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Ogami T, Kliner DE, Toma C, Sanon S, Smith AJC, Serna-Gallegos D, Wang Y, Makani A, Doshi N, Brown JA, Yousef S, Sultan I. Acute Coronary Syndrome After Transcatheter Aortic Valve Implantation (Results from Over 40,000 Patients). Am J Cardiol 2023; 193:126-132. [PMID: 36905688 DOI: 10.1016/j.amjcard.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 03/13/2023]
Abstract
Acute coronary syndrome (ACS) encompasses a broad category of presentations from unstable angina to ST-elevation myocardial infarctions. Most patients undergo coronary angiography upon presentation for diagnosis and treatment. However, the ACS management strategy after transcatheter aortic valve implantation (TAVI) may be complicated because of challenging coronary access. The National Readmission Database was reviewed to identify all patients who were readmitted with ACS within 90 days after TAVI between 2012 and 2018. Their outcomes were described between patients who were readmitted with ACS (ACS group) and without (non-ACS group). A total of 44,653 patients were readmitted within 90 days after TAVI. Among them, 1,416 patients (3.2%) were readmitted with ACS. The ACS group had a higher prevalence of men, diabetes, hypertension, congestive heart failure, peripheral vascular disease, and a history of percutaneous coronary intervention (PCI). In the ACS group, 101 patients (7.1%) developed cardiogenic shock, whereas 120 patients (8.5%) developed ventricular arrhythmias. Overall, 141 patients (9.9%) in the ACS group died during readmissions (vs 3.0% in the non-ACS group, p <0.001). Among the ACS group, PCI was performed in 33 (5.9%), whereas coronary bypass grafting was performed in 12 (0.82%). The factors associated with ACS readmission included a history of diabetes, congestive heart failure, chronic kidney disease, and PCI, and nonelective TAVI. Coronary artery bypass grafting was an independent factor related to in-hospital mortality during ACS readmission (odds ratio 11.9, 95% confidence interval 2.18 to 65.4, p = 0.004), whereas PCI was not (odds ratio 0.19, 95% confidence interval 0.03 to 1.44, p = 0.11). In conclusion, patients readmitted with ACS have significantly higher mortality compared with those readmitted without ACS. History of PCI is an independent factor associated with ACS after TAVI.
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Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Dustin E Kliner
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Saurabh Sanon
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Anson J Conrad Smith
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania; Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber Makani
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Nandini Doshi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsubrgh, Pennsylvania; Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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2
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Kwiecinski J, Tzolos E, Fletcher AJ, Nash J, Meah MN, Cadet S, Adamson PD, Grodecki K, Joshi N, Williams MC, van Beek EJR, Lai C, Tavares AAS, MacAskill MG, Dey D, Baker AH, Leipsic J, Berman DS, Sellers SL, Newby DE, Dweck MR, Slomka PJ. Bypass Grafting and Native Coronary Artery Disease Activity. JACC Cardiovasc Imaging 2022; 15:875-887. [PMID: 35216930 PMCID: PMC9246289 DOI: 10.1016/j.jcmg.2021.11.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to describe the potential of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BACKGROUND As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis. METHODS Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. RESULTS Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. CONCLUSIONS Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.
