1
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Medranda GA, Faraz HA, Thompson JB, Zhang Y, Bharadwaj AS, Osborn EA, Abu-Much A, Lansky AJ, Basir MB, Moses JW, O’Neill WW, Grines CL, Baron SJ. Association of Preprocedural SYNTAX Score With Outcomes in Impella-Assisted High-Risk Percutaneous Coronary Intervention. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101981. [PMID: 39166169 PMCID: PMC11330901 DOI: 10.1016/j.jscai.2024.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 08/22/2024]
Abstract
Background Patients with complex coronary artery disease, as defined by high SYNTAX scores, undergoing percutaneous coronary intervention (PCI) have poorer outcomes when compared with patients with lower SYNTAX I scores. This study aimed to assess if mechanical circulatory support using Impella mitigates the effect of the SYNTAX I score on outcomes after high-risk percutaneous coronary intervention (HRPCI). Methods Using data from the PROTECT III study, patients undergoing Impella-assisted HRPCI between March 2017 and March 2020 were divided into 3 cohorts based on SYNTAX I score-low (≤22), intermediate (23-32), and high (≥33). Procedural and clinical outcomes out to 90 days were compared between groups. Multivariable regression analysis was used to assess the impact of SYNTAX I score on major adverse cardiovascular and cerebrovascular events (MACCE) at 90 days. Results A total of 850 subjects with core laboratory-adjudicated SYNTAX I scores were identified (low: n = 310; intermediate: n = 256; high: n = 284). Patients with high SYNTAX I scores were older than those with low or intermediate SYNTAX I scores (72.7 vs 69.7 vs 70.1 years, respectively; P < .01). After adjustment for covariates, high SYNTAX I score remained a significant predictor of 90-day MACCE (hazard ratio [HR], 2.14; 95% CI, 1.42-3.69; P < .01 vs low), whereas intermediate SYNTAX I score was not (HR, 0.92; 95% CI, 0.47-1.77; P = .80 vs low). These findings persisted after adjustment for post-PCI SYNTAX I score. Conclusions A high SYNTAX I score was associated with higher rates of 90-day MACCE in patients who underwent Impella-assisted HRPCI. Further research is needed to understand the patient and procedural factors driving this finding.
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Affiliation(s)
| | - Haroon A. Faraz
- Interventional Cardiology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Julia B. Thompson
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Aditya S. Bharadwaj
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Eric A. Osborn
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Alexandra J. Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mir B. Basir
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey W. Moses
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- St. Francis Hospital & Heart Center, Roslyn, New York
| | | | - Cindy L. Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | - Suzanne J. Baron
- Interventional Cardiovascular Research, Massachusetts General Hospital, Boston, Massachusetts
- Baim Institute for Clinical Research, Boston, Massachusetts
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2
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Abramik J, Kontogiannis N, Scarsini R, De Maria GL, Raina T, Fragakis N, Kassimis G. Prognostic value of ΔSYNTAX% score in octogenarians undergoing percutaneous coronary intervention. J Geriatr Cardiol 2023; 20:509-515. [PMID: 37576482 PMCID: PMC10412537 DOI: 10.26599/1671-5411.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES To verify whether incomplete revascularisation (IR), quantified using the rSYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and ΔSYNTAX% score, could predict short- (in-hospital mortality) and long-term outcomes (12-month mortality) in octogenarians undergoing percutaneous coronary intervention (PCI). METHODS & RESULTS A retrospective analysis of 665 consecutive octogenarian patients presenting for PCI to a UK centre was performed. The baseline SYNTAX and rSYNTAX scores were assessed from angiographic images. ΔSYNTAX% score was calculated (ΔSYNTAX% = ((SYNTAX - rSYNTAX)/SYNTAX) × 100%)) to measure the relative completeness of revascularisation. Kaplan-Meier analysis assessed survival at 12 months by tertiles of rSYNTAX and ΔSYNTAX% scores. Increasing ΔSYNTAX% score was associated with reduced in-hospital mortality (P = 0.017), and improved survival benefit (log rank 14.8, P = 0.001) at 12 months. CONCLUSIONS Enhancing the completeness of revascularisation in octogenarians selected to undergo PCI is associated with a lower in-hospital mortality and a survival benefit at 12 months.
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Affiliation(s)
- Joanna Abramik
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Nestoras Kontogiannis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Roberto Scarsini
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Luigi De Maria
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Tushar Raina
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Nikolaos Fragakis
- Second Department of Cardiology, Hippokration Hospital, Medical School, Aristotle, University of Thessaloniki, Thessaloniki, Greece
| | - George Kassimis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
- Second Department of Cardiology, Hippokration Hospital, Medical School, Aristotle, University of Thessaloniki, Thessaloniki, Greece
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3
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Henry TD, Kereiakes DJ. QFR Facilitated Functional Lesion Assessment to Guide Revascularization: The Next Paradigm Shift? JACC Cardiovasc Interv 2022; 15:2503-2505. [PMID: 36543444 DOI: 10.1016/j.jcin.2022.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA; Christ Hospital Heart and Vascular Institute, the Christ Hospital, Cincinnati, Ohio, USA.
| | - Dean J Kereiakes
- Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA; Christ Hospital Heart and Vascular Institute, the Christ Hospital, Cincinnati, Ohio, USA
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4
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A Practical Approach to Left Main Coronary Artery Disease. J Am Coll Cardiol 2022; 80:2119-2134. [DOI: 10.1016/j.jacc.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]
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5
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Akbari T, Al-Lamee R. Percutaneous coronary intervention in multi-vessel disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:80-91. [DOI: 10.1016/j.carrev.2022.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/09/2023]
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6
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Askin L. The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2022. [DOI: 10.15212/cvia.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) hassignificantly improved angiographic risk stratification. By analyzing angiographic variables, this score characterizescoronary artery disease qualitatively and quantitatively. To date, combining this score with other non-angiographic clinicalscores has broadened perspectives regarding risk estimation, and future research on this topic appears promising.
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7
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Zhao X, Wang Y, Chen R, Li J, Zhou J, Liu C, Zhou P, Sheng Z, Chen Y, Song L, Zhao H, Yan H. Prognostic value of characteristics of plaque combined with residual syntax score among patients with STEMI undergoing primary PCI: an intravascular optical coherence tomography study. Thromb J 2021; 19:85. [PMID: 34772417 PMCID: PMC8588603 DOI: 10.1186/s12959-021-00329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
Aim The present study aimed to explore these characteristics, particularly thin-cap fibroatheroma (TCFA), in relation to residual syntax score (rSS) in patients who presented with acute MI. Methods and outcomes A total of 434 consecutive patients with MI aged ≥18 years who had STEMI underwent primary PCI. Notably, compared with other subgroups, the presence of TCFA in culprit lesions and a higher level of rSS, were significantly associated with MACE. When rSS was divided into three groups, high rSS levels were associated with a higher incidence of MACE, in the subgroups of without TCFA (P = 0.005), plaque erosion (P = 0.045), macrophage infiltration (P = 0.026), and calcification (P = 0.002). AUC of ROC curve was 0.794 and 0.816, whereas the AUC of the survival ROC was 0.798 and 0.846. Conclusion The results of this study could be used in clinical practice to support risk stratification. Trial registration This study was registered at ClinicalTrials.gov as NCT03593928. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00329-z.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beijing, 100037, China.
| | - Hongbing Yan
- , Fuwai Hospital, Chinese Academy of Medical Sciences, 12 Langshan Rd, Shenzhen, 518000, China.
