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Bruoha S, Maller T, Loutati R, Perel N, Tabi M, Taha L, Yosefy C, Jafari J, Braver O, Amsalem I, Hitter R, Manassra M, Levy N, Abu-Alkean I, Hamyil K, Steinmetz Y, Karameh H, Karmi M, Marmor D, Wolak A, Glikson M, Asher E. Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study. BMC Geriatr 2023; 23:152. [PMID: 36941571 PMCID: PMC10029169 DOI: 10.1186/s12877-023-03851-z] [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: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU). METHODS We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 - July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality. RESULTS A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). CONCLUSION With increasing life expectancy, the prevalence of nonagenarians in ICCU's is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.
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Affiliation(s)
- Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel.
| | - Tomer Maller
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ranel Loutati
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Tabi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chaim Yosefy
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Jamal Jafari
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Hitter
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Manassra
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levy
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ismael Abu-Alkean
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Hahistadrout 2, Ashkelon, 7830604, Israel
| | - Kamal Hamyil
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohamed Karmi
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Jiang W, Zhou Y, Chen S, Liu S. Impact of Chronic Kidney Disease on Outcomes of Percutaneous Coronary Intervention in Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis. Tex Heart Inst J 2023; 50:490702. [PMID: 36753753 PMCID: PMC9969770 DOI: 10.14503/thij-22-7873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The impact of chronic kidney disease (CKD) on adverse cardiovascular outcomes after percutaneous coronary intervention in patients with diabetes mellitus (DM) is still unclear. This study aimed to systematically assess evidence on this topic. METHODS The PubMed, Embase, and CENTRAL databases were searched for studies comparing mortality, myocardial infarction (MI), or revascularization outcomes between patients with DM with and without CKD. RESULTS In 11 studies, the presence of CKD was associated with significantly increased risk of early all-cause mortality (risk ratio [RR], 3.45; 95% CI, 3.07-3.87; I2 = 0%; P < .001), late all-cause mortality (RR, 2.78; 95% CI, 1.92-4.02; I2 = 83%; P < .001), cardiac mortality (RR, 2.90; 95% CI, 1.99-4.22; I2 = 29%; P < .001), and MI (RR, 1.40; 95% CI, 1.06-1.85; I2 = 13%; P = .02) compared with no CKD. There was no difference in the risk of any revascularization between those with and without CKD. Analysis of adjusted hazard ratios (HRs) indicated significantly increased risk of mortality (HR, 2.64; 95% CI, 1.91-3.64; I2 = 0%; P < .001) in the CKD group but only a nonsignificant tendency of increased MI (HR, 1.59; 95% CI, 0.99-2.54; I2 = 0%; P = .05) and revascularization (HR, 1.24; 95% CI, 0.94-1.63; I2 = 2%; P = .12) in the CKD group. CONCLUSION The presence of CKD in patients with DM significantly increases the risk of mortality and MI. However, CKD had no impact on revascularization rates.
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Affiliation(s)
- Wei Jiang
- Nephrology Department, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang Province, People's Republic of China
| | - Yudi Zhou
- Nephrology Department, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang Province, People's Republic of China
| | - Shu Chen
- Endocrinology Department, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang Province, People's Republic of China
| | - Shengxin Liu
- Cardiology Department, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang Province, People's Republic of China
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3
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Jiang Y, Liu Y, Jia X, Xin W, Wang H. The emerging role of adopting protamine for reducing the risk of bleeding complications during the percutaneous coronary intervention: A meta-analysis. J Card Surg 2022; 37:5341-5350. [PMID: 36352811 DOI: 10.1111/jocs.17139] [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: 04/24/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The safety and the benefits of reducing the risk of bleeding complications via protamine administration during the percutaneous coronary intervention (PCI) remains unclear. This study aimed to systematically assessed the efficacy and safety of using protamine in PCI. METHOD Potential academic studies were identified from PubMed, Cochrane Library, EMBASE, and Web of Science. The time range we retrieved from was that from the inception of electronic databases to March 31, 2022. Gray studies were identified from the references of included literature reports. Stata version 12.0 statistical software (StataCorp LP) was used to analyze the pooled data. RESULTS A total of seven studies were involved in our study. The overall participants of the protamine group were 4983, whereas it was 1953 in the nonprotamine group. This meta-analysis indicated that protamine was preferable for PCI as its lower value of major bleeding (odds ratio [OR] = 0.489, 95% confidence interval [CI]: 0.362-0.661, p < .001) and minor bleeding (OR = 0.281, 95% CI: 0.123-0.643, p = .003). Additionally, the protamine did not tend to be related a higher incidence of mortality (p = .143), myocardial infarction (p = .990), and stent thrombosis (p = .698). CONCLUSIONS Based on available evidence, use of protamine may reduce the risk of bleeding complications without increasing the risk of mortality, myocardial infarction, and stent thrombosis. Given the relevant possible biases in our study, adequately powered and better-designed studies with long-term follow-up are required to reach a firmer conclusion.
