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Nabati M, Kavousi S, Yazdani J, Parsaee H. The association between myocardial early systolic lengthening and high risk angiographic territory involvement in patients with non-ST-segment elevation myocardial infarction. J Ultrasound 2024; 27:567-577. [PMID: 38551782 PMCID: PMC11333420 DOI: 10.1007/s40477-024-00885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/19/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) is more common than ST-segment elevation myocardial infarction (STEMI), consisting of 60-70% of myocardial infarctions. When left ventricular (LV) pressure increases during early systole, regionally ischaemic myocardium with a reduced active force exhibit stretching. The aim of this study was to evaluate the role of this parameter in determining high risk angiographic territory involvement in NSTEMI patients. RESULTS This study was a descriptive correlational research that was conducted on 96 patients with NSTEMI and a left ventricular ejection fraction ≥ 50% who underwent coronary angiography (CAG). Patients were divided into two groups based on having or not having high risk angiographic territory involvement in CAG. All patients underwent a transthoracic echocardiography during the first day of hospitalization and early systolic lengthening (ESL), duration of ESL (DESL), left ventricular global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. The results of this study showed DESL, DESLLAD, and DESLLCX were longer in high risk angiographic territory group than other one (P value 0.016, 0.044, and 0.04, respectively). The logistic regression analysis showed among different variables, only age and ESLLAD had an independent association with high risk angiographic territory involvement (P = 0.01, odds ratio [OR] 1.09, 95% CI 1.021-1.164, and P = 0.024, odds ratio [OR] 1.243, 95% CI 1.029-1.50, respectively). CONCLUSIONS Assessment of myocardial ESLLAD by speckle-tracking echocardiography may be helpful in predicting high risk angiographic territory involvement in patients with NSTEMI. Indeed, a higher value can be considered as a high risk parameter which may show benefit of an early invasive strategy versus a conservative approach.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Saeed Kavousi
- Student Research Committee, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani
- Department of Biostatics, Faculty of Health, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homa Parsaee
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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von Zur Mühlen C, Jeuck M, Heidt T, Maulhardt T, Hartikainen T, Supady A, Hilgendorf I, Wolf D, Kaier K, Westermann D, Rilinger J. One-year outcome of robotical vs. manual percutaneous coronary intervention. Clin Res Cardiol 2024:10.1007/s00392-024-02524-0. [PMID: 39167194 DOI: 10.1007/s00392-024-02524-0] [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: 06/06/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (R-PCI) is a promising technology for optimizing the treatment of patients with coronary heart disease. For a better understanding of the potential of R-PCI in clinical routine compared to conventional manual PCI (M-PCI) both initial treatment success of the index procedure and long-term outcome have to be analysed. METHODS Prospective evaluation from the FRiK (DRKS00023868) registry of all R-PCI cases with the CorPath GRX Cardiology by Siemens Healthineers and Corindus in the Freiburg University Heart Center between 04/2022 and 03/2023. Index procedure success and safety, radiation dose of patients and personnel, and 1-year outcome will be reported. Findings will be compared to a prospective control group of M-PCI patients treated by the same team of interventionalists during the same observation period. RESULTS Seventy patients received R-PCI and were included in the registry. PCI success rate was 100%, with 19% requiring manual assistance. No complications (MACE-major adverse cardiovascular events) occurred. Compared with 70 matched-pair M-PCI patients, there was a higher median procedural time (103 min vs. 67 min, p < 0.001) and fluoroscopy time (18 min vs. 15 min, p = 0.002), and more contrast volume was used (180 ml vs. 160 ml, p = 0.041) in R-PCI vs. M-PCI patients. However, there was no significant difference of the dose-area product (4062 vs. 3242 cGycm2, p = 0.361). One year after the intervention, there was no difference in mortality, rehospitalisation, unscheduled PCI or target vessel failure. Health-related quality of life evaluation 6 and 12 months after the index procedure (NYHA, CCS, SAQ7 and EQ-5D-5L) was similar in both groups. CONCLUSION R-PCI is feasible and safe. Compared to M-PCI, index procedure success rate is high, safety profile is favourable, and manual assistance was required in only few cases. At 1-year follow-up results for R-PCI vs. M-PCI considering mortality, rehospitalisation, morbidity and target vessel failure were equal.
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Affiliation(s)
- Constantin von Zur Mühlen
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Marvin Jeuck
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Timo Heidt
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
- Max Grundig Klinik, Bühl, Germany
| | - Thomas Maulhardt
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Tau Hartikainen
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Dennis Wolf
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
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Elbasha K, Alotaibi S, Heyer H, Mankerious N, Toelg R, Geist V, Richardt G, Allali A. Predictors of long-term adverse outcomes after successful chronic total occlusion intervention: physiology or morphology? Clin Res Cardiol 2024; 113:977-986. [PMID: 37542021 DOI: 10.1007/s00392-023-02279-0] [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: 02/25/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and target-vessel SYNTAX score (tvSS) are novel indices used to assess lesion physiology and morphology in percutaneous coronary intervention (PCI). Their prognostic implication after successful recanalization of coronary chronic total occlusion (CTO) is unknown. OBJECTIVES To investigate the prognostic value of QFR measured immediately after successful CTO-recanalization in predicting vessel-oriented adverse events, and to compare it with the pre-procedural morphological tvSS. METHODS QFR was measured offline after successful CTO-PCIs in a single center. We grouped the patients according to a cut-off value of post-PCI QFR (0.91). The primary outcome was target-vessel failure (TVF) at 2 years. RESULTS Among 470 CTO lesions performed during the study period, 324 were eligible for QFR analysis (258 with QFR ≥ 0.91 and 66 with QFR < 0.91). The mean age of the study population was 68.3 ± 10.7 years. The low QFR group had a lower left ventricular ejection fraction (45.8 ± 13.9% vs. 49.8 ± 12.4%, p = 0.025) and a higher rate of atrial fibrillation (19.7% vs. 11.2%, p = 0.020). The mean tvSS was 12.8 ± 4.8, and it showed no significant difference in both groups (13.6 ± 5.1 vs. 12.6 ± 4.6, p = 0.122). Patients with low post-CTO QFR had a trend to develop more TVF at 2 years (21.2% vs. 12.4%, HR 1.74; 95% CI 0.93-3.25, p = 0.086). Low post-CTO QFR failed to predict 2-year TVF (aHR 1.67; 95% CI 0.85-3.29, p = 0.136), while pre-procedural tvSS was an independent predictor for 2-year TVF (aHR 1.06; 95% CI 1.01-1.13, p = 0.030). CONCLUSION We found a limited prognostic value of immediate physiological assessment using QFR after successful CTO intervention. Pre-procedure morphological characteristics of CTO lesions using tvSS can play a role in predicting long-term adverse events.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Sultan Alotaibi
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hajo Heyer
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken GmBH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
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Llerena-Velastegui J, Zumbana-Podaneva K, Velastegui-Zurita S, Mejia-Mora M, Perez-Tomassetti J, Cabrera-Cruz A, Haro-Arteaga P, de Jesus ACFS, Coelho PM, Sanahuja-Montiel C. Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials. Cardiol Res 2024; 15:153-168. [PMID: 38994227 PMCID: PMC11236347 DOI: 10.14740/cr1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/27/2024] [Indexed: 07/13/2024] Open
Abstract
Background Ischemic heart disease (IHD) is a major global health issue and a leading cause of death. This study compares the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the management of IHD, focusing on their impact on revascularization, myocardial infarction (MI), and post-procedural stroke. This study aimed to evaluate and compare the effectiveness of PCI and CABG in treating IHD based on an exhaustive literature review of the past 5 years, emphasizing recent advancements and outcomes in IHD management. Methods A comprehensive literature review analyzed 32 randomized controlled trials (RCTs) retrieved from databases such as PubMed, Cochrane Library, and Google Scholar. The study specifically assessed the incidences of revascularization, stroke, and MI in patients treated with either PCI or CABG. The comparison between CABG and PCI exclusively focused on lesions with a SYNTAX score exceeding 32. Results Our findings highlight CABG's significant efficacy over PCI in reducing revascularization and MI. The aggregated Mantel-Haenszel (M-H) value for revascularization was 1.85 (95% confidence interval (CI): 1.65 - 2.07), signifying CABG's advantage. Additionally, CABG demonstrated superior performance in diminishing MI occurrences (M-H = 2.71, 95% CI: 1.13 - 6.53). In contrast, PCI was more effective in reducing stroke (M-H = 0.80, 95% CI: 0.60 - 1.10). Conclusion The study confirms CABG's superiority in reducing revascularization and MI in IHD patients, highlighting PCI's effectiveness in reducing stroke risk. These findings underscore the importance of personalized treatment strategies in IHD management and emphasize the need for ongoing research and evidence-based guidelines to aid in treatment selection for IHD patients.
