The rates of efficacy and safety primary endpoints were 85.7% and 2.4% respectively (P<0.01 for non-inferior to the pre-defined performance threshold). CONCLUSIONS Introduction of robotic-assisted PCI in a tertiary center was associated with safe and effective results, comparable to pre-defined goals of optimal performance.
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Affiliation(s)
| | | | | | | | | | - Fabio G. Pitta
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Felipe Ramalho
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Gabriel Albuquerque
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ivanise M. Gomes
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Breno B. Affonso
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Felipe Nasser
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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3
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Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry. Heart Vessels 2022; 37:1106-1114. [PMID: 34997289 PMCID: PMC9142436 DOI: 10.1007/s00380-021-02015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022]
Abstract
Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (-) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan-Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.
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4
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Papapostolou S, Dinh DT, Noaman S, Biswas S, Duffy SJ, Stub D, Shaw JA, Walton A, Sharma A, Brennan A, Clark D, Freeman M, Yip T, Ajani A, Reid CM, Oqueli E, Chan W. Effect of Age on Clinical Outcomes in Elderly Patients (>80 Years) Undergoing Percutaneous Coronary Intervention: Insights From a Multi-Centre Australian PCI Registry. Heart Lung Circ 2021; 30:1002-1013. [PMID: 33478864 DOI: 10.1016/j.hlc.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the effect of age in an all-comers population undergoing percutaneous coronary intervention (PCI). BACKGROUND Age is an important consideration in determining appropriateness for invasive cardiac assessment and perceived clinical outcomes. METHODS We analysed data from 29,012 consecutive patients undergoing PCI in the Melbourne Interventional Group (MIG) registry between 2005 and 2017. 25,730 patients <80 year old (78% male, mean age 62±10 years; non-elderly cohort) were compared to 3,282 patients ≥80 year old (61% male, mean age 84±3 years; elderly cohort). RESULTS The elderly cohort had greater prevalence of hypertension, diabetes and previous myocardial infarction (all p<0.001). Elderly patients were more likely to present with acute coronary syndromes, left ventricular ejection fraction <45% and chronic kidney disease (p<0.0001). In-hospital, 30-day and long-term all-cause mortality (over a median of 3.6 and 5.1 years for elderly and non-elderly cohorts, respectively) were higher in the elderly cohort (5.2% vs. 1.9%; 6.4% vs. 2.2%; and 43% vs. 14% respectively, all p<0.0001). In multivariate Cox regression analysis, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 (HR 3.8, 95% CI: 3.4-4.3), cardiogenic shock (HR 3.0, 95% CI: 2.6-3.4), ejection fraction <30% (HR 2.5, 95% CI: 2.1-2.9); and age ≥80 years (HR 2.8, 95% CI: 2.6-3.1) were independent predictors of long-term all-cause mortality (all p<0.0001). CONCLUSION The elderly cohort is a high-risk group of patients with increasing age being associated with poorer long-term mortality. Age, thus, should be an important consideration when individualising treatment in elderly patients.
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Affiliation(s)
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | | | | | | | - Dion Stub
- Alfred Health, Melbourne, Vic, Australia
| | | | | | - Anand Sharma
- Ballarat Base Hospital, Ballarat Central, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | | | | | | | - Andrew Ajani
- Royal Melbourne Hospital, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | | | - Ernesto Oqueli
- Ballarat Base Hospital, Ballarat Central, Vic, Australia
| | - William Chan
- Alfred Health, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia.