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Affiliation(s)
- Yunshan Jiang
- Department of Cardiology, Liaocheng People's Hospital, Liaocheng, People's Republic of China
| | - Yuzhi Liu
- Department of Cardiology, Liaocheng People's Hospital, Liaocheng, People's Republic of China
| | - Xiaoli Jia
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, People's Republic of China
| | - Wenqiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyan Wang
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, People's Republic of China
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4
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Mamudu HM, Jones A, Paul TK, Osedeme F, Stewart D, Alamian A, Wang L, Orimaye S, Bledsoe J, Poole A, Blackwell G, Budoff M. The co-existence of diabetes and subclinical atherosclerosis in rural central Appalachia: Do residential characteristics matter? J Diabetes Complications 2021; 35:107851. [PMID: 33468398 DOI: 10.1016/j.jdiacomp.2021.107851] [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: 12/13/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
UNLABELLED Aim Disparities exist in cardiovascular diseases (CVD) and diabetes in the United States (U.S.) with Central Appalachia having disproportionate burden. This study examined prevalence and correlates of CVD risk-factors among patients with diabetes/subclinical atherosclerosis in Central Appalachia. METHODS During 2012-2016, 3000 patients from Central Appalachia were screened for subclinical atherosclerosis, using coronary artery calcium (CAC) scores; 419 participants had diabetes. Patients were categorized into four groups, with emphasis on those having subclinical atherosclerosis, CAC score ≥ 1. Descriptive statistics and multilevel multinomial logistic regression were conducted to identify CVD risk and spatial factors associated with co-existence of diabetes and subclinical atherosclerosis. RESULTS Among participants, prevalence of CVD risk-factors ranged from 11.7% for current smokers to 69.2% for those with CVD family history. Average BMI was 29.8. Compared to patients with diabetes only, age [RR = 1.07; p ≤ 0.0001], being male [RR = 5.33; p ≤ 0.0001], having hypertension [RR = 2.37; p ≤ 0.05] and being a former smoker were associated with increased likelihood of having diabetes/subclinical atherosclerosis. At the zip-code level, unemployment rate [RR = 1.37; p ≤ 0.05] was significantly associated with having diabetes/subclinical atherosclerosis. CONCLUSION Consistent with clinical guidelines, study results suggest the need to integrate CAC screening into primary care diabetes programs while addressing spatial issues that predispose patients to have diabetes/subclinical atherosclerosis.