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Affiliation(s)
- Jordan Llerena-Velastegui
- Pontifical Catholic University of Ecuador, Medical School, Quito, Ecuador
- Center for Health Research in Latin America (CISeAL), Research Center, Quito, Ecuador
| | | | | | - Melany Mejia-Mora
- Pontifical Catholic University of Ecuador, Medical School, Quito, Ecuador
| | | | - Allison Cabrera-Cruz
- Catholic University of Santiago de Guayaquil, Medical School, Guayaquil, Ecuador
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Huang B, Han X, Huang Y, Chen D, Xie P, Chen S. Early predictors of severe left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction: A dual-center retrospective study. Ann Noninvasive Electrocardiol 2024; 29:e13120. [PMID: 38706219 PMCID: PMC11070634 DOI: 10.1111/anec.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/08/2023] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Early detection of patients concomitant with left main and/or three-vessel disease (LM/3VD) and high SYNTAX score (SS) is crucial for determining the most effective revascularization options regarding the use of antiplatelet medications and prognosis risk stratification. However, there is a lack of study for predictors of LM/3VD with SS in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to identify potential factors that could predict LM/3VD with high SS (SS > 22) in patients with NSTEMI. METHODS This dual-center retrospective study included a total of 481 patients diagnosed with NSTEMI who performed coronary angiography procedures. Clinical factors on admission were collected. The patients were divided into non-LM/3VD, Nonsevere LM/3VD (SS ≤ 22), and Severe LM/3VD (SS > 22) groups. To identify independent predictors, Univariate and logistic regression analyses were conducted on the clinical parameters. RESULTS A total of 481 patients were included, with an average age of 60.9 years and 75.9% being male. Among these patients, 108 individuals had severe LM/3VD. Based on the findings of a multivariate logistic regression analysis, the extent of ST-segment elevation observed in lead aVR (OR: 7.431, 95% CI: 3.862-14.301, p < .001) and age (OR: 1.050, 95% CI: 1.029-1.071, p < .001) were identified as independent predictors of severe LM/3VD. CONCLUSION This study indicated that the age of patients and the extent of ST-segment elevation observed in lead aVR on initial electrocardiogram were the independent predictive factors of LM/3VD with high SS in patients with NSTEMI.
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Affiliation(s)
- Bihan Huang
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Xueying Han
- Department of Intensive CareHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Yulian Huang
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Dongdong Chen
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Peiyi Xie
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Shaoyuan Chen
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
- Department of CardiologyThe 6th Affiliated Hospital of Shenzhen University Medical SchoolShenzhenChina
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Brandt V, Fischer A, Schoepf UJ, Bekeredjian R, Tesche C, Aquino GJ, O'Doherty J, Sharma P, Gülsün MA, Klein P, Ali A, Few WE, Emrich T, Varga-Szemes A, Decker JA. Deep Learning-Based Automated Labeling of Coronary Segments for Structured Reporting of Coronary Computed Tomography Angiography in Accordance With Society of Cardiovascular Computed Tomography Guidelines. J Thorac Imaging 2024; 39:93-100. [PMID: 37889562 DOI: 10.1097/rti.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE To evaluate a novel deep learning (DL)-based automated coronary labeling approach for structured reporting of coronary artery disease according to the guidelines of the Society of Cardiovascular Computed Tomography (CT) on coronary CT angiography (CCTA). PATIENTS AND METHODS A retrospective cohort of 104 patients (60.3 ± 10.7 y, 61% males) who had undergone prospectively electrocardiogram-synchronized CCTA were included. Coronary centerlines were automatically extracted, labeled, and validated by 2 expert readers according to Society of Cardiovascular CT guidelines. The DL algorithm was trained on 706 radiologist-annotated cases for the task of automatically labeling coronary artery centerlines. The architecture leverages tree-structured long short-term memory recurrent neural networks to capture the full topological information of the coronary trees by using a two-step approach: a bottom-up encoding step, followed by a top-down decoding step. The first module encodes each sub-tree into fixed-sized vector representations. The decoding module then selectively attends to the aggregated global context to perform the local assignation of labels. To assess the performance of the software, percentage overlap was calculated between the labels of the algorithm and the expert readers. RESULTS A total number of 1491 segments were identified. The artificial intelligence-based software approach yielded an average overlap of 94.4% compared with the expert readers' labels ranging from 87.1% for the posterior descending artery of the right coronary artery to 100% for the proximal segment of the right coronary artery. The average computational time was 0.5 seconds per case. The interreader overlap was 96.6%. CONCLUSIONS The presented fully automated DL-based coronary artery labeling algorithm provides fast and precise labeling of the coronary artery segments bearing the potential to improve automated structured reporting for CCTA.
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Affiliation(s)
- Verena Brandt
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart
- Department of Cardiology, German Heart Centre Munich
| | - Andreas Fischer
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Cardiology, Clinic Augustinum Munich
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich
| | - Gilberto J Aquino
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Jim O'Doherty
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Siemens Medical Solutions USA, Siemens Healthineers, Malvern, PA
| | - Puneet Sharma
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Mehmet A Gülsün
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Paul Klein
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Asik Ali
- Department of Digital Technology and Innovation, Siemens Healthineers, Bangalore, KA, India
| | - William Evans Few
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Gohannes Gutenberg University Mainz, Mainz
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Josua A Decker
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
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Satheesh S, Kumar R, Pillai AA, Selvaraj R, Nair S, Priya D. Prognostic values of SYNTAX score II in patients with coronary artery disease undergoing percutaneous coronary intervention - Cohort study. Indian Heart J 2024; 76:108-112. [PMID: 38452813 PMCID: PMC11143506 DOI: 10.1016/j.ihj.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 01/30/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The data on prognostic values of SYNTAX score II in patients undergoing percutaneous coronary intervention is limited. We report predictive utility of SYNTAX score II in relation to in hospital and 1 year mortality of the patients undergoing percutaneous coronary intervention. METHODS This was a cohort study of patients who underwent percutaneous coronary intervention (PCI) at a single centre from January 2018 to December 2019. In hospital and 12-month events and mortality was analysed among 1000 patients. The patients were divided into 3 groups based on tertiles of Syntax II score (<22, 22-27.7 and >27.7). RESULT The total mortality at 12 months was 60 (6%). Major adverse cardiac events (MACE) occurred in 87 (9%). The patients who died had higher SYNTAX score II score compared to those alive at 12 months 34 (38, 24) vs 24 (28.1, 20.9) P < 0.01. The same trend was seen in patients who had major adverse cardiac events (MACE) 28 (34, 24) vs 24 (28.6, 21) P < 0.01 Among the 3 groups of SYNTAX score II, in hospital mortality, all-cause mortality, cardiovascular death, myocardial infarction, unstable angina, revascularization and major adverse cardiac events (MACE) were higher in the third tertile (>27.7) compared the lower tertiles. CONCLUSION The patients who had higher SYNTAX score II had more in hospital and 12 month mortality and major adverse cardiac events (MACE). SYNTAX II score is a better predictor of in-hospital, and 12 month cardiovascular and all cause mortality.