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5
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Conrotto F, D'Ascenzo F, Piroli F, Franzé A, de Luca L, Quadri G, Ryan N, Escaned J, Bo M, De Ferrari GM. Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life). Catheter Cardiovasc Interv 2020; 97:755-763. [PMID: 32478451 DOI: 10.1002/ccd.29048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated. The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients. METHODS All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all-cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones. RESULTS Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow-up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all-cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV-death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76-1.38), while it was for all-cause death, along with diabetes, GFR < 60 ml/min, and ULM disease. DISCUSSION Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non-CV death rate, accurate patient selection is mandatory.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Franzé
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Leonardo de Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Turin, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mario Bo
- Division of Geriatrics, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
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6
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Sakamoto K, Matoba T, Mohri M, Ueki Y, Tsujita Y, Yamasaki M, Tanaka N, Hokama Y, Fukutomi M, Hashiba K, Fukuhara R, Suwa S, Matsuura H, Tachibana E, Yonemoto N, Nagao K. Clinical characteristics and prognostic factors in acute coronary syndrome patients complicated with cardiogenic shock in Japan: analysis from the Japanese Circulation Society Cardiovascular Shock Registry. Heart Vessels 2019; 34:1241-1249. [PMID: 30715570 DOI: 10.1007/s00380-019-01354-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/25/2019] [Indexed: 12/22/2022]
Abstract
Cardiogenic shock frequently leads to death even with intensive treatment. Although the leading cause of cardiogenic shock is acute coronary syndrome (ACS), the clinical characteristics and the prognosis of ACS with cardiogenic shock in the present era still remain to be elucidated. We analyzed clinical characteristics and predictors of 30-day mortality in ACS with cardiogenic shock in Japan. The Japanese Circulation Society Cardiovascular Shock registry was a prospective, observational, multicenter, cohort study. Between May 2012 and June 2014, 495 ACS patients with cardiogenic shock were analyzed. The primary endpoint was 30-day all-cause mortality. The median [interquartile range; IQR] age was 71.0 [63.0, 80.0] years. The median [IQR] value of systolic blood pressure (SBP) and heart rate were 75.0 [50.0, 86.5] mm Hg and 65.0 [38.0, 98.0] bpm, respectively. Multivariable analysis showed an odds ratio (OR) of 4.76 (confidence intervals; CI 1.97-11.5, p < 0.001) in the lowest SBP category (< 50 mm Hg) for SBP ≥ 90 mm Hg. Moreover, age per 10 years increase (OR 1.38, CI 1.18-1.61, p = 0.002), deep coma (OR 3.49, CI 1.94-6.34, p < 0.001), congestive heart failure (OR 3.81, CI 2.04-7.59, p < 0.001) and left main trunk disease (LMTD) (OR 2.81, CI 1.55-5.10, p < 0.001) were independent predictors. Severe hypotension, older age, deep coma, congestive heart failure, and LMTD were independent unfavorable factors in ACS complicated by cardiogenic shock in Japan. A prompt assessment of high-risk patients referring to those predictors in emergency room could lead to appropriate treatment without delay.
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Affiliation(s)
- Kazuo Sakamoto
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsuya Matoba
- JCS Shock Registry Scientific Committee, Tokyo, Japan. .,Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Masahiro Mohri
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan
| | - Yasushi Ueki
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Emergency and Critical Care Center, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuyuki Tsujita
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Masao Yamasaki
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiovascular Medicine, NTT Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Yohei Hokama
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Motoki Fukutomi
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Katsutaka Hashiba
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Rei Fukuhara
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Satoru Suwa
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Hirohide Matsuura
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Eizo Tachibana
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Naohiro Yonemoto
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Ken Nagao
- JCS Shock Registry Scientific Committee, Tokyo, Japan.,Cardiovascular Center, Nihon University Hospital, Tokyo, Japan
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7
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Hejazi SF, Iranirad L, Doostali K, Khodadadi N, Norouzi S. In-Hospital Clinical Outcomes and Procedural Complications of Percutaneous Coronary Intervention in Elderly Patients. Cardiol Res 2017; 8:199-205. [PMID: 29118881 PMCID: PMC5667706 DOI: 10.14740/cr582e] [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: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 12/02/2022] Open
Abstract
Background As population growth leads to an increase in the number of the elderly with coronary artery disease, an evaluation of the clinical outcomes of percutaneous coronary intervention (PCI) in the elderly patients seems to be essential. Methods A prospective, observational cohort study was performed on 468 patients in two groups of elderly and non-elderly patients (mean age: 60.01 ± 10.84 years; ≥ 70 years, 20.1%; men, 62%) who underwent PCI, to evaluate the procedural success and in-hospital major and minor adverse cardiovascular events in the elderly patients. Results The procedural success rate was significantly lower (95.7% vs. 99.5%, P = 0.017) and the rates of in-hospital complications were significantly higher (10.6% vs. 0.8%, P < 0.0001) in elderly (+70) than in non-elderly patients. On the basis of a multivariate analysis, being elderly was not an independent predictor of procedural failure, but increased the chance of in-hospital complications to 8% higher (odds ratio: 0.08; 95% confidence interval: 0.01 - 0.39; P = 0.002). Conclusion Regardless of the difference in the procedural success and in-hospital complication rates between our two study groups, aging is not an important predictor of them. Furthermore, PCI should not be refused in elderly patients if indicated.