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Affiliation(s)
- Hadii M Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Antwan Jones
- Department of Sociology and Department of Epidemiology & Biostatistics, The George Washington University, Washington, DC 20052, USA
| | - Timir K Paul
- John H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Fenose Osedeme
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - David Stewart
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Arsham Alamian
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Liang Wang
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Sylvester Orimaye
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - James Bledsoe
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Amy Poole
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | | | - Mathew Budoff
- Los Angeles Biomedical Research Institute, University of California in Los Angeles, Los Angeles, California 90502, USA
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Kubota M, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Mid-term Clinical Outcomes of Immediate Protamine Use Following Elective Percutaneous Coronary Interventions. Int Heart J 2020; 61:865-871. [PMID: 32921667 DOI: 10.1536/ihj.20-126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bleeding complication has been considered as a serious problem in current percutaneous coronary interventions (PCI). Fortunately, several groups have already reported the effectiveness of protamine use just after PCI to immediately remove any arterial sheath. However, there is a concern that protamine reversal may increase non-occlusive thrombus and, in turn, lead to mid-term cardiovascular events such as target vessel revascularization (TVR) or stent thrombosis. Thus, the purpose of this study was to evaluate whether protamine use following elective PCI was associated with mid-term clinical outcomes. In total, 472 patients were included in this study; subsequently, they were divided into protamine group (n = 142) and non-protamine group (n = 330). The primary endpoint was the composite of ischemia-driven TVR and stent thrombosis. The median follow-up period was determined to be at 562 days. In total, 32 primary endpoints were observed during the study period, and the incidence of primary endpoints tended to be greater in the protamine group than in the non-protamine group (P = 0.056). However, the lesion length, the degree of calcification, and the prevalence of hemodialysis were significantly determined greater in the protamine group than in the non-protamine group. In the multivariate Cox proportional hazards model, the use of protamine (versus non-protamine: hazard ratio 0.542 and 95% confidence interval 0.217-1.355, P = 0.191) was deemed not to be associated with the primary endpoint after controlling legion length, calcification, and hemodialysis. In conclusion, immediate protamine use following elective PCI did not increase mid-term ischemia-driven TVR or stent thrombosis. However, immediate protamine use after PCI should be discussed further for the safety of the patient.
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Affiliation(s)
- Masayuki Kubota
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Numasawa Y, Inohara T, Ishii H, Yamaji K, Kohsaka S, Sawano M, Kodaira M, Uemura S, Kadota K, Amano T, Nakamura M. Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J-PCI Registry). J Am Heart Assoc 2020; 8:e011183. [PMID: 30791799 PMCID: PMC6474917 DOI: 10.1161/jaha.118.011017] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Scarce data exist about the outcomes after percutaneous coronary intervention ( PCI ) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J-PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome ( ACS ) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in-hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in-hospital mortality, cardiac tamponade, cardiogenic shock after PCI , and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in-hospital mortality (odds ratio, 3.60; 95% CI , 3.10-4.18 in ACS ; odds ratio , 6.24; 95% CI, 3.82-10.20 in non- ACS ) and bleeding complications ( odds ratio, 1.79; 95% CI, 1.35-2.36 in ACS ; odds ratio , 2.70; 95% CI, 1.68-4.35 in non- ACS ) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in-hospital mortality and bleeding complications. Conclusions Older patients, especially nonagenarians, carried a greater risk of in-hospital death and bleeding compared with younger patients after PCI . Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI .
