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LI YX, WANG BN, FAN FF, ZHANG Y, JIANG J, LI JP, HAN YL, Huo Y. Thirty-day outcomes of in-hospital multi-vessel versus culprit-only revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease. J Geriatr Cardiol 2023; 20:485-494. [PMID: 37576484 PMCID: PMC10412540 DOI: 10.26599/1671-5411.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. However, only a few single-center retrospective studies were performed on small Chinese cohorts. Our study aims to demonstrate the advantage of multivessel percutaneous intervention (PCI) strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population. METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project, 5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed. After 5: 1 propensity score matching, 3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of myocardial infarction, all-cause death, stent thrombosis, heart failure, and stroke. RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE (adjusted OR = 0.75, 95% CI: 0.57-0.98, P = 0.032) than culprit-only PCI and conferred no increased risk of all-cause death, myocardial infarction, stent thrombosis, stroke, or bleeding. Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access (OR = 0.34, 95% CI: 0.15-0.74) than with trans-radial access (OR = 0.87, 95% CI: 0.66-1.16, P for interaction = 0.017). CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.
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Affiliation(s)
- Yu-Xi LI
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bei-Ning WANG
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fang-Fang FAN
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan ZHANG
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jie JIANG
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jian-Ping LI
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ya-Ling HAN
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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Wang G, Zhao Q, Cheng Q, Zhang X, Tian L, Wu X. Comparison short time discharge with long time discharge following uncomplicated percutaneous coronary intervention for Non-ST elevation myocardial infarction patients. BMC Cardiovasc Disord 2019; 19:109. [PMID: 31088360 PMCID: PMC6518450 DOI: 10.1186/s12872-019-1096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/03/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The rational length of stay following non-complicated percutaneous coronary intervention (PCI) for Non-ST elevation myocardial infarction (NSTEMI) patients remains controversial. Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients, but short-time discharge is not uncommon in real world practice. This study examined the impact of short time discharge following non-complicated PCI on 30-day net adverse clinical events in NSTEMI patients. METHODS This retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI. Of these patients, 432 were discharged early (< 24 h), whereas the remaining 992 NSTEMI patients underwent routine discharge. The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days. The differences between the two groups were analyzed after propensity score matching to reduce selection bias. RESULTS The incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6% (115/992) compared with 8.6% (37/432) in the short-time discharge group, although this difference was not significant (P = 0.09). This difference was mainly due to lesser radial access selected in the long-time discharge group (827/932, 83.4% vs. 387/432, 89.5%, P < 0.0005). After PS matching to balance the access difference, there was no significant difference in the incidence of the events mentioned above between two groups. CONCLUSIONS If an NSTEMI patient undergoes PCI without any procedural or hospital complications, short-time discharge after successful PCI would be feasible and safe in selected NSTEMI patients.
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Affiliation(s)
- Guozhong Wang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China.
| | - Quanming Zhao
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Qing Cheng
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaoxia Zhang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Lei Tian
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaofan Wu
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
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Morttada A, Shahin S. Incidence and predictors of bleeding among Egyptian patients presenting with acute coronary syndrome: Using CRUSADE risk score. Egypt Heart J 2018; 70:135-142. [PMID: 30190637 PMCID: PMC6123232 DOI: 10.1016/j.ehj.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/20/2018] [Indexed: 11/28/2022] Open
Abstract
Background Early invasive strategies; in management of acute coronary syndrome; has led to improvement of patient outcomes. However, these invasive therapies have their own risks, namely bleeding and blood transfusion. The aim of this study was to determine the incidence of bleeding, its location and severity among the study population, to correlate between the patients' characteristics and the risk profile of the patients based upon the CRUSADE risk score and increased bleeding events, and lastly; to identify the predictors of increased bleeding risk among Egyptian patients who presented with acute coronary syndrome. Methods The study had included eight hundred and twenty-three patients referred to coronary care unit (CCU), to (Ain Shams University hospital, Specialized Ain Shams hospital, and 6th October insurance hospital) with diagnosis of Acute Coronary Syndrome “ACS” within a period from 1/2014 till 7/2014, and they were followed up for additional three months following discharge with assessment of their bleeding risk and risk scores. Results More bleeding events had been witnessed among the study population who were older, diabetics, had renal impairment, had peripheral vascular disease, had congestive heart failure picture at presentation; more among female sex category and more among patients receiving GPIIbIIIa antagonists. Those bleeding events had been experienced during hospital stay. Conclusion Risk of bleeding can be evaluated using a simple risk score in both STEMI & NSTEMI patients, and across anti-coagulant strategies, providing important prognostic information. Variability in the rates of bleeding is likely based on differences in baseline characteristics, comorbidities, and invasive treatment strategies rather than specific anti-coagulation regimens. Patients at highest risk of bleeding are also at highest risk of ischaemia and thrombotic complications. Thus higher risk patients need a more careful treatment approach to maximize the efficacy of therapy and to reduce thrombotic risk while reducing the bleeding risk.