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Affiliation(s)
- Jacek Kwiecinski
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Evangelos Tzolos
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander J Fletcher
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Nash
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kajetan Grodecki
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nikhil Joshi
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Chi Lai
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark G MacAskill
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew H Baker
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephanie L Sellers
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Tawakol A, Osborne MT. Multimodal Imaging Insights Into Graft Vasculopathy and Progression of Native CAD Following CABG. JACC Cardiovasc Imaging 2022; 15:888-890. [PMID: 35512959 PMCID: PMC9210977 DOI: 10.1016/j.jcmg.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Michael T Osborne
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Wolny R, Mintz GS, Matsumura M, Kim SY, Ishida M, Fujino A, Lee T, Shlofmitz E, Goldberg A, Liu Y, Zhang Z, Zhang M, Hu X, Jeremias A, Petrossian G, Shlofmitz RA, Maehara A. Left coronary artery calcification patterns after coronary bypass graft surgery: An in-vivo optical coherence tomography study. Catheter Cardiovasc Interv 2020; 98:483-491. [PMID: 32915510 DOI: 10.1002/ccd.29220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We sought to evaluate the severity and patterns of calcifications in the left main coronary artery (LMCA) and proximal segments of left anterior descending coronary artery (LAD) and left circumflex artery (LCX) using optical coherence tomography (OCT) in patients with and without prior coronary artery bypass grafting (CABG). BACKGROUND CABG may accelerate upstream calcium development. METHODS OCT images (n = 76) of the LMCA bifurcation from either the LAD or LCX in 76 patients with at least one patent left coronary graft, on average 7.0 ± 5.6 years post-CABG, were compared with 148 OCT images in propensity-score-matched non-CABG controls. RESULTS Minimum lumen areas in the LMCA, LAD, and LCX in post-CABG patients were smaller than non-CABG controls. Maximum calcium arc and thickness as well as calcium length were greater in the LMCA and LCX, but not in the LAD in post-CABG patients versus non-CABG controls. Calcium located at the carina of a bifurcation, calcified nodules (CN), thin intimal calcium, and lobulated calcium were more prevalent in post-CABG patients. After adjusting for multiple covariates, prior CABG was an independent predictor of calcification at the carina of a bifurcation (odds ratio [OR] 5.77 [95% confidence interval, CI: 1.5-21.6]), thin intimal calcium (4.7 [1.5-14.4]), and the presence of a CN (15.60 [3.2-76.2]). CONCLUSIONS Prior CABG is associated with greater amount of calcium in the LMCA and the proximal LCX, as well as higher prevalence of atypical calcium patterns, including CN, thin or lobulated calcium, and calcifications located at the carina of a bifurcation, compared with non-CABG controls.
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Affiliation(s)
- Rafal Wolny
- National Institute of Cardiology, Warsaw, Poland.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Song-Yi Kim
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Masaru Ishida
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Akiko Fujino
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | - Evan Shlofmitz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | | | - Yangbo Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mingyou Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Xun Hu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,St. Francis Hospital, Roslyn, New York, USA
| | | | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Shang Y, Mintz GS, Pu J, Guo J, Kobayashi N, Franklin-Bond T, Leon MB, Moses JW, Maehara A, Shimizu T, Yakushiji T. Bypass to the left coronary artery system may accelerate left main coronary artery negative remodeling and calcification. Clin Res Cardiol 2013; 102:831-5. [DOI: 10.1007/s00392-013-0598-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
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6
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The management of patients on the waiting list for coronary artery bypass grafting: a case study. ACTA ACUST UNITED AC 2000. [DOI: 10.1054/chec.2000.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7
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Bergeron GA, Björk VO. Progression of coronary artery disease. Am Heart J 1984; 108:1585. [PMID: 6507264 DOI: 10.1016/0002-8703(84)90722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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8
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Ivert T. Clinical follow-up of 106 patients five years after coronary bypass surgery for angina pectoris. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1981; 15:171-7. [PMID: 6977840 DOI: 10.3109/14017438109101043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
One hundred and six consecutive survivors were re-examined five years after coronary bypass surgery for stable angina pectoris (88 patients) or unstable angina (18 patients). Ninety-two per cent had less symptoms than before operation, 70% were so improved that they were not restricted in daily life and 30% considered themselves free from angina. Excluding one patient, who experienced chest pain at the exercise test and three asymptomatic patients who had undergone repeat operations, only 26% were free from angina at the five-year evaluation. Patients without angina had significantly lower diastolic blood pressure than those with residual symptoms, whereas the type of angina, smoking habits, serum lipids and common risk factors did not differ significantly. Thirteen per cent were employed on admittance for surgery, 49% had been able to work after surgery and 36% of those, who did not have old-age pension or invalidity pension for non-cardiac causes, worked full-time five years after surgery. Patients with sedentary work returned more often (53%) than those with manual labour (22%) and patients with sick-leave less than six months before surgery more often (91%) than those with sick-leave more than two years (13%). Peri-operative infarction was recorded in 5% and a further 10% suffered late myocardial infarction.
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