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Affiliation(s)
| | - Ritesh Kumar
- Department of Cardiology IGMC Shimla, Room No. 310, 3rd Floor, India.
| | | | - Raja Selvaraj
- Department of Cardiology, JIPMER, Puducherry, India.
| | | | - Dhivya Priya
- Department of Cardiology, JIPMER, Puducherry, India.
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Özderya A, Tekbil M, Ertürk N, Maz MA, Yerlikaya MG, Sayın MR. Comparison of coronary artery lesion complexity and body component parameters measured by TANITA. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:37-44. [PMID: 38616937 PMCID: PMC11008519 DOI: 10.5114/aic.2024.136905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Obesity is one of the main reversible causes of coronary artery disease. Aim To investigate the relationship between body component measurements calculated with TANITA and SYNTAX score (SXscore), which indicates coronary complexity. Material and methods 200 acute subendocardial myocardial infarction patients were included in our study. Body component measurements were made with the TANITA BC-601 device. After coronary angiography, patients were divided into two groups: high SXscore (≥ 22) and low-medium SXscore (< 22). Results When the high SXscore group (50 patients) was compared with the low medium SXscore group (150 patients); for waist height ratio (p = 0.001), total fat weight (p = 0.001), total fat percentage (p = 0.006), total water percentage (p = 0.001), trunk fat percentage (p = 0.001), internal fat (p = 0.001) and metabolic age (p < 0.001), a statistical difference was found. In the correlation analysis, a correlation was detected between high SXscore and the waist height ratio (p = 0.042), trunk fat percentage (p = 0.047), internal fat (p < 0.001) and metabolic age (p = 0.009). ROC curve analysis for prediction of high SXscore detection; the cut-off value for internal fat and metabolic age was found to be 13.5-60.5 with 60-64% sensitivity and 61.3-62.7% specificity. Conclusions We demonstrated the relationship between parameters such as internal fat, trunk fat percentage and metabolic age calculated by TANITA and SXscore, which is the coronary complexity score. We recommend that patients with high values detected during TANITA measurements be followed more carefully in terms of primary preventive medicine.
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Affiliation(s)
- Ahmet Özderya
- Department of Cardiology, Trabzon Kanuni Training and Research Hospital Cardiology Clinic, Trabzon, Turkey
| | - Muhammed Tekbil
- Department of Cardiology, University of Health Sciences Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Nurel Ertürk
- Department of Physiotherapy and Rehabilitation, Tarsus University, Mersin, Turkey
| | - Mehmet A. Maz
- Department of Cardiology, University of Health Sciences Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Murat G. Yerlikaya
- Department of Cardiology, University of Health Sciences Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Muhammet R. Sayın
- Department of Cardiology, University of Health Sciences Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
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Khameneh Bagheri R, Mousavi SH, Mehrad‐Majd H, Jamili MJ, Nasimi Shad A, Baradaran Rahimi V. Evaluating the association between opium abuse, blood lead levels, and the complexity of coronary artery disease. Physiol Rep 2024; 12:e15975. [PMID: 38480374 PMCID: PMC10937294 DOI: 10.14814/phy2.15975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/02/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
Opium abuse and exposure to heavy metals elevate the risk of coronary artery disease (CAD). Therefore, we aimed to determine the association between opium abuse and blood lead levels (BLLs) and the CAD complexity. We evaluated patients with acute coronary symptoms who underwent coronary angiography, and those with >50% stenosis in at least one of the coronary arteries were included. Furthermore, Synergy between PCI with Taxus and Cardiac Surgery I (SYNTAX I) score and BLLs were measured. Based on the opium abuse, 95 patients were subdivided into opium (45) and control (50) groups. Differences in demographics and CAD risk factors were insignificant between the two groups. The median BLLs were remarkably higher in the opium group than in controls (36 (35.7) and 20.5 μg/dL (11.45), respectively, p = 0.003). We also revealed no significant differences in SYNTAX score between the two groups (15.0 (9.0) and 17.5 (14.0), respectively, p = 0.28). Additionally, we found no significant correlation between BLLs and the SYNTAX scores (p = 0.277 and r = -0.113). Opium abuse was associated with high BLLs. Neither opium abuse nor high BLLs were correlated with the complexity of CAD. Further studies are warranted to establish better the relationship between opium abuse, BLLs, and CAD.
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Affiliation(s)
- Ramin Khameneh Bagheri
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Seyed Hadi Mousavi
- Medical Toxicology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Hassan Mehrad‐Majd
- Clinical Research Development Unit, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Mohammad Javad Jamili
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Arya Nasimi Shad
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Pharmacological Research Center of Medicinal PlantsMashhad University of Medical SciencesMashhadIran
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10
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Ajagbe T, Bello O, Fagbemi O, Ungvari T. Impella-Driven High-Risk Percutaneous Coronary Intervention: A Novel, Single Non-Surgical-Centre Case Report. Cureus 2023; 15:e49128. [PMID: 38125232 PMCID: PMC10732543 DOI: 10.7759/cureus.49128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Complex percutaneous coronary intervention (PCI) procedures have been routinely performed in non-surgical centres in the UK for more than two decades. These procedures follow strict guidelines and recommendations by the British Cardiovascular Intervention Society to ensure a more effective running of PCI programs. Even more so, expected guiding principles necessary for the safe optimisation of complex PCI procedures have also been created. An 81-year-old male was admitted with non-ST-elevation myocardial infarction (NSTEMI) and severely impaired left ventricle ejection fraction (LVEF; 26% according to the cardiac MRI report). Angiogram findings revealed severe multiple-vessel coronary artery disease affecting the following arteries: right coronary artery (RCA), left anterior descending artery (LAD), left circumflex artery (LCx), and intermediate artery (IM). There was also severe disease in the distal left main stem (LMS) bifurcation extending to the ostia of the LAD, LCx, and IM branches. Following a multidisciplinary meeting, the patient underwent Impella-supported high-risk PCI (complex PCI) using the DK crush technique with no peri- and post-procedure complication and a significant LV function improvement (45-49%). This is the first known case of this procedure performed at the Royal Cornwall Hospital in Treliske (RCHT), Truro, Cornwall. This case report highlights that when the decision to choose between coronary artery bypass graft (CABG) and PCI is not straightforward following an individualised risk-stratification scoring system analysis and in the setting of patient comorbidities, a high-risk PCI supported with the Impella device is a suitable alternative with promising short-term and long-term outcomes.