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8
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Barthélémy O, Rouanet S, Brugier D, Vignolles N, Bertin B, Zeitouni M, Guedeney P, Hauguel-Moreau M, Hage G, Overtchouk P, Akin I, Desch S, Vicaut E, Zeymer U, Thiele H, Montalescot G. Predictive Value of the Residual SYNTAX Score in Patients With Cardiogenic Shock. J Am Coll Cardiol 2021; 77:144-155. [PMID: 33446307 DOI: 10.1016/j.jacc.2020.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In hemodynamically stable patients, complete revascularization (CR) following percutaneous coronary intervention (PCI) is associated with a better prognosis in chronic and acute coronary syndromes. OBJECTIVES This study sought to assess the extent, severity, and prognostic value of remaining coronary stenoses following PCI, by using the residual SYNTAX score (rSS), in patients with cardiogenic shock (CS) related to myocardial infarction (MI). METHODS The CULPRIT-SHOCK (Culprit Lesion Only Percutaneous Coronary Intervention [PCI] Versus Multivessel PCI in Cardiogenic Shock) trial compared a multivessel PCI (MV-PCI) strategy with a culprit lesion-only PCI (CLO-PCI) strategy in patients with multivessel coronary artery disease who presented with MI-related CS. The rSS was assessed by a central core laboratory. The study group was divided in 4 subgroups according to tertiles of rSS of the participants, thereby isolating patients with an rSS of 0 (CR). The predictive value of rSS for the 30-day primary endpoint (mortality or severe renal failure) and for 30-day and 1-year mortality was assessed using multivariate logistic regression. RESULTS Among the 587 patients with an rSS available, the median rSS was 9.0 (interquartile range: 3.0 to 17.0); 102 (17.4%), 100 (17.0%), 196 (33.4%), and 189 (32.2%) patients had rSS = 0, 0 < rSS ≤5, 5 < rSS ≤14, and rSS >14, respectively. CR was achieved in 75 (25.2%; 95% confidence interval [CI]: 20.3% to 30.5%) and 27 (9.3%; 95% CI: 6.2% to 13.3%) of patients treated using the MV-PCI and CLO-PCI strategies, respectively. After multiple adjustments, rSS was independently associated with 30-day mortality (adjusted odds ratio per 10 units: 1.49; 95% CI: 1.11 to 2.01) and 1-year mortality (adjusted odds ratio per 10 units: 1.52; 95% CI: 1.11 to 2.07). CONCLUSIONS Among patients with multivessel disease and MI-related CS, CR is achieved only in one-fourth of the patients treated using an MV-PCI strategy. and the residual SYNTAX score is independently associated with early and late mortality.
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Affiliation(s)
- Olivier Barthélémy
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | | | - Delphine Brugier
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Nicolas Vignolles
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Benjamin Bertin
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Michel Zeitouni
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Marie Hauguel-Moreau
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Georges Hage
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Pavel Overtchouk
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Ibrahim Akin
- First Department of Medicine, Mannheim University Medical Center, Mannheim, Germany
| | - Steffen Desch
- Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Eric Vicaut
- ACTION Study Group, Clinical Research Unit, Lariboisière Hospital, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Holger Thiele
- Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France.
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9
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Schäfer A, Westenfeld R, Sieweke JT, Zietzer A, Wiora J, Masiero G, Sanchez Martinez C, Tarantini G, Werner N. Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality. Front Cardiovasc Med 2021; 8:678748. [PMID: 34307495 PMCID: PMC8299360 DOI: 10.3389/fcvm.2021.678748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Acute myocardial infarction-related cardiogenic shock (AMI-CS) still has high likelihood of in-hospital mortality. The only trial evidence currently available for the intra-aortic balloon pump showed no benefit of its routine use in AMI-CS. While a potential benefit of complete revascularisation has been suggested in urgent revascularisation, the CULPRIT-SHOCK trial demonstrated no benefit of multivessel compared to culprit-lesion only revascularisation in AMI-CS. However, mechanical circulatory support was only used in a minority of patients. Objectives: We hypothesised that more complete revascularisation facilitated by Impella support is related to lower mortality in AMI-CS patients. Methods: We analysed data from 202 consecutive Impella-treated AMI-CS patients at four European high-volume shock centres (age 66 ± 11 years, 83% male). Forty-seven percentage (n = 94) had cardiac arrest before Impella implantation. Revascularisation was categorised as incomplete if residual SYNTAX-score (rS) was >8. Results: Overall 30-day mortality was 47%. Mortality was higher when Impella was implanted post-PCI (Impella-post-PCI: 57%, Impella-pre-PCI: 38%, p = 0.0053) and if revascularisation was incomplete (rS ≤ 8: 37%, rS > 8: 56%, p = 0.0099). Patients with both pre-PCI Impella implantation and complete revascularisation had significantly lower mortality (33%) than those with incomplete revascularisation and implantation post PCI (72%, p < 0.001). Conclusions: Our retrospective analysis suggests that complete revascularisation supported by an Impella microaxial pump implanted prior to PCI is associated with lower mortality than incomplete revascularisation in patients with AMI-CS.
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Affiliation(s)
- Andreas Schäfer
- Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Cardiac Arrest Center, Heinrich Heine University, Düsseldorf, Germany
| | - Jan-Thorben Sieweke
- Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany
| | - Andreas Zietzer
- Department of Cardiology, University Heart Center, Bonn, Germany
| | - Julian Wiora
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Cardiac Arrest Center, Heinrich Heine University, Düsseldorf, Germany
| | - Giulia Masiero
- Department of Cardiology, University of Padua, Padua, Italy
| | - Carolina Sanchez Martinez
- Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany
| | | | - Nikos Werner
- Department of Cardiology, University Heart Center, Bonn, Germany
- Department of Cardiology, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
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10
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. Eur J Cardiothorac Surg 2021; 59:522-531. [PMID: 33459337 DOI: 10.1093/ejcts/ezaa402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/12/2022] Open
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discusses strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Catania, Italy
| | - Miguel Sousa-Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Department of Cardiology, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Yan L, Li P, Wang Y, Han D, Li S, Jiang M, Cao X, Cao F. The Incremental Prognostic Value of the Clinical Residual SYNTAX Score for Patients With Chronic Renal Insufficiency Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:647720. [PMID: 33937361 PMCID: PMC8082103 DOI: 10.3389/fcvm.2021.647720] [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: 01/24/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The residual SYNTAX score (RSS) is considered a powerful prognostic indicator for determining a reasonable revascularization strategy in patients undergoing percutaneous coronary intervention (PCI), but the absence of clinical parameters is one of the limitations of RSS, especially in the chronic renal insufficiency (CRI) comorbidity setting. The present work aimed to investigate the incremental prognostic value of clinical residual SYNTAX score (CRSS) compared with RSS in CRI cases after PCI. Methods: Totally 2,468 consecutive CRI cases who underwent PCI from January 2014 to September 2017 were included in this retrospective analysis. CRSS was obtained by multiplying RSS by the modified ACEF score. Individuals with CRSS >0 were considered to have incomplete revascularization and stratified by CRSS tertiles, the remaining cases constituted the complete revascularization (CR) group. The outcomes between these groups were compared. Results: At a median follow-up of 3 years, compared with CR group, individuals with CRSS >12 showed elevated rates of all clinical outcomes, and those with CRSS ≤ 12 showed similar all-cause and cardiac mortality rates. In multivariable analysis, CRSS was a powerful independent predictive factor of all clinical outcomes. The net reclassification improvement levels of CRSS over RSS for all-cause and cardiac mortality rates were 10.3% (p = 0.007) and 16.4% (p < 0.001), respectively. Compared with RSS, CRSS markedly ameliorated all-cause and cardiac mortality risk stratification. Conclusions: Compared with RSS, CRSS has incremental predictability for long-term all-cause and cardiac mortality in CRI cases following PCI.