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Affiliation(s)
- Seyed Fakhreddin Hejazi
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Leili Iranirad
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Kobra Doostali
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Narges Khodadadi
- Department of Medicine, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Sameeye Norouzi
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
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8
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Hashizume N, Miura T, Miyashita Y, Motoki H, Ebisawa S, Izawa A, Koyama J, Ikeda U, Kuwahara K. Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry. Angiology 2017; 68:884-892. [PMID: 28956475 DOI: 10.1177/0003319717697883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle-brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups-low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.
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Affiliation(s)
- Naoto Hashizume
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- 2 Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hirohiko Motoki
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Izawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Koyama
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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9
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Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: A sub-analysis of the SHINANO registry. Int J Cardiol 2017; 230:413-419. [DOI: 10.1016/j.ijcard.2016.12.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/09/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
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10
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Miura T, Miyashita Y, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Aso S, Hashizume N, Ebisawa S, Ikeda U. Efficacy and Safety of Percutaneous Coronary Intervention for Elderly Patients in the Second-Generation Drug-Eluting Stent Era: The SHINANO Registry. Angiology 2016; 68:688-697. [DOI: 10.1177/0003319716679341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: We evaluated the 1-year outcomes of percutaneous coronary intervention (PCI) for elderly patients (aged ≥ 80 years) in the second-generation drug-eluting stent (DES) era. Methods and Results: Between August 2012 and July 2013, 1923 consecutive patients (mean age, 71 ± 11 years; ≥80 years, 23%; men, 77%) who underwent 2250 elective/urgent PCI procedures were enrolled in the Shinshu Prospective Multicenter Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention registry. The primary end point was major adverse cardiovascular events (MACEs; cardiovascular death, myocardial infarction, and stroke) at 1 year. The 1-year incidence of MACEs, cardiac death, and stroke was significantly higher in elderly patients than in nonelderly patients (12.4% vs 5.3%, P < .0001; 7.8% vs 2.2%, P < .0001; and 2.8% vs 1.3%, P = .033, respectively). However, no significant difference in elective PCI procedures was detected. In elderly patients, the incidence of cardiac death and target lesion revascularization was significantly lower for DES than for non-DES (2.7% vs 10.5%, P = .0001 and 4.1% vs 8.6%, P = .029, respectively). Conclusion: Although elderly patients had a significantly poorer prognosis than younger patients, the adverse events rate was comparable in those patients who underwent elective PCI in the second-generation DES era.