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Affiliation(s)
- Yohei Numasawa
- 1 Department of Cardiology Japanese Red Cross Ashikaga Hospital Ashikaga Japan
| | - Taku Inohara
- 2 Duke Clinical Research Institute Duke University Medical Center Durham NC.,3 Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Hideki Ishii
- 4 Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kyohei Yamaji
- 5 Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Shun Kohsaka
- 3 Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Mitsuaki Sawano
- 3 Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Masaki Kodaira
- 1 Department of Cardiology Japanese Red Cross Ashikaga Hospital Ashikaga Japan
| | - Shiro Uemura
- 6 Department of Cardiology Kawasaki Medical School Kurashiki Japan
| | - Kazushige Kadota
- 7 Department of Cardiology Kurashiki Central Hospital Kurashiki Japan
| | - Tetsuya Amano
- 8 Department of Cardiology Aichi Medical University Nagakute Japan
| | - Masato Nakamura
- 9 Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
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Plasma Choline as a Diagnostic Biomarker in Slow Coronary Flow. Cardiol Res Pract 2020; 2020:7361434. [PMID: 32411450 PMCID: PMC7204336 DOI: 10.1155/2020/7361434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Abstract
Aim The slow coronary flow (SCF) phenomenon was characterized by delayed perfusion of epicardial arteries, and no obvious coronary artery lesion in coronary angiography. The prognosis of patients with slow coronary flow was poor. However, there is lack of rapid, simple, and accurate method for SCF diagnosis. This study aimed to explore the utility of plasma choline as a diagnostic biomarker for SCF. Methods Patients with coronary artery stenosis <40% evaluated by the coronary angiogram method were recruited in this study and were grouped into normal coronary flow (NCF) and SCF by thrombolysis in myocardial infarction frame count (TFC). Plasma choline concentrations of patients with NCF and SCF were quantified by Ultra Performance Liquid Chromatography Tandem Mass Spectrometry. Correlation analysis was performed between plasma choline concentration and TFC. Receiver operating characteristic (ROC) curve analysis with or without confounding factor adjustment was applied to predict the diagnostic power of plasma choline in SCF. Results Forty-four patients with SCF and 21 patients with NCF were included in this study. TFC in LAD, LCX, and RCA and mean TFC were significantly higher in patients with SCF in comparison with patients with NCF (32.67 ± 8.37 vs. 20.66 ± 3.41, P < 0.01). Plasma choline level was obviously higher in patients with SCF when compared with patients with NCF (754.65 ± 238.18 vs. 635.79 ± 108.25, P=0.007). Plasma choline level had significantly positive correlation with Mean TFC (r = 0.364, P=0.002). Receiver operating characteristic (ROC) analysis showed that choline with or without confounding factor adjustment had an AUC score of 0.65 and 0.77, respectively. Conclusions TFC were closely related with plasma choline level, and plasma choline can be a suitable and stable diagnostic biomarker for SCF.
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Gao X, Ge Z, Kong X, Wang Z, Zuo G, Wang F, Chen S, Zhang J. Clinical Outcomes of Antithrombotic Strategies for Patients with Atrial Fibrillation After Percutaneous Coronary Intervention. Int Heart J 2019; 60:546-553. [PMID: 31105152 DOI: 10.1536/ihj.18-464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remain challenging. This study aims to explore the best antithrombotic strategy for AF patients after PCI based on a network meta-analysis. This study was registered in PROSPERO (CRD42018093928). The PubMed, Cochrane, and EMBASE databases were searched to identify clinical trials concerning antithrombotic therapy for AF patients with PCI from inception to April 2018. Pairwise and network meta-analysis were conducted to compare clinical outcomes of different antithrombotic therapy. The primary endpoint was major bleeding. Fifteen studies including 16,382 patients were identified with follow-up ranging from 3 to 12 months. Non-vitamin K oral anticoagulants (NOAC) plus P2Y12 inhibitor ranked first with a reduced risk of major bleeding compared with vitamin K antagonist (VKA) plus dual antiplatelet therapy (OR: 0.57, 95% CI: 0.43-0.75) but with no significant difference compared with VKA plus single platelet therapy (OR: 0.85, 95% CI: 0.62-1.16). Similar thrombotic events were evident among these groups. Subgroup analysis showed that VKA plus aspirin exhibited a similar risk of major bleeding compared with VKA plus clopidogrel (OR: 0.94, 95% CI: 0.73-1.23) but was associated with increased risks of ischaemic stroke (OR: 2.10, 95% CI: 1.33-3.32) and all-cause death (OR: 1.77, 95% CI: 1.15-2.74) versus VKA plus clopidogrel. In AF patients undergoing PCI, NOAC plus P2Y12 inhibitor and VKA plus clopidogrel, but not VKA plus aspirin, were associated with reduced risk of major bleeding compared with the recommended VKA-based triple therapy, while thrombotic events were similar among these treatments.