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Affiliation(s)
| | - Olamide Bello
- Haematology, Somerset NHS Foundation Trust, Taunton, GBR
| | - Ona Fagbemi
- General Surgery, University Hospital North Midlands Stoke, Stoke-on-Trent, GBR
| | - Tamas Ungvari
- Cardiology, Royal Cornwall Hospital Treliske, Truro, GBR
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11
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Samir A, Almahjori M, Zarif B, Elshinawi M, Yehia H, Elhafy M, Shehata A, Farrag A. Characterization of features and outcomes of young patients (< 45 years) presenting with ST-segment elevation myocardial infarction. Egypt Heart J 2023; 75:32. [PMID: 37097520 PMCID: PMC10127970 DOI: 10.1186/s43044-023-00357-2] [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: 12/05/2022] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the commonest cause of death worldwide. ST-segment elevation myocardial infarction (STEMI) and its consequences can be devastating particularly at younger age for a bigger impact on the patient's psychology and ability to work. Little is known about the differential features and outcomes of young STEMI patients in Egypt. This study characterized young STEMI patients (≤ 45 years) compared to patients > 45 years and evaluated 1-year outcomes. RESULTS A total of 492 eligible STEMI patients who presented to the National Heart Institute and Cairo University Hospitals were recruited. Young STEMI patients (< 45 years old) represented 20% of all STEMI comers. Male gender was predominant in both groups, yet with a significantly higher proportion in the younger compared to older patients (87% vs. 73%, p = 0.004). Compared to older patients, young STEMI patients had characteristically higher rates of smoking (72.4% vs. 49.7%, p < 0.001) and family history (13.3% vs. 4.8%, p = 0.002), while significantly lower rate of other conventional CAD risk factors as diabetes, hypertension, and dyslipidemia (20.4% vs. 44.7%, 20.4% vs. 44.9% and 12.7% vs. 21.8%, respectively, p < 0.05 for all). Follow-up was continued for at least 12 months after the index event. Younger STEMI patients had fewer major adverse cardiovascular events and fewer heart failure hospitalizations compared to the older controls (10.2 vs. 23.9% and 18.4% vs. 34.8%, respectively, p < 0.005 for both), however, 1-year mortality was similar (3.1% vs. 4.1%, p = 0.64). CONCLUSIONS Younger STEMI patients (≤ 45 years) show peculiar characteristics, with significantly higher rates of smoking and family history of premature CAD, while less prevalence of other conventional CAD risk factors. Overall MACE occurred less in younger STEMI patients; however, the mortality rate was similar to the older controls.
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Affiliation(s)
- Ahmad Samir
- Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | | | | | - Hesham Yehia
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Azza Farrag
- Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Li L, Sun G, Yu J, Shan G, Su L, Dong G. Identification of predictors for the comprehensive clinical risk and severity of coronary lesions of acute coronary syndrome. Front Cardiovasc Med 2023; 10:1046895. [PMID: 37089882 PMCID: PMC10117978 DOI: 10.3389/fcvm.2023.1046895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundAcute coronary syndrome (ACS) is the most common cause of death in patients with coronary artery disease. The aim of the study was to identify the predictors of both comprehensive clinical risk and severity of coronary lesions by comprehensive use of GRACE and SYNTAX scores in patients with ACS.MethodsClinical data of 225 ACS patients who underwent coronary angiography between 2015 and 2016 were collected. Multiple logistic regression analysis (stepwise) was used to identify the predictors. The predictive ability of predictors and the model were determined using receiver operating characteristics analyses.ResultsMultivariable logistic regression analyses showed that high aspartate aminotransferase (AST) predicted the comprehensive clinical risk with odds ratios (ORs) and 95% confidence intervals (CIs) of 1.011 (1.002–1.021). High total cholesterol (TC) and red blood cell distribution width (RDW) predicted the severity of coronary lesions with ORs and 95% CIs of 1.517 (1.148–2.004) and 1.556 (1.195–2.028), respectively. Low prealbumin predicted both severity of coronary lesions and comprehensive clinical risk of ACS patients with ORs and 95% CIs of 0.743 (0.672–0.821) and 0.836 (0.769–0.909), respectively. The model with a combination of prealbumin and AST had the highest predictive efficacy for comprehensive clinical risk, and the combination of prealbumin, TC, and RDW had the highest predictive efficacy for the severity of coronary lesions. The sensitivity and specificity, and the optimal cut-off values of these four indexes were determined.ConclusionsFour predictors for the comprehensive clinical risk and severity of coronary lesions of ACS were identified, which provided important information for the early diagnosis and appropriate treatment of ACS.
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Affiliation(s)
- Lihui Li
- Department of Cardiovascular, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guangfeng Sun
- Department of Emergency, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Jiangbo Yu
- Department of Cardiovascular, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gaojun Shan
- Department of Cardiovascular, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lide Su
- Department of Cardiovascular, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guo Dong
- Department of Cardiovascular, First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Guo Dong
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13
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Nabati M, Golshani S, Taghavi M, Alipour A, Parsaee H. The association between tissue doppler-derived E/(e's') ratio and coronary atherosclerosis severity measured by the SYNTAX score in patients with non-ST elevation-acute coronary syndrome. BMC Cardiovasc Disord 2023; 23:98. [PMID: 36809994 PMCID: PMC9945393 DOI: 10.1186/s12872-023-03128-8] [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: 11/10/2022] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The prognosis of patients hospitalized with non-ST elevation-acute coronary syndrome (NSTE-ACS) is typically determined by the existence and severity of myocardial necrosis and left ventricular (LV) remodeling. AIM The present study was to assess the association between the E/(e's') ratio and the coronary atherosclerosis severity, measured by the SYNTAX score, in patients with NSTE-ACS. METHODS Utilizing a descriptive correlational research design, this study was prospectively conducted on 252 patients with NSTE-ACS, undergoing an echocardiography to determine the left ventricular ejection fraction (LVEF), the left atrial (LA) volume, the pulsed-wave (PW) Doppler-derived transmitral early (E) and late (A) diastolic velocities, and the tissue Doppler (TD)-derived mitral annular early diastolic (e') and peak systolic (s') velocities. After that, a coronary angiography (CAG) was performed, and the SYNTAX score was calculated. RESULTS The patients were divided into two groups, viz., those with the E/(e's') ratio < 1.63 and the cases with the ratio ≥ 1.63. The results revealed that the patients with a high ratio were older, had a higher prevalence of females, a SYNTAX score ≥ 22, and a lower glomerular filtration rate than those with a low ratio (p-value < 0.001). Besides, these patients had larger indexed LA volume and lower LVEF than others (p-value: 0.028 and 0.023, respectively). Furthermore, the multiple linear regression outcomes established a positive independent association between the E/(e's') ratio ≥ 1.63 (B = 5.609, 95% CI 2.324-8.894, p-value = 0.001) and the SYNTAX score. CONCLUSION The study results demonstrated that the patients hospitalized with NSTE-ACS and the E/(e's') ratio ≥ 1.63 had worse demographic, echocardiographic, and laboratory profiles and a higher prevalence of a SYNTAX score ≥ 22 than those with a lower ratio.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Samad Golshani
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Taghavi
- Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Community Medicine Department, Medical Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homa Parsaee
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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14
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Nabati M, Golshani S, Rahmani M, Yazdani J, Parsaee H. The Association Between Postsystolic Index and SYNTAX Score in Hospitalized Patients With Non-ST-Elevation Acute Coronary Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2023. [DOI: 10.1177/87564793231153656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: Non-ST-elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous disorder including subgroups with a low or high risk for myocardial ischemia. The presence of postsystolic index (PSI) is associated with myocardial ischemia. The focus of this study was to find probable association between PSI and severity of coronary artery disease (CAD) in a cohort of patients. Materials and Methods: This was a cross-sectional study that consisted of 83 patients with unstable angina, non-ST-segment myocardial infarction (UA/NSTEMI), and a left ventricular ejection fraction ≥50%, without visible regional wall motion abnormalities. All patients underwent echocardiography, and global longitudinal strain (GLS), PSI, and mitral annular peak systolic (s′) and early diastolic (e′) velocities were measured. Coronary angiography was then performed, and a SYNTAX score was calculated. Results: The patient cohort was divided into two groups based on their high and low SYNTAX scores. PSI and GLS were higher in those patients with a higher SYNTAX score than in individuals with a lower score (85.04% ± 67.02% vs 46.67 ± 39.03, P = .001 and −16.09 ± 3.70 vs −17.99 ± 2.87, P = .012, respectively). Among the different variables assessed, only PSI was an independent predictor of a high SYNTAX score ( B = 1.014, 95% confidence interval [CI]: 1.001–1.027, P = .034). Conclusion: This cohort study demonstrated that a cumulative PSI may be predictive of much more complex and extensive CAD, especially in patients with UA/NSTEMI.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Fatemeh Zahra Teaching Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samad Golshani