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Affiliation(s)
- Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hideki Kobayashi
- Department of Cardiology, Shinshu Ueda Medical Center, Ueda, Japan
| | | | - Hiroyuki Nakajima
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Hikaru Kimura
- Department of Cardiology, Saku Central Hospital, Saku, Japan
| | - Hiroshi Akanuma
- Department of Cardiology, Iida Municipal Hospital, Iida, Japan
| | | | - Toshio Sato
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Shoji Hotta
- Department of Cardiology, Ina Central Hospital, Ina, Japan
| | | | - Takuya Maruyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Noboru Watanabe
- Department of Cardiology, Hokushin General Hospital, Nakano, Japan
| | - Takayuki Eisawa
- Department of Cardiology, Komoro Kosei General Hospital, Komoro, Japan
| | - Shinichi Aso
- Department of Cardiology, Aizawa Hospital, Matsumoto, Japan
| | - Naoto Hashizume
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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11
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Minamisawa M, Miura T, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Aso S, Uchikawa S, Senda K, Morita T, Hashizume N, Abe N, Ebisawa S, Izawa A, Miyashita Y, Koyama J, Ikeda U. Prediction of 1-year clinical outcomes using the SYNTAX score in patients with prior heart failure undergoing percutaneous coronary intervention: sub-analysis of the SHINANO registry. Heart Vessels 2016; 32:399-407. [PMID: 27709325 PMCID: PMC5371627 DOI: 10.1007/s00380-016-0896-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/30/2016] [Indexed: 01/06/2023]
Abstract
Although coronary artery disease (CAD) is common in patients with heart failure (HF), little is known about the prognostic significance of coronary lesion complexity in patients with prior HF undergoing percutaneous coronary intervention (PCI). The aim of this study was to investigate whether the coronary Synergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score could improve risk stratification in HF patients with CAD. Two hundred patients (mean age 73 ± 11 years, left ventricular ejection fraction 49 ± 15 %) with prior HF who underwent PCI were divided into two groups stratified by SYNTAX score (median value 12) and tracked prospectively for 1 year. The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for worsening HF. Adverse events were observed in 39 patients (19.5 %). Patients with high SYNTAX scores (n = 100) showed worse prognoses than those with low scores (n = 100) (26.0 vs. 13.0 %, respectively, P = 0.021). In multivariate Cox-regression analysis, SYNTAX score ≥12 was significantly associated with MACE (hazard ratio: 1.99, 95 % confidence interval: 1.02–3.97; P = 0.045). In patients with prior HF and CAD, high SYNTAX scores predicted a high incidence of MACE. These results suggest that the SYNTAX score might be a useful parameter for improving risk stratification in these patients.
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Affiliation(s)
- Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hideki Kobayashi
- Department of Cardiology, Shinshu Ueda Medical Center, Ueda, Japan
| | | | - Hiroyuki Nakajima
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Hikaru Kimura
- Department of Cardiology, Saku Central Hospital, Saku, Japan
| | - Hiroshi Akanuma
- Department of Cardiology, Iida Municipal Hospital, Iida, Japan
| | | | - Toshio Sato
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Shoji Hotta
- Department of Cardiology, Ina Central Hospital, Ina, Japan
| | | | - Takuya Maruyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Noboru Watanabe
- Department of Cardiology, Hokushin General Hospital, Nakano, Japan
| | - Takayuki Eisawa
- Department of Cardiology, Komoro Kosei General Hospital, Komoro, Japan
| | - Shinichi Aso
- Department of Cardiology, Aizawa Hospital, Matsumoto, Japan
| | | | - Keisuke Senda
- Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan
| | - Takehiro Morita
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Naoyuki Abe
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Atsushi Izawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Koyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, -1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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12
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Miura T, Miyashita Y, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eizawa T, Aso S, Uchikawa S, Hashizume N, Senda K, Morita T, Ebisawa S, Izawa A, Koyama J, Ikeda U. Comparison of mid-term outcomes between patients with and without atrial fibrillation undergoing coronary stenting in the second-generation drug-eluting stent era: from the SHINANO registry. Cardiovasc Interv Ther 2016; 32:206-215. [DOI: 10.1007/s12928-016-0406-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/09/2016] [Indexed: 01/30/2023]
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13
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Won H, Her AY, Kim BK, Kim YH, Shin DH, Kim JS, Ko YG, Choi D, Kwon HM, Jang Y, Hong MK. Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris. Yonsei Med J 2016; 57:382-7. [PMID: 26847290 PMCID: PMC4740530 DOI: 10.3349/ymj.2016.57.2.382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/02/2015] [Accepted: 06/16/2015] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. MATERIALS AND METHODS One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. RESULTS Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016). CONCLUSION Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.