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Affiliation(s)
- Xiaofei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University.,Department of Cardiology, Nanjing Heart Centre
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Xiangquan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Zhimei Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Guangfeng Zuo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Feng Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University.,Department of Cardiology, Nanjing Heart Centre
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University.,Department of Cardiology, Nanjing Heart Centre
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Januszek R, Dziewierz A, Siudak Z, Rakowski T, Dudek D, Bartuś S. Chronic obstructive pulmonary disease and periprocedural complications in patients undergoing percutaneous coronary interventions. PLoS One 2018; 13:e0204257. [PMID: 30273363 PMCID: PMC6166928 DOI: 10.1371/journal.pone.0204257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background The relationship between chronic obstructive pulmonary disease (COPD) and periprocedural complications of percutaneous coronary interventions (PCIs) is influenced by several factors. We aimed to investigate the association between COPD, its complication type and rate in patients undergoing PCI. Methods Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all PCIs performed in Poland between January 2015 and December 2016. COPD was present in 5,594 of the 221,187 patients undergoing PCI. We assessed the frequency and predictors of periprocedural complications in PCI. Results Patients with COPD were elder individuals (70.3 ± 9.9 vs. 67 ± 10.8 years; p < 0.05). We noted 145 (2.6%) periprocedural complications in the COPD group and 4,121 (1.9%) in the non-COPD group (p < 0.001). The higher incidence of periprocedural complications in the COPD patients was mainly attributed to cardiac arrest (p = 0.001), myocardial infarctions (p = 0.002) and no-reflows (p < 0.001). COPD was not an independent predictor of all periprocedural complications. On the other hand, COPD was found to be an independent predictor of increased no-reflow risk (odds ratio [OR] 1.447, 95% CI 1.085–1.929; p = 0.01), and at the same time, of decreased risk of periprocedural allergic reactions (OR 0.117, 95% CI 0.016–0.837; p = 0.03). Conclusions In conclusion, periprocedural complications of PCIs are more frequent in patients with COPD. COPD is an independent positive predictor of no-reflow and a negative predictor of periprocedural allergic reactions.
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Affiliation(s)
- Rafał Januszek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- * E-mail:
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Ito S, Endo A, Okada T, Yoshitomi H, Hyakudomi R, Tajima Y, Tanabe K. A Case of Left Ventricular Thrombus with Superior Mesenteric Vein Thrombosis Due to Atopic Dermatitis. Int Heart J 2018; 59:881-886. [PMID: 29877306 DOI: 10.1536/ihj.17-386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 55-year-old man was presented to the emergency room because of abdominal pain for 4 days. He had a history of atopic dermatitis. Left ventricular (LV) asynergy and thrombus was detected on echocardiography, and superior mesenteric vein thrombosis was detected by computed tomography. There are no reported cases of this combination of thrombi. We hypothesized that the reason for this complication is the combination of coagulation disorder due to atopic dermatitis, silent myocardial infarction, and exacerbation of the coagulation abnormality due to bacteremia, leading to superior mesenteric vein and LV thrombosis. Atopic dermatitis that has potential risk factors of thrombus with sepsis could provoke thrombophilic state. Atopic dermatitis is a common disease, but continuous medical care is essential.
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Affiliation(s)
- Shimpei Ito
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Taiji Okada
- Division of Cardiology, Shimane University Faculty of Medicine
| | | | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine
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11
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Yamamoto S, Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Safety of Reversing Anticoagulation by Protamine Following Elective Transfemoral Percutaneous Coronary Intervention in the Drug-Eluting Stent Era. Int Heart J 2018; 59:482-488. [PMID: 29743410 DOI: 10.1536/ihj.17-352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bleeding complications following percutaneous coronary interventions (PCI) have been closely associated with morbidity and mortality. Although radial arteries have been widely used in current PCI, including primary PCI, transfemoral PCI remains necessary for complex PCI. The purpose of this study was to compare the incidence of complications following elective transfemoral PCI between manual compression with and without protamine. We identified 249 consecutive patients who underwent elective transfemoral PCI from hospital records, and divided them into two groups: patients who used protamine for manual compression (the protamine group; n = 205) and patients who did not (the non-protamine group, n = 44). Complications including acute thrombosis, bleeding requiring blood transfusion, transient hypotension, skin rash, and death within 30 days were compared between groups. The baseline clinical and procedural characteristics were comparable between the protamine and non-protamine groups. The incidences of all complications were not different between the protamine (5.9%) and the non-protamine groups (9.1%) (P = 0.43). While more than 90% of the patients received drug-eluting stent implantation, there was no acute thrombus in either group. The incidence of bleeding requiring blood transfusion was significantly lower in the protamine group (0.5%) than in the non-protamine group (6.8%) (P = 0.002). Multivariate logistic regression analysis revealed the inverse association between protamine use and bleeding requiring blood transfusion (odds ratio 0.08, 95% confidence interval 0.01-0.84, P = 0.04). In conclusion, the use of protamine for manual compression following elective transfemoral PCI was safe and was associated with less bleeding complications.