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Affiliation(s)
- Liqiu Yan
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.,Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Peiyao Li
- Department of Computer Science, Tsinghua University, Beijing, China.,Artificial Intelligence Lab, Global Health Drug Discovery Institute, Beijing, China
| | - Yabin Wang
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Dong Han
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Min Jiang
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xufen Cao
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Feng Cao
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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12
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Kochar A, Varshney AS, Wang DE. Residual SYNTAX Score After Revascularization in Cardiogenic Shock: When Is Complete Complete? J Am Coll Cardiol 2021; 77:156-158. [PMID: 33446308 PMCID: PMC8244621 DOI: 10.1016/j.jacc.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Ajar Kochar
- Division of Cardiovascular Medicine, Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Anubodh S Varshney
- Division of Cardiovascular Medicine, Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David E Wang
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:83-93. [PMID: 33721018 DOI: 10.1093/ehjacc/zuaa013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022]
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discuss strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Italy
| | - Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, 2790-134 Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern 3010, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clincal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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A sex paradox in clinical outcomes following complex percutaneous coronary intervention. Int J Cardiol 2020; 329:67-73. [PMID: 33278415 DOI: 10.1016/j.ijcard.2020.11.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the number of complex percutaneous coronary intervention (CPCI) procedures is increasing, data regarding sex-related outcomes following CPCI are scarce. METHODS We retrospectively analyzed data of patients enrolled in a single-center registry between 2009 and 2017. Patients were divided into two groups (CPCI and non-CPCI) stratified by sex. CPCI was defined as any PCI procedure with ≥1 of the following characteristics: ≥3 target vessels/lesions, ≥3 stents implanted, bifurcation with ≥2 stents, stent length > 60 mm, or chronic total occlusion. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target vessel revascularization, at oneon-year follow-up. RESULTS Among 20,419 patients, 5004 (24.5%) underwent CPCI of whom 25.6% (n = 1281) women and 74.4% (n = 3723) men. Women presented with more comorbidities yet less complex coronary anatomy than men (syntax score: 19.5 ± 10.3 vs. 20.6 ± 10.7, p = 0.009). Moreover, women were more likely to fulfill a single rather than multiple CPCI criteria. At one year, a higher rate of MACE occurred in women (14.0% vs. 11.6%, p = 0.02). After multivariable adjustment for confounders, the risk of MACE at one year was similar among both sexes (HR:1.04, 95% CI [0.85-1.26], p = 0.71), without significant interaction between the complexity of the procedure and sex (p-interaction = 0.96). Nonetheless, the risk of MI was significantly higher in women than men undergoing CPCI (HR:1.63, 95% CI [1.12-2.38], p = 0.01). CONCLUSIONS Despite presenting with less challenging lesions than men, women had a higher rate of MI at one year following CPCI, even after adjusting for potential confounders.
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15
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Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions. Cardiol Res Pract 2020; 2020:9245431. [PMID: 33178454 PMCID: PMC7644317 DOI: 10.1155/2020/9245431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Aims We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Methods Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). Conclusions High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI.
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16
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Ishida K, Martin-Yuste V, Prat S, Cardona M, Ferreira I, Sabaté M. Prognosis of Patients With Reduced Left Ventricular Ejection Fraction and Chronic Total Occlusion According to Treatment Applied. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 27:22-27. [PMID: 32771401 DOI: 10.1016/j.carrev.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) is common among patients with coronary artery disease. Very few studies have focused on outcomes of patients with CTO and reduced left ventricular ejection fraction (LVEF), according to treatment applied. The aim of our study was to determine the potential influence of the selected treatment on the prognosis in patients with CTO associated with reduced LVEF. METHODS Between June 2010 and October 2013, all consecutive patients with at least one CTO and reduced LVEF (<40%) were enrolled. Major adverse cardiac events (MACE), defined as the composite of cardiac mortality or myocardial infarction (MI) and its individual components, were compared between three treatment groups: medical therapy (MT), percutaneous coronary intervention (PCI), and coronary bypass graft (CABG). RESULTS In 256 included patients, the follow-up was 1129 ± 556 days. The incidence of MACE was 40% in the MT group, compared with PCI (20.3%) and CABG (16.7%); p < 0.001. All-cause and cardiac mortality were also higher in the MT group (40.7% and 33.3%, respectively) versus the PCI (21.9% and 15.6%) and CABG (11.9% and 9.5%) groups (p < 0.001 for both endpoints); MI rate did not differ among groups. In the adjusted multivariate analysis, CABG had lower MACE risk, compared with MT (HR = 0.39, 0.17-0.91; p = 0.029); successful PCI also trended toward lower risk of MACE, compared with MT. CONCLUSIONS Patients with CTO and reduced LVEF treated with MT had a worse prognosis than those treated with revascularization (either CABG or PCI). Patients with an indication for CABG appeared to perform best during long-term follow-up.
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Affiliation(s)
- Kohki Ishida
- Cardiovascular Institute, Interventional Cardiology Section, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Victoria Martin-Yuste
- Cardiovascular Institute, Interventional Cardiology Section, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.
| | - Susanna Prat
- Cardiovascular Institute, Interventional Cardiology Section, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Montserrat Cardona
- Cardiovascular Institute, Interventional Cardiology Section, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Ignacio Ferreira
- Cardiology Department, Hospital del Valle de Hebron, Barcelona, Spain
| | - Manel Sabaté
- Cardiovascular Institute, Interventional Cardiology Section, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
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17
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Basman C, Hemli JM, Kim MC, Seetharam K, Brinster DR, Pirelli L, Kliger CA, Scheinerman SJ, Singh VP, Patel NC. Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods. J Card Surg 2020; 35:2710-2718. [DOI: 10.1111/jocs.14891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Craig Basman
- Department of Cardiovascular Medicine Lenox Hill Hospital/Northwell Health New York New York
| | - Jonathan M. Hemli
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
| | - Michael C. Kim
- Department of Cardiovascular Medicine Lenox Hill Hospital/Northwell Health New York New York
| | - Karthik Seetharam
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
| | - Derek R. Brinster
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
| | - Luigi Pirelli
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
| | - Chad A. Kliger
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
| | - S. Jacob Scheinerman
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
| | - Varinder P. Singh
- Department of Cardiovascular Medicine Lenox Hill Hospital/Northwell Health New York New York
| | - Nirav C. Patel
- Department of Cardiovascular and Thoracic Surgery Lenox Hill Hospital/Northwell Health New York New York
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18
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Cho SW, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, Choi JH, Gwon HC, Lee SH, Choi SH. Clinical Implications of Early Exercise Treadmill Testing after Percutaneous Coronary Intervention in the Drug-eluting Stent Era. J Korean Med Sci 2020; 35:e229. [PMID: 32657087 PMCID: PMC7358060 DOI: 10.3346/jkms.2020.35.e229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limited data are available on the clinical meaning of early routine exercise treadmill testing (ETT) after percutaneous coronary intervention (PCI) in the drug-eluting stent era. We aimed to determine the clinical utility and implications of early routine ETT after PCI. METHODS This was a single-center, prospective cohort study. A total of 776 patients underwent ETT within 3 months after index PCI were analyzed. We classified patients into ETT positive (+) and negative (-) groups and compared major adverse cardiac events (MACE) including all-cause death, myocardial infarction, and coronary revascularization. RESULTS The median follow-up duration was 19.6 months (interquartile range, 15.4 to 33.5 months). ETT was positive for 63 patients (17.1%) with single-vessel disease (VD) and 150 patients (36.9%) with multi-VD. Previous PCI, absence of thrombotic lesion, multi-VD, and residual Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score > 8 were independent predictors of ETT (+). Compared with the ETT (-) group, the ETT (+) group was associated with increased risk of MACE for patients with single-VD (18.1% vs. 52.3%; adjusted hazard ratio [HR], 2.67; 95% confidence interval [CI], 1.10-6.49; P = 0.03) and residual SYNTAX score ≤ 8 (26.5% vs. 42.1%; adjusted HR, 1.90; 95% CI, 1.09-3.30; P = 0.02), but not for patients with multi-VD and residual SYNTAX score > 8. CONCLUSION Early routine ETT after PCI might be helpful for predicting clinical outcomes in patients with single-VD and residual SYNTAX score ≤ 8 but not multi-VD and residual SYNTAX score > 8.