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Affiliation(s)
- Hoyoun Won
- Cardiovascular and Arrhythmia Center, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Ae Young Her
- Department of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hoon Kim
- Department of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Dong Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Moon Kwon
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
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14
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Hioki H, Miura T, Miyashita Y, Ebisawa S, Motoki H, Izawa A, Koyama J, Ikeda U. Circulating eicosapentaenoic acid to oleic acid ratio and risk for cardiovascular events in patients with coronary artery disease: A sub-analysis of the SHINANO registry. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ijcme.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Predictive Value of Combining the Ankle-Brachial Index and SYNTAX Score for the Prediction of Outcome After Percutaneous Coronary Intervention (from the SHINANO Registry). Am J Cardiol 2016; 117:179-85. [PMID: 26684515 DOI: 10.1016/j.amjcard.2015.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/23/2022]
Abstract
The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospective Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤ 0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤ 22 was defined as 0, 23 to 32 as 1, and ≥ 33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.
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16
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Hioki H, Miura T, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Mawatari E, Akanuma H, Sato T, Ebisawa S, Miyashita Y, Ikeda U, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Aso S, Uchikawa S, Hashizume N, Sekimura N, Morita T. Lean body mass index prognostic value for cardiovascular events in patients with coronary artery disease. HEART ASIA 2015; 7:12-18. [PMID: 26345318 PMCID: PMC4559317 DOI: 10.1136/heartasia-2015-010644] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/05/2023]
Abstract
Objective Little is known about the relationship between body composition indicators, including body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI), and adverse outcomes after percutaneous coronary intervention (PCI) in Asian populations. The aim of this study was to clarify this relationship. Methods The SHINANO registry is a prospective, observational, multicenter cohort registry that enrolled 1923 consecutive patients with coronary heart disease (CHD) from August 2012 to July 2013; 66 patients were excluded because of missing data. We evaluated 1857 patients with CHD who underwent PCI (aged 70±11 years; 23% women; BMI 23.8±3.5 kg/m2; LBMI 18.3±1.8 kg/m2; FMI 5.4±2.2 kg/m2). Patients were divided into three groups, based on BMI, LBMI and FMI tertiles, to assess the prognostic value of the three indicators. The primary endpoint was major adverse cardiac events (MACE), including all cause death, non-fatal myocardial infarction and ischaemic stroke at 1 year. Results Over a 1 year follow-up period (1776 patients, 95.6%), the cumulative MACE incidence was 8.7% (161 cases). Using Kaplan–Meier analysis, the MACE incidence was significantly higher in patients with lower BMI values (13.4–22.2 kg/m2) (p=0.002) and lower LBMI values (11.6–17.6 kg/m2) (p<0.001); this trend was not observed for FMI. Multivariate Cox regression analysis showed that lower LBMI but not lower BMI values were predictive of a higher MACE incidence (HR 1.55; 95% CI 1.05 to 2.30). Conclusions Lower LBMI values are associated with adverse outcomes in an Asian population with CHD undergoing PCI. LBMI is a better predictor of MACE than BMI or FMI. Clinical trial registration UMIN-ID; 000010070.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takashi Miura
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Hideki Kobayashi
- Department of Cardiology , Nagano Red Cross Hospital , Nagano , Japan
| | - Masanori Kobayashi
- Department of Cardiology , Matsumoto Kyoritsu Hospital , Matsumoto , Japan
| | - Hiroyuki Nakajima
- Department of Cardiology , Nagano Matsushiro General Hospital , Nagano , Japan
| | - Hikaru Kimura
- Department of Cardiology , Saku Central Hospital , Saku , Japan
| | | | - Hiroshi Akanuma
- Department of Cardiology , Iida Municipal Hospital , Iida , Japan
| | - Toshio Sato
- Department of Cardiology , Shinonoi General Hospital , Nagano , Japan
| | - Souichirou Ebisawa
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | | | - Shoji Hotta
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Yuichi Kamiyoshi