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Affiliation(s)
- Shingo Yamamoto
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiology, Saitama Medical Center, Jichi Medical University
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12
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Chen G, Wu L, Zheng L, Ding L, Wong T, Zhang S, Yao Y. Combining Percutaneous Ultrasound-Guided Hematoma Aspiration and Compression Repair to Treat Femoral Artery Pseudoaneurysm after Cardiac Catheterization. Int Heart J 2018; 59:333-338. [PMID: 29563376 DOI: 10.1536/ihj.17-026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.
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Affiliation(s)
- Gang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lingmin Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lihui Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ligang Ding
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Tom Wong
- Heart Rhythm Centre, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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13
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Erben Y, Mena-Hurtado CI, Miller SM, Jean RA, Sumpio BJ, Velasquez CA, Mojibian H, Aruny J, Dardik A, Sumpio BE. Increased mortality in octogenarians treated for lifestyle limiting claudication. Catheter Cardiovasc Interv 2018; 91:1331-1338. [DOI: 10.1002/ccd.27523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Young Erben
- Section of Vascular and Endovascular Surgery, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | - Carlos I. Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Samuel M. Miller
- Warren Alpert Medical School at Brown University; Providence Rhode Island
| | - Raymond A. Jean
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
- National Clinician Scholars Program, Department of Internal Medicine; Yale School of Medicine; New Haven Connecticut
| | - Brandon J. Sumpio
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | | | - Hamid Mojibian
- Section of Vascular Interventional Radiology, Department of Radiology; Yale University School of Medicine; New Haven Connecticut
| | - John Aruny
- Section of Vascular Interventional Radiology, Department of Radiology; Yale University School of Medicine; New Haven Connecticut
| | - Alan Dardik
- Section of Vascular and Endovascular Surgery, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | - Bauer E. Sumpio
- Section of Vascular and Endovascular Surgery, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
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14
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Kherad B, Waliszewski M, Leschke M, Kader MA, Bang LH, Ruiz-Poveda FL, Pieske B, Krackhardt F. 9-month results of polymer-free sirolimus eluting stents in young patients compared to a septuagenarian and octogenarian all-comer population. J Interv Cardiol 2017; 31:338-344. [DOI: 10.1111/joic.12472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Behrouz Kherad
- Department of Internal Medicine and Cardiology; Charité - Universitätsmedizin Berlin; Campus Virchow Klinikum
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology; Charité - Universitätsmedizin Berlin; Campus Virchow Klinikum
- Medical Scientific Affairs; B.Braun Melsungen AG; Berlin Germany
| | - Matthias Leschke
- Klinik für Kardiologie; Angiologie und Pneumologie; Klinikum Esslingen Esslingen Germany
| | | | - Liew Houng Bang
- Department of Cardiology; Hospital Queen Elizabeth II; Kota Kinabalu Malaysia
| | - Fernando Lozano Ruiz-Poveda
- Servicio de Hemodinámica y Cardiología Intervencionista; Hospital General Universitario de Ciudad Real; Spain
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology; Charité - Universitätsmedizin Berlin; Campus Virchow Klinikum
| | - Florian Krackhardt
- Department of Internal Medicine and Cardiology; Charité - Universitätsmedizin Berlin; Campus Virchow Klinikum
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