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Affiliation(s)
- Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Falcão F, Oliveira F, Cantarelli F, Cantarelli R, Brito Júnior P, Lemos H, Silva P, Camboim I, Freire MC, Carvalho O, Sobral Filho DC. Carbohydrate antigen 125 for mortality risk prediction following acute myocardial infarction. Sci Rep 2020; 10:11016. [PMID: 32620821 PMCID: PMC7335179 DOI: 10.1038/s41598-020-67548-8] [Citation(s) in RCA: 6] [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: 05/17/2019] [Accepted: 06/08/2020] [Indexed: 11/08/2022] Open
Abstract
Carbohydrate antigen 125 (CA125) is a congestion and inflammation biomarker and has been proved to be related to a worse prognosis in heart diseases. However, the precise relationship between elevated CA125 in patients with ST-segment elevation myocardial infarction (STEMI) has not yet been sufficiently studied. We set out to determine the association of CA125 with all-cause mortality at 6 months in STEMI. CA125, N-terminal pro brain natriuretic peptide (NTproBNP) and high sensitive C-reactive protein (hs-CRP) were measured in 245 patients admitted consecutively with STEMI undergoing coronary angioplasty. The mean age in our sample was 63.7 years, 64.9% were males, 28.3% had diabetes and 17.7% presented with acute heart failure (Killip ≥ 2). The median serum level of CA125 was 8.1 U/ml. At 6 months, the rate of all-cause mortality was 18% (44 patients). Receiver operating characteristic curve analysis demonstrated that CA125 presented similar performance to predict mortality as NTproBNP and hs-CRP. Patients with CA125 ≥ 11.48 had a higher rate of mortality (Hazard Ratio = 2.07, 95% confidence interval = 1.13-3.77, p = 0.017) than patients with CA125 < 11.48. This study suggests that elevated CA125 levels might be used to identify patients with STEMI with a higher risk of death at 6 months. CA125 seems to be a similar predictor of mortality compared to NTproBNP and hs-CRP.
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Affiliation(s)
- Felipe Falcão
- Departamento de Medicina Interna, Universidade de Pernambuco (UPE), Garanhuns, PE, Brazil.
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil.
| | - Flávio Oliveira
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Fabiano Cantarelli
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Rodigo Cantarelli
- Unidade de Cardiologia Invasiva (UCI) - Hospital Memorial São José, Rede d'Or São Luiz, Recife, PE, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Paulo Brito Júnior
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Hygor Lemos
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Paloma Silva
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | - Irla Camboim
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
| | | | - Osmário Carvalho
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE-UPE), Recife, PE, Brazil
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20
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Residual SYNTAX Score and One-Year Outcome in Elderly Patients With Acute Coronary Syndrome. CJC Open 2020; 2:236-243. [PMID: 32695974 PMCID: PMC7365822 DOI: 10.1016/j.cjco.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background The residual burden of coronary artery disease after percutaneous coronary intervention (PCI) has been associated with worse ischemic outcome. However, data are conflicting in elderly patients. The aim of our study was to verify the incremental value of the residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (rSS) over clinical variables and baseline SYNTAX score (bSS) in predicting 1-year mortality or cardiovascular events. Methods A post hoc analysis of data collected in the Elderly-ACS 2 multicenter randomized trial was performed. We included 630 patients aged > 75 years with multivessel coronary disease undergoing PCI for acute coronary syndrome (ACS). The primary outcome was a composite of death, recurrent myocardial infarction, and stroke at 1-year follow up. Change in c-statistic and standardized net benefit were used to evaluate the incremental value of the rSS. Results Event rates were significantly higher in patients with incomplete revascularization (rSS > 8). When the rSS was included in a core Cox regression model containing age, previous myocardial infarction, and ACS type, the hazard ratio for patients with score values > 8 was 2.47 (95% confidence interval, 1.51-4.06). However, the core model with rSS did not increase the c-statistic compared with the core model with the bSS (from 0.69 to 0.70) and gave little incremental value in the standardized net benefit. Conclusions In elderly patients with ACS with multivessel disease undergoing PCI, incomplete revascularization was associated with worse outcome at 1-year follow-up. However, there was no clear incremental value of the rSS in the prediction of 1-year adverse outcome compared with a model including clinical variables and bSS.
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Bağcı A, Aksoy F, Baş HA. Akut koroner sendromda kontrast nefropati gelişimi ile Syntax Skoru arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.512112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Yan L, Li P, Wang Y, Han D, Li S, Zhang J, Jiang M, Fan L, Han Y, Cao F. Impact of the residual SYNTAX score on clinical outcomes after percutaneous coronary intervention for patients with chronic renal insufficiency. Catheter Cardiovasc Interv 2019; 95 Suppl 1:606-615. [PMID: 31868307 PMCID: PMC7078880 DOI: 10.1002/ccd.28652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study demonstrated the prognostic value of the residual SYNTAX score (rSS) for patients with chronic renal insufficiency (CRI). BACKGROUND The rSS has been proposed as a useful tool for quantifying and stratifying the degree and complexity of residual stenosis and predicting long-term clinical outcomes following percutaneous coronary intervention (PCI). However, it has never been validated for patients with CRI. METHODS A total of 2,468 consecutive patients with an estimated glomerular filtration rate <90 ml/min/1.73 m2 who underwent PCI were retrospectively enrolled. Patients with rSS >0 were defined as having incomplete revascularization and were stratified into the reasonable incomplete revascularization (RICR; 0 < rSS ≤ 8) group or the incomplete revascularization (ICR; rSS >8) group. Their outcomes were compared to those of the complete revascularization (CR) group. RESULTS During follow-up (median, 3 years; range, 1.5-5 years), the ICR group had the highest incidence of all-cause death, cardiac death, myocardial infarction (MI), unplanned revascularization, stroke, and major adverse cardiovascular and cerebrovascular events (MACCE). Despite having higher rates of unplanned revascularization and MACCE, RICR group had comparable all-cause mortality, cardiac mortality, MI, and stroke with CR group. A multivariable Cox analysis indicated that rSS was an independent predictor of cardiac death, MI, unplanned revascularization, stroke, and MACCE. Furthermore, compared with baseline SYNTAX score, rSS had stronger prognostic accuracy when predicting the risk of unplanned revascularization, stroke, and MACCE at the 3-year follow-up. CONCLUSIONS The rSS is a powerful indicator of clinical outcomes and may help determine reasonable levels of revascularization for patients with CRI following PCI.