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takuya Maruyama
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Noboru Watanabe
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takayuki Eisawa
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Shinichi Aso
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Shinichirou Uchikawa
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Noriyuki Sekimura
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takehiro Morita
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
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17
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Hioki H, Miura T, Miyashita Y, Motoki H, Shimada K, Kobayashi M, Nakajima H, Kimura H, Mawatari E, Akanuma H, Sato T, Ebisawa S, Ikeda U. Risk stratification using the CHA 2DS 2-VASc score in patients with coronary heart disease undergoing percutaneous coronary intervention; sub-analysis of SHINANO registry. IJC HEART & VASCULATURE 2015; 7:76-81. [PMID: 28785649 PMCID: PMC5497243 DOI: 10.1016/j.ijcha.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/21/2015] [Indexed: 11/28/2022]
Abstract
Background CHADS2 or CHA2DS2-VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS2 score is reported to have prognostic value in acute coronary syndrome without AF. However, clinical validation of CHA2DS2-VASc score for prognostic stratification in coronary heart disease (CHD) without AF remains uncertain. In this study, we evaluate whether CHA2DS2-VASc score could predict clinical outcome in CHD without known AF. Methods SHINANO registry was a prospective, observational, multicenter cohort study, enrolling 1923 consecutive patients with CHD from August 2012 to July 2013. Two hundred nine patients were excluded because of known AF. We calculated CHA2DS2-VASc score in the remaining 1714 patients (mean age 70 ± 11 years, 23% female) without known AF. To assess the clinical validation of CHA2DS2-VASc score, we divided patients into 3 groups according to the tertiles (score 0–2, 3–4, and ≥ 5). The primary endpoint was MACE including death, nonfatal myocardial infarction, and ischemic stroke at 1 year. Results One-year follow-up was completed in 1632 patients (95.2%). Cumulative incidence of MACE was 139 cases. In Kaplan–Meier analysis, incidence of MACE was significantly higher in patients with CHA2DS2-VASc score ≥ 5 compared to 3–4 and 0–2 (14.6% vs. 6.8% vs. 5.3%, p < 0.001). In multivariate Cox-regression analysis, CHA2DS2-VASc score was an independent predictor for MACE (hazard ratio 1.26, 95% confidence interval 1.15–1.39p < 0.001). Conclusions This study demonstrated that CHA2DS2-VASc score could provide prognostic information in CHD without known AF.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Shimada
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Hiroyuki Nakajima
- Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Hikaru Kimura
- Department of Cardiology, Saku Central Hospital, Saku, Japan
| | | | - Hiroshi Akanuma
- Department of Cardiology, Iida Municipal Hospital, Iida, Japan
| | - Toshio Sato
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Souichirou Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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18
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Kuma S, Morisaki K, Kodama A, Guntani A, Fukunaga R, Soga Y, Shirai S, Ishida M, Okazaki J, Mii S. Ultrasound-Guided Percutaneous Thrombin Injection for Post-Catheterization Pseudoaneurysm. Circ J 2015; 79:1277-81. [DOI: 10.1253/circj.cj-14-1119] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sosei Kuma
- Department of Vascular Surgery, Kokura Memorial Hospital
| | - Koichi Morisaki
- Department of Surgery and Surgical Science, Graduate School of Medicine, Kyushu University
| | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Atsushi Guntani
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors’ Hospital
| | | | | | | | - Masaru Ishida
- Department of Vascular Surgery, Kokura Memorial Hospital
| | - Jin Okazaki
- Department of Vascular Surgery, Kokura Memorial Hospital
| | - Shinsuke Mii
- Department of Vascular Surgery, Steel Memorial Yawata Hospital
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19
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Lee SH, Yang JH, Choi SH, Song YB, Hahn JY, Choi JH, Kim WS, Lee YT, Gwon HC. Long-Term Clinical Outcomes of Medical Therapy for Coronary Chronic Total Occlusions in Elderly Patients (≥75 Years). Circ J 2015; 79:1780-6. [DOI: 10.1253/circj.cj-15-0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seung Hwa Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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