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Fatemeh Zahra Teaching Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Rahmani
- Student Research Committee, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani
- Department of Biostatics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homa Parsaee
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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15
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Chen X, Wu H, Li L, Zhao X, Zhang C, Wang WE. The prognostic utility of GRACE risk score in predictive adverse cardiovascular outcomes in patients with NSTEMI and multivessel disease. BMC Cardiovasc Disord 2022; 22:568. [PMID: 36572851 PMCID: PMC9791745 DOI: 10.1186/s12872-022-03025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND GRACE risk score models are capable of predicting all-cause mortality of non-ST elevation myocardial infarction (NSTEMI) patients. However, its utility for evaluating major adverse cardiovascular events (MACE) in NSTEMI patients with multivessel disease (MVD) remains unclear. METHODS AND RESULTS This study was designed as a retrospective cohort study that recruited patients with NSTEMI and multivessel disease between September 2013 and December 2018 in Daping Hospital, Chongqing, China. The primary outcome was a composite outcome that included all-cause mortality, recurrent angina, non-fatal myocardial infarction, coronary re-vascularization, and non-fatal strokes. Of the 827 patients with NSTEMI, 32 did not complete follow-up and 430 were excluded because of single-vessel disease. The remaining 365 NSTEMI patients with MVD had a median follow-up of 3.0 (IQR 2.6-3.3) years, 78 patients experienced outcomes. The GRACE risk score predicted the MACE (hazard ratio 1.014, 95% CI 1.006-1.021, P < 0.001). The GRACE risk score performed well in predicting all-cause mortality (c-statistic 0.72, 95% CI 0.59-0.85, P = 0.001) in MVD but was less powerful in predicting MACE (c-statistic 0.69, 95% CI 0.62-0.75, P < 0.001). When combining the GRACE risk score with the SYNTAX score, and blood urea nitrogen for predicting all-cause mortality and MACE events, the c-statistic value increased to 0.82 and 0.81 (P < 0.001). CONCLUSION In NSTEMI patients with MVD, the GRACE score showed an acceptable predictive value for all-cause mortality, but it was less powerful in predicting MACE. Blood urea nitrogen may be valuable in assessing long-term cardiovascular events in patients with MVD.
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Affiliation(s)
- Xiaokang Chen
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China ,Department of Cardiology, Santai County People’s Hospital (Affiliated Hospital of North Sichuan Medical College in Santai County), Mianyang, 621100 China
| | - Hao Wu
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Liangpeng Li
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Xiaofang Zhao
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Chao Zhang
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
| | - Wei Eric Wang
- grid.410570.70000 0004 1760 6682Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University), 10 Changjiang Branch Road, Chongqing, 400042 China
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16
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Lin MC, Tseng VS, Lin CS, Chiu SW, Pan LK, Pan LF. Quantitative Prediction of SYNTAX Score for Cardiovascular Artery Disease Patients via the Inverse Problem Algorithm Technique as Artificial Intelligence Assessment in Diagnostics. Diagnostics (Basel) 2022; 12:diagnostics12123180. [PMID: 36553187 PMCID: PMC9777487 DOI: 10.3390/diagnostics12123180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The quantitative prediction of the SYNTAX score for cardiovascular artery disease patients using the inverse problem algorithm (IPA) technique in artificial intelligence was explored in this study. A 29-term semi-empirical formula was defined according to seven risk factors: (1) age, (2) mean arterial pressure, (3) body surface area, (4) pre-prandial blood glucose, (5) low-density-lipoprotein cholesterol, (6) Troponin I, and (7) C-reactive protein. Then, the formula was computed via the STATISTICA 7.0 program to obtain a compromised solution for a 405-patient dataset with a specific loss function [actual-predicted]2 as low as 3.177, whereas 0.0 implies a 100% match between the prediction and observation via "the lower, the better" principle. The IPA technique first created a data matrix [405 × 29] from the included patients' data and then attempted to derive a compromised solution of the column matrix of 29-term coefficients [29 × 1]. The correlation coefficient, r2, of the regression line for the actual versus predicted SYNTAX score was 0.8958, showing a high coincidence among the dataset. The follow-up verification based on another 105 patients' data from the same group also had a high correlation coefficient of r2 = 0.8304. Nevertheless, the verified group's low derived average AT (agreement) (ATavg = 0.308 ± 0.193) also revealed a slight deviation between the theoretical prediction from the STATISTICA 7.0 program and the grades assigned by clinical cardiologists or interventionists. The predicted SYNTAX scores were compared with earlier reported findings based on a single-factor statistical analysis or scanned images obtained by sonography or cardiac catheterization. Cardiologists can obtain the SYNTAX score from the semi-empirical formula for an instant referral before performing a cardiac examination.
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Affiliation(s)
- Meng-Chiung Lin
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 10041, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 40044, Taiwan
| | - Vincent S. Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu 10041, Taiwan
| | - Chih-Sheng Lin
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of the Nanjing Medical University, Nanjing 210000, China
| | - Shao-Wen Chiu
- Department of Pet Business Management, Taipei University of Marine Technology, Taipei 10001, Taiwan
| | - Lung-Kwang Pan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung 40044, Taiwan
| | - Lung-Fa Pan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung 40044, Taiwan
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 40044, Taiwan
- Correspondence:
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17
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Bouzid F, Gtif I, Alfadhli S, Charfeddine S, Ghorbel W, Abdelhédi R, Benmarzoug R, Abid L, Bouayed Abdelmoula N, Elloumi I, Masmoudi S, Rebai A, Kharrat N. A potential oral microbiome signature associated with coronary artery disease in Tunisia. Biosci Rep 2022; 42:BSR20220583. [PMID: 35695679 PMCID: PMC9251586 DOI: 10.1042/bsr20220583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
The coronary artery disease (CAD) is a chronic inflammatory disease involving genetic as well as environmental factors. Recent evidence suggests that the oral microbiome has a significant role in triggering atherosclerosis. The present study assessed the oral microbiome composition variation between coronary patients and healthy subjects in order to identify a potential pathogenic signature associated with CAD. We performed metagenomic profiling of salivary microbiomes by 16S ribosomal RNA (rRNA) next-generation sequencing. Oral microbiota profiling was performed for 30 individuals including 20 patients with CAD and ten healthy individuals without carotid plaques or previous stroke or myocardial infarction. We found that oral microbial communities in patients and healthy controls are represented by similar global core oral microbiome. The predominant taxa belonged to Firmicutes (genus Streptococcus, Veillonella, Granulicatella, Selenomonas), Proteobacteria (genus Neisseria, Haemophilus), Actinobacteria (genus Rothia), Bacteroidetes (genus Prevotella, Porphyromonas), and Fusobacteria (genus Fusobacterium, Leptotrichia). More than 60% relative abundance of each sample for both CAD patients and controls is represented by three major genera including Streptococcus (24.97 and 26.33%), Veillonella (21.43 and 19.91%), and Neisseria (14.23 and 15.33%). Using penalized regression analysis, the bacterial genus Eikenella was involved as the major discriminant genus for both status and Syntax score of CAD. We also reported a significant negative correlation between Syntax score and Eikenella abundance in coronary patients' group (Spearman rho = -0.68, P=0.00094). In conclusion, the abundance of Eikenella in oral coronary patient samples compared with controls could be a prominent pathological indicator for the development of CAD.