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Affiliation(s)
- Liqiu Yan
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China.,Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, China
| | - Peiyao Li
- Department of Computer Science, Tsinghua University, Beijing, China.,Department of Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
| | - Yabin Wang
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Dong Han
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Sulei Li
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Jibin Zhang
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Min Jiang
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Li Fan
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Feng Cao
- Department of Cardiology & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
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23
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Falcão FJA, Oliveira FRA, Cantarelli F, Cantarelli R, Brito-Júnior P, Lemos H, Silva P, Camboim I, Freire MC, Carvalho O, Sobral-Filho DC. Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2019; 52:e9124. [PMID: 31826182 PMCID: PMC6903802 DOI: 10.1590/1414-431x20199124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022]
Abstract
Carbohydrate antigen 125 (CA125) has long been used as an ovarian cancer biomarker. However, because it is not specific for ovarian cells, CA125 could also be used to monitor congestion and inflammation in heart disease. Acute heart failure (HF) is used to identify patients with a worse prognosis in ST-segment elevation myocardial infarction (STEMI). We aimed to determine the association of CA125 with acute HF in STEMI and to compare CA125 with N-terminal pro brain natriuretic peptide (NTproBNP) with a cross-sectional study. At admission, patients were examined to define Killip class and then underwent coronary angioplasty. Blood samples, preferably taken in the hemodynamic ward, were centrifuged (1500 g for 15 min at ambient temperature) and stored at −80°C until biomarker assays were performed. Patients were divided into two groups according to the presence or absence of congestion. Patients in Killip class ≥II were in the congestion group and those with Killip <II in the absence of congestion group. We evaluated 231 patients. The mean age was 63.3 years. HF at admission was identified in 17.7% of patients. CA125 and NTproBNP levels were higher in patients with Killip class ≥II than those with Killip class <II (8.03 vs 9.17, P=0.016 and 772.45 vs 1925, P=0.007, respectively). The area under the receiver operator characteristic curve was 0.60 (95%CI 0.53−0.66, P=0.024) for CA125 and 0.63 (95%CI 0.56−0.69, P=0.001) for NTproBNP. There was no statistical difference between the curves (P=0.69). CA125 has similar use to NTproBNP in identifying acute HF in patients presenting with STEMI.
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Affiliation(s)
- F J A Falcão
- Faculdade de Ciência, Educação e Tecnologia, Universidade de Pernambuco, Garanhuns, PE, Brasil.,Centro de Ciências Médicas, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - F R A Oliveira
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - F Cantarelli
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - R Cantarelli
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil.,Unidade de Cardiologia Invasiva, Hospital Memorial São José, Rede D'Or São Luiz, Recife, PE, Brasil.,Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - P Brito-Júnior
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - H Lemos
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - P Silva
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - I Camboim
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - M C Freire
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - O Carvalho
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
| | - D C Sobral-Filho
- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brasil
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Chen S, Karmpaliotis D, Redfors B, Shlofmitz E, Ben-Yehuda O, Crowley A, Mehdipoor G, Puskas JD, Kandzari DE, Banning AP, Morice MC, Taggart DP, Sabik JF, Serruys PW, Kappetein AP, Stone GW. Does an occluded RCA affect prognosis in patients undergoing PCI or CABG for left main coronary artery disease? Analysis from the EXCEL trial. EUROINTERVENTION 2019; 15:e531-e538. [PMID: 31186220 DOI: 10.4244/eij-d-19-00263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The impact of an occluded right coronary artery (RCA) in patients with left main coronary artery disease (LMCAD) undergoing revascularisation is unknown. We compared outcomes for patients with LMCAD randomised to percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) according to the presence of an occluded RCA in the EXCEL trial. METHODS AND RESULTS The EXCEL trial randomised 1,905 patients with LMCAD and SYNTAX scores ≤32 to PCI with everolimus-eluting stents versus CABG. Patients were categorised according to whether they had an occluded RCA at baseline, and their outcomes were examined using multivariable Cox proportional hazards regression. The primary endpoint was a composite of death, stroke, or myocardial infarction at three years. Among 1,753 patients with a dominant RCA by core laboratory analysis, the RCA was occluded in 130 (7.4%) at baseline. PCI was attempted in 34 of 65 patients with an occluded RCA (52.3%) and was successful in 27 (79.4% of those attempted; 41.5% of all RCAs recanalised). The RCA was bypassed in 42 of 65 patients with an occluded RCA (64.6%; p=0.0008 versus PCI). The three-year absolute and relative rates of the primary endpoint were similar between PCI and CABG, in patients with or without an occluded RCA (pinteraction=0.92). CONCLUSIONS In the EXCEL trial, the presence of an occluded RCA at baseline did not confer a worse three-year prognosis in patients undergoing revascularisation for LMCAD and did not affect the relative outcomes of PCI versus CABG in this high-risk patient cohort.
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Affiliation(s)
- Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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25
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Ieroncig F, Breau JB, Bélair G, David LP, Noiseux N, Hatem R, Avram R. Novel Approaches to Define Outcomes in Coronary Revascularization. Can J Cardiol 2019; 35:967-982. [DOI: 10.1016/j.cjca.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
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26
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Clinical impact of complex percutaneous coronary intervention in patients with coronary artery disease. Cardiovasc Interv Ther 2019; 35:234-241. [PMID: 31350706 DOI: 10.1007/s12928-019-00608-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
For the revascularization of patients with clinical and anatomical complexities, several technical skills are often required. However, the prognostic effect of complex percutaneous coronary intervention (C-PCI) on the clinical outcomes is not well known. The aim of this study was to investigate the relationship between the C-PCI and mid-term clinical outcomes. We assessed 1062 patients who underwent PCI with newer-generation drug-eluting stent and stratified the patients according to whether they had complex PCI (C-PCI, n = 358) or non-complex PCI (non-C-PCI, n = 704). C-PCI was defined as a procedure with at least 1 of the following features: 3 vessels treated, ≥ 3 stents per vessel implanted, ≥ 3 lesions treated, use of a 2-stent technique, the total stent length per vessel > 60 mm, chronic total occlusion, unprotected left main coronary artery stenting, and rotational atherectomy use. All-cause death and major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke) were evaluated. The median follow-up period was 1.9 (0.8-3.0) years. The baseline SYNTAX score was significantly higher in the C-PCI group than in the non-C-PCI group [20 (14-27) vs. 10 (6-17), p < 0.001]. Kaplan-Meier analysis showed that the cumulative incidences of all-cause death (log-rank p = 0.12) and MACCE (log-rank p = 0.64) did not differ between the two groups. On multivariable Cox analysis, C-PCI did not adversely affect the clinical outcomes. Despite a high rate of anatomically complex coronary lesions, the patients who underwent C-PCI had comparable "hard" clinical outcomes with those of non-C-PCI.