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He P, Liu Y, Wei X, Jiang L, Guo W, Guo Z, Lin C, Tan N, Chen J. Comparison of enoxaparin and unfractionated heparin in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention: a systematic review and meta-analysis. J Thorac Dis 2018; 10:3308-3318. [PMID: 30069327 DOI: 10.21037/jtd.2018.05.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background No randomized trial has been conducted to directly compare enoxaparin with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In an era where early invasive strategies are recommended in high risk patients, the effect of enoxaparin and UFH needs to be re-evaluated. The authors performed a meta-analysis to determine whether enoxaparin is superior to UFH in patients with NSTE-ACS undergoing PCI. Methods The composite efficacy end point included all-cause mortality and myocardial infarction (MI) in the hospital or within 60 days. Major bleeding, as defined in the individual clinical trials evaluated, was the main safety endpoint within the same time period. Pooled estimates of the difference in outcome between enoxaparin and UFH were calculated using fixed or random effects models. Results A total of 8,861 patients from 4 trials were included. In the pooled analysis, rates of death or MI were similar in patients treated with enoxaparin and UFH [risk ratio (RR), 0.89, 95% confidence interval (CI): 0.77-1.02, P=0.09; I2 =50%]. Major bleeding was also similar between enoxaparin and UFH (RR, 1.21, 95% CI: 0.94-1.56, P=0.15, I2=39%). A subgroup analysis, including randomized trials only or trials with a large sample size, and a leave-one-out sensitivity analysis, demonstrated similar results with above, respectively. Conclusions In patients undergoing PCI for NSTE-ACS, rates for both death/MI and major bleeding were similar between patients treated with enoxaparin and UFH.
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Affiliation(s)
- Pengcheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China.,Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong General Hospital's Nanhai Hospital, Foshan 528251, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China
| | - Xuebiao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China
| | - Wei Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China
| | - Zhiqiang Guo
- Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong General Hospital's Nanhai Hospital, Foshan 528251, China
| | - Chunying Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China.,Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong General Hospital's Nanhai Hospital, Foshan 528251, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510100, China
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Andò G, Porto I, Montalescot G, Bolognese L, Trani C, Oreto G, Harrington RA, Bhatt DL. Radial access in patients with acute coronary syndrome without persistent ST-segment elevation: Systematic review, collaborative meta-analysis, and meta-regression. Int J Cardiol 2016; 222:1031-1039. [PMID: 27537543 DOI: 10.1016/j.ijcard.2016.07.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/29/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Consistent evidence of benefit exists for radial access (RA) in ST-elevation acute myocardial infarction (STEMI). Patients with non ST-elevation acute coronary syndrome (NSTE-ACS) have a more varied ischemic and bleeding profile. No randomized trial of vascular access ever focused on NSTE-ACS and landmark studies did not provide conclusive results in this heterogeneous subset of patients. METHODS We assessed in a meta-analysis whether RA is associated with improved outcomes in NSTE-ACS patients. Included studies had to meet the following criteria: 1) enrolling patients with NSTE-ACS undergoing invasive management; 2) reporting outcomes with respect to RA as compared with femoral access (FA); 3) reporting short-term (procedural, in-hospital and up to 30-day) or long-term clinical outcomes. Studies were pooled with fixed and random effects models and heterogeneity was investigated by weighted meta-regression. RESULTS Eleven studies were included encompassing 131.339 patients, 46.451 receiving RA and 84.888 receiving FA. Thirty-day mortality and MACE were lower with RA (p<0.001 with fixed effects, p=NS with random effects model), but these results depended on one large observational database. Major bleeding was consistently reduced by RA (p<0.001), albeit an inverse relationship with the proportion of patients in each study receiving FA and experiencing major bleeding was evident. The association of RA with reduced long-term mortality was of borderline significance (p=0.054 with random-effects, p=0.001 with fixed-effect model) and also depended on major bleeding in FA patients. CONCLUSIONS RA is associated with better outcomes as compared with FA in NSTE-ACS, although this observation is influenced by nonrandomized comparisons. Large heterogeneity exists among studies. REGISTRATION This study is registered in the PROSPERO database (CRD42015029459).