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Affiliation(s)
- Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Suad Alfadhli
- Department of Medical Laboratory, Faculty of Allied Health, Kuwait University, Sulaibekhat 90805, State of Kuwait
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Walid Ghorbel
- Department of Dentistry, Hédi Chaker University Hospital, Faculty of Dental Medicine of Monastir, University of Monastir, Tunisia
| | - Rania Abdelhédi
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Riadh Benmarzoug
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia
| | - Nouha Bouayed Abdelmoula
- Department of Histology: UR17ES36 Genomics of Signalopathies in the Service of Medicine, University of Sfax, Tunisia
| | - Inés Elloumi
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Saber Masmoudi
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Ahmed Rebai
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
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18
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Soh RYH, Sia CH, Djohan AH, Lau RH, Ho PY, Neo JWH, Ho JSY, Sim HW, Yeo TC, Tan HC, Chan MYY, Loh JPY. Clinical Characteristics and Long-Term Outcomes of Patients With Differing Haemoglobin Levels Undergoing Semi-Urgent and Elective Percutaneous Coronary Intervention in an Asian Population. Front Cardiovasc Med 2022; 9:687555. [PMID: 35369342 PMCID: PMC8971291 DOI: 10.3389/fcvm.2022.687555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to investigate the impact of anaemia on long-term clinical outcomes in patients who underwent semi-urgent and elective percutaneous coronary intervention (PCI) in an Asian population. Although the effects of anaemia on outcomes in Asian patients are well studied for acute coronary syndrome, its impact on Asian patients undergoing semi-urgent and elective PCI is unclear. Methods This was a retrospective cohort study of patients who underwent semi-urgent and elective PCI from January 1, 2014, to December 31, 2015, at a tertiary academic centre. A total of 1,685 patients were included. They were stratified into three groups: normal (≥12 g/dL), intermediate (10–11.9 g/dL), and low (<10 g/dL) haemoglobin levels. Demographics, risk factors, and end-points including the 5-point major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation), cardiovascular death, and bleeding events were analysed. Results Patients in intermediate and low haemoglobin level groups were older with more comorbidities. Compared to the normal haemoglobin level group, low haemoglobin level group patients were associated with an increased risk of composite endpoints of all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation [adjusted hazard ratio (aHR) 1.89, 95% confidence interval (CI):1.22, 2.92; p = 0.004]. This was driven by the increased risk of target lesions revascularisation observed in the low haemoglobin level group compared to the normal haemoglobin level group (aHR 17.74, 95% CI: 1.74, 180.80; p = 0.015). The patients in the low haemoglobin level group were also associated with a higher risk of bleeding events compared to the normal haemoglobin level group (aHR 7.18, 95% CI: 1.13, 45.40; p = 0.036). Conclusion In our Asian cohort, patients with anaemia undergoing PCI were associated with a higher comorbid burden. Despite adjustments for comorbidities, these patients had higher mortality and worse cardiovascular outcomes following contemporary PCI.
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Affiliation(s)
- Rodney Yu-Hang Soh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
- *Correspondence: Ching-Hui Sia,
| | | | - Rui-Huai Lau
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Pei-Ying Ho
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jonathan Wen-Hui Neo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Jamie Sin-Ying Ho
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hui-Wen Sim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Joshua Ping-Yun Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
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Deda O, Panteris E, Meikopoulos T, Begou O, Mouskeftara T, Karagiannidis E, Papazoglou AS, Sianos G, Theodoridis G, Gika H. Correlation of Serum Acylcarnitines with Clinical Presentation and Severity of Coronary Artery Disease. Biomolecules 2022; 12:biom12030354. [PMID: 35327546 PMCID: PMC8945505 DOI: 10.3390/biom12030354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/23/2022] Open
Abstract
Recent studies support that acylcarnitines exert a significant role in cardiovascular disease development and progression. The aim of this metabolomics-based study was to investigate the association of serum acylcarnitine levels with coronary artery disease (CAD) severity, as assessed via SYNTAX Score. Within the context of the prospective CorLipid trial (NCT04580173), the levels of 13 circulating acylcarnitines were accurately determined through a newly developed HILIC-MS/MS method in 958 patients undergoing coronary angiography in the AHEPA University Hospital of Thessaloniki, Greece. Patients presenting with acute coronary syndrome had significantly lower median acylcarnitine C8, C10, C16, C18:1 and C18:2 values, compared to patients with chronic coronary syndrome (p = 0.012, 0.007, 0.018, 0.011 and <0.001, respectively). Among CAD subgroups, median C5 levels were significantly decreased in unstable angina compared to STEMI (p = 0.026), while median C10, C16, C18:1 and C18:2 levels were higher in stable angina compared to STEMI (p = 0.019 p = 0.012, p = 0.013 and p < 0.001, respectively). Moreover, median C2, C3, C4 and C8 levels were significantly elevated in patients with diabetes mellitus (p < 0.001, <0.001, 0.029 and 0.011, respectively). Moreover, short-chain acylcarnitine C2, C4, C5 and C6 levels were elevated in patients with heavier calcification and lower left ventricular ejection fraction (LVEF) % (all p-values less than 0.05). With regard to CAD severity, median C4 and C5 levels were elevated and C16 and C18:2 levels were reduced in the high CAD complexity group with SYNTAX Score > 22 (p = 0.002, 0.024, 0.044 and 0.012, respectively), indicating a potential prognostic capability of those metabolites and of the ratio C4/C18:2 for the prediction of CAD severity. In conclusion, serum acylcarnitines could serve as clinically useful biomarkers leading to a more individualized management of patients with CAD, once further clinically oriented metabolomics-based studies provide similar evidence.
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Affiliation(s)
- Olga Deda
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
- Correspondence: (O.D.); (E.P.); (H.G.)
| | - Eleftherios Panteris
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
- Correspondence: (O.D.); (E.P.); (H.G.)
| | - Thomas Meikopoulos
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Olga Begou
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Thomai Mouskeftara
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (G.S.)
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (G.S.)
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (E.K.); (A.S.P.); (G.S.)
| | - Georgios Theodoridis
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Helen Gika
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Biomic_AUTh, CIRI-AUTH Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (T.M.); (O.B.); (G.T.)
- Correspondence: (O.D.); (E.P.); (H.G.)
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Mo Y, Xing B. Correlation between coronary CTA -SYNTAX score and invasive coronary angiography -SYNTAX score. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:884-888. [PMID: 34565734 PMCID: PMC10929964 DOI: 10.11817/j.issn.1672-7347.2021.200837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/03/2022]
Abstract
It is important to evaluate the complex coronary artery disease in the diagnosis and treatment of coronary heart disease.The SYNTAX score based on invasive coronary angiography (ICA) (also referred to as ICA-SYNTAX score) plays a positive role in the selection of revascularization of complex coronary artery disease and the prediction of adverse events.The development of coronary computed tomography angiography (CCTA) technology promotes the clinical application of SYNTAX score (CCTA-SYNTAX score) based on coronary CTA, and also enriches the examination methods of patients with coronary heart disease. The CCTA-SYNTAX score has the advantages of non-invasiveness, simple operation, good reproducibility, and relatively low cost, which can make it play an increasingly important role in the diagnosis of coronary heart disease. A number of foreign studies have confirmed that CCTA-SYNTAX score is highly correlated with ICA-SYNTAX score, which further promotes the study of CCTA-SYNTAX score in revascularization of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and adverse event prediction.Therefore, the CCTA-SYNTAX score can be an auxiliary method for the ICA-SYNTAX score, as the first choice for preoperative evaluation and postoperative review of patients with coronary heart disease.