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27
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Patel NC, Hemli JM, Kim MC, Seetharam K, Pirelli L, Brinster DR, Scheinerman SJ, Singh VP. Short- and intermediate-term outcomes of hybrid coronary revascularization for double-vessel disease. J Thorac Cardiovasc Surg 2018; 156:1799-1807.e3. [DOI: 10.1016/j.jtcvs.2018.04.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
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28
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Song Y, Gao Z, Tang XF, Jiang P, Xu JJ, Yao Y, Li JX, Zhao XY, Qiao SB, Yang YJ, Gao RL, Xu B, Yuan JQ. Impact of Residual SYNTAX Score and Its Derived Indexes on Clinical Outcomes after Percutaneous Coronary Intervention: Data from a Large Single Center. Chin Med J (Engl) 2018; 131:1390-1396. [PMID: 29893355 PMCID: PMC6006821 DOI: 10.4103/0366-6999.233958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Residual SYNTAX score (rSS) and its derived indexes including SYNTAX revascularization index (SRI) and clinical rSS had been developed to quantify and describe the extent of incomplete revascularization. This study was conducted to explore the utility of the three scores among real-world patients after percutaneous coronary intervention (PCI). Methods From January 2013 to December 2013, patients underwent PCI treatment at Fuwai Hospital were included. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events. The secondary endpoints were myocardial infarction, revascularization, stroke, and stent thrombosis. Kaplan-Meier methodology was used to determine the outcomes. Cox multivariable regression was to test the associations between scores and all-cause mortality. Results A total of 10,344 patients were finally analyzed in this study. Kaplan-Meier survival analysis indicated that greater residual coronary lesions quantified by rSS and its derived indexes were associated with increased risk of adverse cardiovascular events. However, after multivariate analysis, only clinical rSS was an independent predictor of 2-year all-cause death (hazard ratio: 1.02, 95% confidence interval: 1.01-1.03, P < 0.01). By receiver operating characteristic (ROC) curve analysis, clinical rSS had superior predictability of 2-year all-cause death than rSS and SRI (area under ROC curve [AUC]: 0.59 vs. 0.56 vs. 0.56, all P < 0.01), whereas rSS was superior in predicting repeat revascularization than clinical rSS and SRI (AUC: 0.62 vs. 0.61 vs. 0.61; all P < 0.01). When comparing the predictive capability of rSS ≥8 with SRI <70%, their predictabilities were not significantly different. Conclusions This study indicates that all three indexes (rSS, clinical rSS, and SRI) are able to risk-stratify patients and predict 2-year outcomes after PCI. However, their prognostic capabilities are different.
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Affiliation(s)
- Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhan Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ping Jiang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jing-Jing Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Yao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Xin Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu-Bin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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29
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Javanainen T, Sans-Roselló J, Harjola VP, Nieminen MS, Lassus J, Sionis A, Varpula M, Jurkko R. Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock. Catheter Cardiovasc Interv 2018; 93:1-8. [DOI: 10.1002/ccd.27716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 04/10/2018] [Accepted: 06/10/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Tuija Javanainen
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Jordi Sans-Roselló
- Department of Cardiology, Acute and Intensive Cardiovascular Care Unit; Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat Autònoma de Barcelona, CIBER-CV; Barcelona Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services; University of Helsinki, Helsinki University Hospital; Helsinki Finland
| | - Markku S. Nieminen
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Johan Lassus
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Alessandro Sionis
- Department of Cardiology, Acute and Intensive Cardiovascular Care Unit; Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat Autònoma de Barcelona, CIBER-CV; Barcelona Spain
| | - Marjut Varpula
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
| | - Raija Jurkko
- Cardiology; University of Helsinki, Heart and Lung Center, Helsinki University Hospital; Helsinki Finland
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30
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Kobayashi Y, Lønborg J, Jong A, Nishi T, De Bruyne B, Høfsten DE, Kelbæk H, Layland J, Nam CW, Pijls NH, Tonino PA, Warnøe J, Oldroyd KG, Berry C, Engstrøm T, Fearon WF. Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS. J Am Coll Cardiol 2018; 72:1321-1329. [DOI: 10.1016/j.jacc.2018.06.069] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
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31
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Song Y, Gao Z, Tang X, Jiang P, Xu J, Yao Y, Li J, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Impact of residual SYNTAX score on clinical outcomes after incomplete revascularisation percutaneous coronary intervention: a large single-centre study. EUROINTERVENTION 2017; 13:1185-1193. [DOI: 10.4244/eij-d-17-00132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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32
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Melina G, Angeloni E, Refice S, Benegiamo C, Lechiancole A, Matteucci M, Roscitano A, Bianchini R, Capuano F, Comito C, Spitaleri P, Tonelli E, Speciale G, Pristipino C, Monti F, Serdoz R, Paneni F, Sinatra R. Residual SYNTAX score following coronary artery bypass grafting. Eur J Cardiothorac Surg 2017; 51:547-553. [PMID: 28007880 DOI: 10.1093/ejcts/ezw356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives To quantify residual coronary artery disease measured using the SYNTAX score (SS) and its relation to outcomes after coronary artery bypass grafting (CABG). Methods We conducted a retrospective analysis on a consecutive series of 1608 patients [mean age 68 years, standard deviation (SD): 7, F:M, 242:1366] undergoing first-time isolated CABG from 2004 to 2015. The baseline SS was retrospectively determined from preoperative angiograms, and the residual SS (rSS) was measured during assessment of the actual operative report for each patient after CABG. Patients were then stratified according to tercile cut points of low (rSS low 0-11, N = 537), intermediate (rSS mid >11-18.5, N = 539) and high residual SS (rSS high >18.5, N = 532). The Cox regression model was used to investigate the impact of rSS on major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Results The mean preoperative SS was 26.6 (SD: 9.4) (range 10.1-53), and the residual SS after CABG was 15.3 (SD: 8.4) (range 0-34) ( P < 0.001 versus preoperative). At 1 year, cumulative incidence of MACCE in the low rSS was 1.5% ( N = 8/537), 4.5% ( N = 24/539) in the intermediate and 8.8% ( N = 47/532) in the high rSS group. Kaplan-Meier analysis showed a statistically significant difference of MACCE-free survival between the three groups (log-rank test, P < 0.001). The estimated MACCE-free survival rate at 1 year was 98.1% [standard error (SE): 1.6] for the rSS low , 95.5% (SE: 1.9) for the rSS mid , and 90.5% (SE: 1.3) for the rSS high group, respectively. After multivariable adjustment, the rSS high group was independently associated with a higher incidence of MACCE at 1 year (hazard ratio 1.92, 95% confidence interval 1.21-3.23) compared to the rSS low group. Conclusions These unanticipated findings suggest that a residual SS may be a useful tool for risk stratification of patients undergoing isolated first-time CABG. Our study may set the stage for further investigations addressing this important clinical question.
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Affiliation(s)
- Giovanni Melina
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | - Simone Refice
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Maria Matteucci
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Fabio Capuano
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Cosimo Comito
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Pietro Spitaleri
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Euclide Tonelli
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Giulio Speciale
- Catheterization Laboratory, Ospedale San Filippo Neri, Rome, Italy
| | | | - Francesco Monti
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Roberto Serdoz
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Riccardo Sinatra
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
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Braga CG, Cid-Alvarez AB, Diéguez AR, Alvarez BA, Otero DL, Sánchez RO, Pena XS, Salvado VG, Trillo-Nouche R, González-Juanatey JR. Prognostic impact of residual SYNTAX score in patients with ST-elevation myocardial infarction and multivessel disease: Analysis of an 8-year all-comers registry. Int J Cardiol 2017; 243:21-26. [DOI: 10.1016/j.ijcard.2017.04.054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/05/2017] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
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Barillà F, Pelliccia F, Borzi M, Camici P, Cas LD, Di Biase M, Indolfi C, Mercuro G, Montemurro V, Padeletti L, Filardi PP, Vizza CD, Romeo F. Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention: 2016 consensus position of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2017; 18:1-9. [PMID: 27635937 DOI: 10.2459/jcm.0000000000000434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Definition of the optimal duration of dual anti-platelet therapy (DAPT) is an important clinical issue, given the large number of patients having percutaneous coronary intervention (PCI), the costs and risks of pharmacologic therapy, the consequences of stent thrombosis, and the potential benefits of DAPT in preventing ischaemic outcomes beyond stent thrombosis. Nowadays, the rationale for a prolonged duration of DAPT should be not only the prevention of stent thrombosis, but also the prevention of ischaemic events unrelated to the coronary stenosis treated with index PCI. A higher predisposition to athero-thrombosis may persist for years after an acute myocardial infarction, and even stable patients with a history of prior myocardial infarction are at high risk for major adverse cardiovascular events. Recently, results of pre-specified post-hoc analyses of randomized clinical trials, including the PEGASUS-TIMI 54 trial, have shed light on strategies of DAPT in various clinical situations, and should impact the next rounds of international guidelines, and also routine practice. Accordingly, the 2015 to 2016 the Board of the Italian Society of Cardiology addressed newer recommendations on duration of DAPT based on most recent scientific information. The document states that physicians should decide duration of DAPT on an individual basis, taking into account ischaemic and bleeding risks of any given patient. Indeed, current controversy surrounding optimal duration of DAPT clearly reflects the fact that, nowadays, a one size fits all strategy cannot be reliably applied to patients treated with PCI. Indeed, patients usually have factors for both increased ischaemic and bleeding risks that must be carefully evaluated to assess the benefit/risk ratio of prolonged DAPT. Personalized management of DAPT must be seen as a dynamic prescription with regular re-evaluations of the risk/benefit to the patient according to changes in his/her clinical profile. Also, in order to derive more benefit than harm from new treatments, a multi-parametric approach using several risk scores of the ischaemic and bleeding risks might improve the process of risk factor characterization. In patients with high ischaemic risk, particularly those with a history of myocardial infarction, the benefits of extended DAPT (particularly with ticagrelor up to 3 years) are likely to outweigh the risks.