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Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Italo Porto
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gilles Montalescot
- ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (AP-HP), Paris, France
| | - Leonardo Bolognese
- Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
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Abdul Jabbar A, Mufti O, Sabol A, Markert R, White B, Broderick G. Arterial Access in Patients With De Novo Acute Coronary Syndrome Undergoing Coronary Angiography. Angiology 2016; 68:360-365. [PMID: 27252244 DOI: 10.1177/0003319716652277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bleeding is a major limitation of antithrombotic therapy among invasively managed patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs). Randomized clinical trials have generally failed to favor either the femoral or the radial arterial approach for coronary angiography or intervention in NSTE-ACS. In 561 hospitalized patients with a new diagnosis of NSTE-ACS referred for coronary angiography, 364 and 197 patients underwent the femoral and the radial approach, respectively. Femoral and radial access did not differ in bleeding complications in the first 72 hours (8 of 364 or 2.2% vs 8 of 197 or 4.1%, P = .21), duration of hospitalization (4.67 ± 5.02 vs 4.51 ± 4.81, P = .28) nor in-hospital mortality (0.8% vs 0.5%, P = .67). Contrast volume was higher for femoral versus radial cases (204 ± 119 vs 168 ± 104, P < .001). In patients with de novo NSTE-ACS without prior cardiac bypass, radial and femoral arterial access did not differ in instances of bleeding within the first 72 hours postoperatively, length of hospital stay, or in-hospital mortality. Less contrast was used in radial cases, which may represent an advantage for patients with renal insufficiency.
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Affiliation(s)
- Ali Abdul Jabbar
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA.,2 Division of Cardiovascular Medicine, Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Omar Mufti
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Angeline Sabol
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Ronald Markert
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Bryan White
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - George Broderick
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
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Bavishi C, Panwar SR, Dangas GD, Barman N, Hasan CM, Baber U, Kini AS, Sharma SK. Meta-Analysis of Radial Versus Femoral Access for Percutaneous Coronary Interventions in Non-ST-Segment Elevation Acute Coronary Syndrome. Am J Cardiol 2016; 117:172-8. [PMID: 26704032 DOI: 10.1016/j.amjcard.2015.10.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
Radial access for percutaneous coronary intervention (PCI) has been shown to reduce mortality and vascular complications compared to femoral access in patients with ST-segment elevation myocardial infarction. However, efficacy and safety of radial access PCI in non-ST-segment elevation acute coronary syndrome (NSTE ACS) is not well understood. A systematic search of electronic databases was performed through July 2015 to search and identify relevant studies. We evaluated the following short-term outcomes: all-cause mortality, major bleeding, access site bleeding, and need for blood transfusions. In addition, we evaluated 1-year mortality. Studies were pooled using random effects model. Nine studies including a total of 220,126 patients (radial approach: 94,663 patients [43%], femoral approach: 125,463 patients [57%]) were included in the analysis. On pooled analysis, no significant difference in incidence of short-term all-cause mortality was found between radial and femoral access (odds ratio [OR] 0.78, 95% CI 0.57 to 1.07, p = 0.12). Radial access was associated with significant reduction in major bleeding (OR 0.52, 95% CI 0.36 to 0.73, p = 0.0002), access-site bleeding (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007), and need for blood transfusions (OR 0.61, 95% CI 0.41 to 0.91, p = 0.02). Furthermore, the 1-year mortality was significantly lower in radial approach (OR 0.72, 95% CI 0.55 to 0.95, p = 0.02). In conclusion, in patients with non-ST-segment elevation acute coronary syndrome undergoing PCI, radial access is associated with decreased bleeding and access-site complications.
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Affiliation(s)
- Chirag Bavishi
- Department of Cardiology, Mount Sinai St. Luke's & West Hospitals, New York, New York
| | - Sadik R Panwar
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - George D Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Nitin Barman
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Choudhury M Hasan
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Usman Baber
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Annapoorna S Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
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