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Affiliation(s)
- Ye Mo
- Department of Cardiology, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou 570100, China.
| | - Bo Xing
- Department of Cardiology, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou 570100, China.
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El-Hadidy A, Ali M, Adel Gawish M, Moharram A, Taema K. One-year Outcome of Different Unprotected Left Main Percutaneous Coronary Interventions Techniques in Acute Coronary Syndromes. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: We intended in this study to evaluate the impact of the different techniques of unprotected left main coronary artery (ULMCA) stenting on the clinical outcomes.
Methods: The study included 65 patients with ACS and left main disease subjected to UPLMCA intervention [46 males (70.8%) with median(Q1-Q3) age of 63(53-70) years old] in an observational prospective cohort study. Data were collected through reviewing patient’s medical records and angiographic procedures. Angiographic assessment included evaluation of Syntax II score, EURO II score, and TIMI flow grading. The primary outcome was the major adverse cardiac and cerebral events (MACCE) at 1 year while the secondary outcomes included the development of acute kidney injury (AKI), one year mortality, and need for CABG post PCI.
Results: One-year MACCE was 46.2 % when the angle between LAD and LCX was>70o compared to 81.5% when it was less than 70o (P=0.008). The wide angle was also associated with 0% 1-year mortality compared to 18.5% for narrow angle, a difference which is statistically significant (P=0.03). The 1-year MACCE was 35.7% compared to 74.4% when it was not used (P=0.013). When POT was used, the 1-year MACCE was 47.6% compared to 75% when it was not used (P=0.041). None of the other studied parameters including those related to procedure technique was significantly affecting the outcome in our study.
Conclusion: We concluded that the non-use of FKI nor POT together with the lower angulation between LAD and LCX could predict worse clinical outcome at one-year in unprotected left main PCI.
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22
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Quisi A, Alici G, Harbalioglu H, Genc O, Kurt IH, Cayli M. Association Between Morning Surge in Systolic Blood Pressure and SYNTAX Score I in Patients With Stable Coronary Artery Disease. Tex Heart Inst J 2021; 48:465915. [PMID: 34086955 DOI: 10.14503/thij-19-7092] [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: 11/23/2022]
Abstract
A high morning surge in systolic blood pressure poses a risk in people who have cardiovascular disease. We investigated the relationship between this phenomenon and the SYNTAX score I in patients who had stable coronary artery disease. Our single-center study included 125 consecutive patients (109 men and 16 women; mean age, 54.3 ± 9 yr) in whom coronary angiography revealed stable coronary artery disease. We calculated each patient's sleep-trough morning surge in systolic blood pressure, then calculated the SYNTAX score I. The morning surge was significantly higher in patients whose score was >22 (mean, 22.7 ± 13.2) than in those whose score was ≤22 (mean, 12.4 ± 7.5) (P <0.001). Forward stepwise logistic regression analysis revealed that morning surge in systolic blood pressure was the only independent predictor of an intermediate-to-high score (odds ratio=1.183; 95% CI, 1.025-1.364; P=0.021). To our knowledge, this is the first study to show an association between morning surge in systolic blood pressure and the SYNTAX score I in patients who have stable coronary artery disease.
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Affiliation(s)
- Alaa Quisi
- Department of Cardiology, Medline Adana Hospital, Adana, Turkey
| | - Gokhan Alici
- Department of Cardiology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Hazar Harbalioglu
- Department of Cardiology, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Omer Genc
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ibrahim Halil Kurt
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Murat Cayli
- Department of Cardiology, Medline Adana Hospital, Adana, Turkey
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Erdogan G, Yontar OC, Yenercag M, Gul S, Arslan U. Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction. J Electrocardiol 2020; 61:86-91. [PMID: 32554162 DOI: 10.1016/j.jelectrocard.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early risk stratification based on SYNTAX score plays a crucial role to identify the need for early invasive strategy in patients with NSTEMI. The predictive role of frontal QRS-T angle [f(QRS-T)] on the atherosclerotic burden of CAD is less clear in NSTEMI patients. In this study, we aimed to investigate the relationship between f(QRS-T) and SYNTAX score in NSTEMI patients. METHODS A total of consecutive 269 patients with the diagnosis of NSTEMI transferred to coronary care unit were included in the study. f(QRS-T) was calculated as the absolute value of the difference between the frontal plane QRS and T axes based on automatic report of ECG machine. Syntax score was computed using an online SYNTAX score calculator by well-experienced two cardiologists blinded to the study data. The study population was divided into two groups based on the SYNTAX score low SYNTAX score (≤23), and high SYNTAX score (>23). RESULTS Left ventricle ejection fraction (LVEF) (p = 0.001), hemoglobin (p = 0.03) and HDL-C (p = 0.04) levels were lower in the intermediate-high SYNTAX group. Age (72.1 ± 12.5 vs. 64.6 ± 9.4 respectively; p < 0.001), LAD as infarct-related artery 30 (%65.2) vs. 50 (%29.1) respectively; (p = 0.001), f(QRS-T) (100.5 ± 55.3 vs. 65.1 ± 53.1 respectively p = 0.006), troponin I peak (p = 0.06) were higher among patients with intermediate-high Syntax score. In receiver-operating characteristic (ROC) curve analysis, the value for f(QRS-T) to detect syntax score ≥ 23 with a sensitivity of 77% and specificity of 63% was 73,5° in NSTEMI patients(AUC = 0.69). Univariate logistic regression analysis identified that age, LVEF, HDL-C, hemoglobin, infarct-related artery, f(QRS-T) were significantly associated with SYNTAX score. Multivariate logistic regression analysis showed that age (OR: 1.135, 95% CI: 1.039-1.153, p = 0.045), infarct related artery-LAD (OR: 2.897, 95% CI: 1.023-8.209, p = 0.001) and f(QRS-T) (OR: 3.587, 95% CI: 1.093-11.772, p = 0.001) were the independent predictors of SYNTAX score. CONCLUSION In NSTEMI patients, f(QRS-T) has been found to be a useful decision-making tool to predict SYNTAX score to assess early invasive strategy.
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Affiliation(s)
- Guney Erdogan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Osman Can Yontar
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey.
| | - Mustafa Yenercag
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Sefa Gul
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Ugur Arslan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
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Jia S, Zhang C, Liu Y, Yuan D, Zhao X, Gao R, Yang Y, Xu B, Gao Z, Yuan J. Long-Term Clinical Outcomes for Non-ST Elevation Acute Coronary Syndrome Patients with High-Risk Angiographic Findings Undergoing Percutaneous Coronary Intervention. J Interv Cardiol 2020; 2020:2139617. [PMID: 32489330 PMCID: PMC7229566 DOI: 10.1155/2020/2139617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aim to evaluate the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with high-risk coronary anatomy (HRCA). BACKGROUND Coronary disease severity is important for therapeutic decision-making and prognostication among patients presenting with NSTE-ACS. However, long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with HRCA is still unknown. METHOD NSTE-ACS patients undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and subsequently divided into HRCA and low-risk coronary anatomy (LRCA) groups according to whether angiography complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal LAD lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year and 5-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. RESULTS Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to the HRCA group, while 1,232 patients belonged to the LRCA group. Compared with the LRCA group, patients in the HRCA group had worse baseline characteristics including higher age, more comorbidities, and worse angiographic findings. Patients in the HRCA group had higher incidence of unplanned revascularization (2 years: 9.7% vs. 5.1%, p < 0.001; 5 years: 15.4% vs. 10.3%, p < 0.001), 2-year MACCE (13.1% vs. 8.8%, p < 0.001), and 5-year death/MI/revascularization/stroke (23.0% vs. 18.4%, p = 0.001). Kaplan-Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of revascularization (2 years: HR = 1.636, 95% CI: 1.225-2.186; 5 years: HR = 1.460, 95% CI: 1.186-1.798), 2-year MACCE (HR = 1.275, 95% CI = 1.019-1.596) and 5-year death/MI/revascularization/stroke (HR = 1.183, 95% CI: 1.010-1.385). CONCLUSION In our large cohort of Chinese patients, HRCA is an independent risk factor for long-term unplanned revascularization and MACCE.