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Affiliation(s)
- Francesco Barillà
- aDepartment of Cardiovascular Sciences, Sapienza University bDepartment of Cardiovascular Disease, Tor Vergata University of Rome, Rome cCardiothoracic and Vascular Department, Vita-Salute University, Milan dDepartment of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia eDepartment of Medical & Surgical Sciences, University of Foggia, Foggia fDivision of Cardiology, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro gDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari hHeart and Vessels Department, University of Florence, Florence iDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Armstrong EJ, Graham LA, Waldo SW, Valle JA, Maddox TM, Hawn MT. Incomplete Revascularization Is Associated With an Increased Risk for Major Adverse Cardiovascular Events Among Patients Undergoing Noncardiac Surgery. JACC Cardiovasc Interv 2017; 10:329-338. [PMID: 28161261 DOI: 10.1016/j.jcin.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 11/03/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether incomplete revascularization is associated with a higher risk for major adverse cardiovascular events (MACE) and myocardial infarction (MI) among patients undergoing noncardiac surgery. BACKGROUND Patients with coronary artery disease and prior percutaneous coronary intervention (PCI) frequently undergo noncardiac surgery. These patients may have had PCI either on all obstructive lesions (i.e., complete revascularization) or only on some (i.e., incomplete revascularization). METHODS Patients were identified using the Veterans Affairs Clinical Assessment, Reporting, and Tracking program. Veterans Affairs and non-Veterans Affairs surgical records were used to link patients who underwent noncardiac surgery within 2 years after stent placement. Incomplete revascularization was defined as a residual stenosis of ≥50% in the left main coronary artery or ≥70% in another major epicardial coronary artery on the basis of operator visual estimate. RESULTS In total, 4,332 patients (34.7%) had incomplete revascularization. A total of 567 MACE occurred within 1 month post-operatively. Patients with incomplete revascularization had an unadjusted 19% increased odds of post-operative MACE, compared with those with complete revascularization (odds ratio: 1.19; 95% confidence interval [CI]: 1.00 to 1.41). Among the MACE components, post-operative MI appears to contribute the most, with a 37% increased risk for post-operative MI among patients with incomplete revascularization (odds ratio: 1.37; 95% CI: 1.10 to 1.70). After adjustment, there was a significant interaction between time from PCI and outcomes after noncardiac surgery; incomplete revascularization was associated with significantly increased risk for post-operative MI primarily if surgery was performed within 6 weeks after PCI (adjusted odds ratio: 1.84; 95% CI: 1.04 to 2.38). The number of vessels with incomplete revascularization was also associated with an increased risk for post-operative MI: for each additional vessel with incomplete revascularization, there was a 17% increased odds of post-operative MI. CONCLUSIONS Incomplete revascularization among patients with coronary artery disease is associated with an increased risk for MI after noncardiac surgery.
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Affiliation(s)
- Ehrin J Armstrong
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
| | | | - Stephen W Waldo
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado
| | - Javier A Valle
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado
| | - Thomas M Maddox
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado
| | - Mary T Hawn
- Department of Surgery, Stanford University, Stanford, California
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Nagaraja V, Ooi SY, Nolan J, Large A, De Belder M, Ludman P, Bagur R, Curzen N, Matsukage T, Yoshimachi F, Kwok CS, Berry C, Mamas MA. Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:JAHA.116.004598. [PMID: 27986755 PMCID: PMC5210416 DOI: 10.1161/jaha.116.004598] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta‐analysis. Methods and Results A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random‐effects meta‐analysis was used to estimate the odds of adverse outcomes. Meta‐regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty‐eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61‐0.78), repeat revascularization (OR 0.60, 95% CI 0.45‐0.80), myocardial infarction (OR 0.64, 95% CI 0.50‐0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50‐0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53‐0.80). A meta‐regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR. Conclusion CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score‐based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - James Nolan
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.,Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom
| | - Adrian Large
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mark De Belder
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Peter Ludman
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine and Department of Epidemiology & Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nick Curzen
- University Hospital Southampton & Faculty of Medicine University of Southampton, United Kingdom
| | - Takashi Matsukage
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | - Chun Shing Kwok
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.,Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Mamas A Mamas
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom .,Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom
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Kobayashi Y, Nam CW, Tonino PAL, Kimura T, De Bruyne B, Pijls NHJ, Fearon WF. The Prognostic Value of Residual Coronary Stenoses After Functionally Complete Revascularization. J Am Coll Cardiol 2016; 67:1701-11. [PMID: 27056776 DOI: 10.1016/j.jacc.2016.01.056] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The residual SYNTAX score (RSS) and SYNTAX revascularization index (SRI) quantitatively assess angiographic completeness of revascularization for patients with multivessel coronary artery disease. Whether residual angiographic disease remains of prognostic importance after "functionally" complete revascularization with fractional flow reserve (FFR) guidance is unknown. OBJECTIVES This study sought to investigate the prognostic value of the RSS and SRI after FFR-guided functionally complete revascularization. METHODS From the FFR-guided percutaneous coronary intervention (PCI) cohort of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial, the RSS and SRI were calculated in 427 patients after functionally complete revascularization. The RSS was defined as the SYNTAX score (SS) recalculated after PCI. The SRI was calculated as: 100 × (1 - RSS/baseline SS) (%). We compared differences in 1- and 2-year outcomes among patients with RSS of 0, >0 to 4, >4 to 8, and >8, and with SRI of 100%, 50% to <100%, and 0 to <50%. RESULTS The mean baseline SS, RSS, and SRI were 14.4 ± 7.2, 6.5 ± 5.8, and 55.1 ± 32.5%, respectively. Major adverse cardiac events (MACE) at 1 year occurred in 53 patients (12.4%). Patients with MACE had higher SS than those without (18.0 [interquartile range (IQR): 11.0 to 21.0] vs. 12.0 [IQR: 9.0 to 18.0], p = 0.001), but had similar RSS and SRI after PCI (RSS: 6.0 [IQR: 3.0 to 10.0] vs. 5.0 [IQR: 2.0 to 9.5], p = 0.51 and SRI: 60.0% [IQR: 40.9% to 78.9%] vs. 58.8% [IQR: 26.7% to 81.8%], p = 0.24, respectively). Kaplan-Meier analysis showed similar 1-year incidence of MACE with RSS/SRI stratifications (log-rank p = 0.55 and p = 0.54, respectively). Results were similar with 2-year outcome data analysis. CONCLUSIONS After functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774).