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Affiliation(s)
- Sida Jia
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Ce Zhang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Liu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Deshan Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xueyan Zhao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yuejin Yang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zhan Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jinqing Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Qanitha A, Uiterwaal CSPM, Henriques JPS, Mappangara I, Amir M, Saing SG, de Mol BAJM. Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes. Sci Rep 2019; 9:19163. [PMID: 31844078 PMCID: PMC6915772 DOI: 10.1038/s41598-019-55299-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/25/2019] [Indexed: 11/09/2022] Open
Abstract
In South-East Asian populations and particularly in Indonesia, access to coronary angiography (CAG) is limited. We aimed to assess the adherence for undergoing CAG for indicated patients, according to the guideline recommendations. We then examined whether this adherence would have an impact on patients' short- and medium-term mortality and morbidity. We consecutively enrolled 474 patients with acute and stable coronary artery disease who had indication for CAG at Makassar Cardiac Center, Indonesia from February 2013 to December 2014. We found that adherence to CAG recommendation in poor South-East Asian setting is low. Of 474 recommended patients, only 273 (57.6%) underwent the procedure. Factors for not undergoing CAG were: older age, female gender, low educational and socio-economic status, and insurance type. While reasons for patients refusing CAG and subsequent intervention included fear, symptoms reduction, and lack of trust concerning the procedure benefit. During follow-up (median 19 (IQR 6-39.3) months), 155 (32.7%) patients died, and 259 (54.6%) experienced at least one adverse event. Adherence to CAG recommendation was associated with a significantly lower short- and medium-term mortality, independent of revascularization and other potential confounders. In sub-group analysis, adhered patients "with revascularization" had significantly better outcomes compared to the "non-revascularization" and "not adhere" groups.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Sumarsono G Saing
- Makassar Cardiac Center, Catheterization Laboratory Unit, DR. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Rahmani R, Majidi B, Ariannejad H, Shafiee A. The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:514-517. [PMID: 31495747 DOI: 10.1016/j.carrev.2019.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/23/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND In patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), Global Registry for Acute Coronary Events (GRACE) score is a valid tool for risk stratification. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score is an angiographic scoring system to guide the decision-making between coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI). The aim of the present study was to assess the accuracy of the GRACE score in predicting the severity and extent of coronary artery stenosis by SYNTAX score. METHODS A total of 330 patients with acute coronary syndrome (ACS) were enrolled in the study. For every patient, the GRACE score was calculated. All patients underwent coronary angiography within 2 days and the SYNTAX scoring system was used to evaluate the severity and extent of coronary stenotic lesions. Based on ROC curve analysis, the cut-off value of GRACE score that could predict SYNTAX score ≥ 23 was calculated. RESULTS GRACE score was 107.12 ± 34.4 in patients with SYNTAX SCORE < 23 and 134.80 ± 48.3 in patients with SYNTAX score ≥ 23 (p value = 0.001). A positive correlation was observed between the GRACE score and angiographic SYNTAX score (r = 0.34 p < 0.001). We found that a GRACE score of 109 is the optimal cut-off to predict SYNTAX score ≥ 23 with a sensitivity of 73.5% and specificity of 60% (p < 0.001). Its negative predictive value was 94.0%. CONCLUSION GRACE score had significant but modest value to predict the severity and extent of coronary artery stenosis in patients with ACS.
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Affiliation(s)
- Reza Rahmani
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Babak Majidi
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ariannejad
- Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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Alidoosti M, Lotfi R, Lotfi-Tokaldany M, Nematipour E, Salarifar M, Poorhosseini H, Jalali A. Correlates of the "No-Reflow" or "Slow-Flow" Phenomenon in Patients Undergoing Primary Percutaneous Coronary Intervention. J Tehran Heart Cent 2018; 13:108-114. [PMID: 30745923 PMCID: PMC6368911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades: those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784, 95% CI: 0.742-0.826; P<0.001). Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.
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Affiliation(s)
- Mohammad Alidoosti
- Corresponding Author: Mohammad Alidoosti, Associate Professor in Cardiology, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: + 98 21 88089256. Fax: + 98 21 88089256..
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28
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Aghajani H, Alkamel A, Shafiee A, Jalali A, Nozari Y, Pourhosseini H, Kassaian SE, Salarifar M, Hajizeinali A, Amirzadegan A, Alidoosti M, Masoudkabir F, Nematipour E. Predictors of major adverse cardiac events following elective stenting of large coronary arteries. Indian Heart J 2018; 70:20-23. [PMID: 29455782 PMCID: PMC5902817 DOI: 10.1016/j.ihj.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/26/2017] [Accepted: 06/18/2017] [Indexed: 11/06/2022] Open
Abstract
Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
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Affiliation(s)
- Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdolhakim Alkamel
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Younes Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Gursoy M, Hokenek AF, Duygu E, Atay M, Yavuz A. Clinical SYNTAX Score Can Predict Acute Kidney Injury following On-Pump but Not Off-Pump Coronary Artery Bypass Surgery. Cardiorenal Med 2015; 5:297-305. [PMID: 26648946 DOI: 10.1159/000437394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/06/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The complexity of coronary artery disease is usually a neglected factor in risk stratification systems. We aimed to analyze the discriminative ability of the clinical SYNTAX score (CSS) for acute kidney injury (AKI) following on- and off-pump coronary artery surgery. METHODS A total of 193 patients were reviewed in this study. Patients were divided into two groups according to the surgical procedure (group I: off-pump coronary artery bypass grafting, n = 89; group II: on-pump coronary artery bypass grafting, n = 104). Preoperative demographic data, the CSS and postoperative renal functions were evaluated. The postoperative AKI classification was made using the RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) criteria. RESULTS Postoperative AKI occurred in 14 of 89 patients (15.7%) in group I and in 29 of 104 patients in group II (27.8%; p = 0.046). The CSS did not vary much between the groups (31.52 ± 13.08 vs. 29.89 ± 15.70; p = 0.638). In group I, the CSS was not different between patients with AKI and those without AKI (30.167 ± 3.93 vs. 31.91± 14.75; p = 0.78). In group II, the CSS was 36.85 ± 18.33 in patients with AKI and 28.02 ± 12.32 in those without, and the difference was significant (p = 0.02). The discriminative ability of the CSS for postoperative AKI using the AUC analysis was 0.500 in group I and 0.840 in group II. CONCLUSION The CSS may be a simple and successful means of risk prediction of postoperative AKI in on-pump coronary artery surgery.
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Affiliation(s)
- Mete Gursoy
- Department of Cardiovascular Surgery, Istanbul, Turkey
| | | | - Egemen Duygu
- Department of Cardiology, Acibadem International Hospital, Istanbul, Turkey
| | - Mehmet Atay
- Department of Cardiovascular Surgery, Karaman State Hospital, Karaman, Turkey
| | - Asuman Yavuz
- Department of Nephrology, Acibadem University, Istanbul, Turkey
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