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Affiliation(s)
- Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | - Chang-Wook Nam
- Keimyung University College of Medicine, Dongsan Medical Center, Daegu, South Korea
| | | | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | | | | | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford, California.
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Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a semiquantitative angiographic score developed to prospectively characterize the disease complexity of the coronary vasculature. With more than 50 validation studies, the SYNTAX score is the most-studied risk model in the setting of percutaneous coronary intervention. In this article, the evolutionary journey of the SYNTAX score is reviewed, with emphasis on its sequential modifications and adaptations, now culminating in the development and validation of the SYNTAX score II.
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Affiliation(s)
- Davide Capodanno
- Dipartimento Cardio-Toraco-Vasculare, Ferrarotto Hospital, University of Catania, Via Citelli, 6, Catania 95124, Italy.
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Giustino G, Baber U, Aquino M, Sartori S, Stone GW, Leon MB, Genereux P, Dangas GD, Chandrasekhar J, Kimura T, Salianski O, Stefanini GG, Steg PG, Windecker S, Wijns W, Serruys PW, Valgimigli M, Morice MC, Camenzind E, Weisz G, Smits PC, Kandzari DE, Galatius S, Von Birgelen C, Saporito R, Jeger RV, Mikhail GW, Itchhaporia D, Mehta L, Ortega R, Kim HS, Kastrati A, Chieffo A, Mehran R. Safety and Efficacy of New-Generation Drug-Eluting Stents in Women Undergoing Complex Percutaneous Coronary Artery Revascularization. JACC Cardiovasc Interv 2016; 9:674-84. [DOI: 10.1016/j.jcin.2015.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/18/2022]
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Alidoosti M, Saroukhani S, Lotfi-Tokaldany M, Jalali A, Sobh-Rakhshankhah A. Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:308-12. [PMID: 27198530 DOI: 10.1016/j.carrev.2016.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/12/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies reported conflicting results regarding the impact of incomplete revascularization on the outcome of percutaneous coronary intervention (PCI). We evaluated the association between residual SYNTAX score (RSS) as a quantitative measure of incomplete revascularization and one-year outcome of patients with native multi-vessel disease undergoing PCI. METHODS A total of 760 patients (mean age=59.14±10.36years, 70.4% males) who underwent successful PCI with the incomplete revascularization strategy between September 2008 and March 2010 were included. The RSS was used to quantify the extent and complexity of residual coronary stenosis following PCI. Multivariable analysis was used to evaluate the impact of RSS on one-year major adverse cardiac events (MACE) including death, myocardial infarction, and revascularization. RESULTS Overall incidence of one-year MACE was 4.74%. Using ROC curve analysis a cut-off of >5 for baseline RSS had a significant association with occurrence of 12-month MACE (area under the curve=0.769; P value<0.001, sensitivity =75% and specificity=72%). Unadjusted effect of RSS>5 on 12months MACE showed a hazard ratio of 7.34 (p value<0.001). By multivariable analysis, effect of the RSS>5 on 12months MACE was adjusted for potential confounders. After adjustment to clinical SYNTAX score as the sole confounder, RSS>5 remained a strong associate with 12months MACE and its effect outweighed that of before adjustment (hazard ratio=8.03, p value<0.001). CONCLUSIONS The RSS is a quantified measure of the complexity of residual coronary stenoses, and RSS>5 could be able to discriminate patients with an increased risk of one-year MACE.
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Affiliation(s)
- Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Sepideh Saroukhani
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Masoumeh Lotfi-Tokaldany
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Arash Jalali
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
| | - Amir Sobh-Rakhshankhah
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1411713138, Iran.
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Loutfi M, Ayad S, Sobhy M. Impact of the Residual SYNTAX Score on Outcomes of Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:29-35. [PMID: 26997875 PMCID: PMC4786097 DOI: 10.4137/cmc.s35730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI.
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Affiliation(s)
- Mohamed Loutfi
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sherif Ayad
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sobhy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Khan R, Al-Hawwas M, Hatem R, Azzalini L, Fortier A, Joliecoeur EM, Tanguay JF, Lavoie-L'Allier P, Ly HQ. Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2016; 88:740-747. [DOI: 10.1002/ccd.26413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/23/2015] [Accepted: 12/26/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Razi Khan
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Malek Al-Hawwas
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Raja Hatem
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | | | - Annik Fortier
- Montreal Heart Institute Coordinating Center and Université De Montréal; Montreal Quebec Canada
| | | | - Jean-Francois Tanguay
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Philippe Lavoie-L'Allier
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Hung Q. Ly
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
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Bettinger N, Palmerini T, Caixeta A, Dressler O, Litherland C, Francese DP, Giustino G, Mehran R, Leon MB, Stone GW, Généreux P. Risk stratification of patients undergoing medical therapy after coronary angiography. Eur Heart J 2015; 37:3103-3110. [DOI: 10.1093/eurheartj/ehv674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
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Généreux P, Campos CM, Yadav M, Palmerini T, Caixeta A, Xu K, Francese DP, Dangas GD, Mehran R, Leon MB, Serruys PW, Stone GW. Reasonable incomplete revascularisation after percutaneous coronary intervention: the SYNTAX Revascularisation Index. EUROINTERVENTION 2015; 11:634-42. [DOI: 10.4244/eijy14m10_05] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Witberg G, Lavi I, Assali A, Vaknin-Assa H, Lev E, Kornowski R. The incremental impact of residual SYNTAX score on long-term clinical outcomes in patients with multivessel coronary artery disease treated by percutaneous coronary interventions. Catheter Cardiovasc Interv 2015; 86:3-10. [DOI: 10.1002/ccd.25753] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 11/15/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Guy Witberg
- Department of Cardiology; Rabin Medical Center; PetachTikva Israel
| | - Ifat Lavi
- Department of Cardiology; Rabin Medical Center; PetachTikva Israel
| | - Abid Assali
- Department of Cardiology; Rabin Medical Center; PetachTikva Israel
| | - Hana Vaknin-Assa
- Department of Cardiology; Rabin Medical Center; PetachTikva Israel
| | - Eli Lev
- Department of Cardiology; Rabin Medical Center; PetachTikva Israel
| | - Ran Kornowski
- Department of Cardiology; Rabin Medical Center; PetachTikva Israel
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Xu B, Généreux P, Yang Y, Leon MB, Xu L, Qiao S, Wu Y, Yan H, Chen J, Zhao Y, Zhao Y, Palmerini T, Stone GW, Gao R. Validation and Comparison of the Long-Term Prognostic Capability of the SYNTAX Score-II Among 1,528 Consecutive Patients Who Underwent Left Main Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2014; 7:1128-37. [DOI: 10.1016/j.jcin.2014.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022]
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Xu B, Yang YJ, Han YL, Lu SZ, Li B, Liu Q, Zhu GY, Cui JY, Li L, Zhao YL, Kirtane AJ. Validation of residual SYNTAX score with second-generation drug-eluting stents: one-year results from the prospective multicentre SEEDS study. EUROINTERVENTION 2014; 10:65-73. [DOI: 10.4244/eijv10i1a12] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yadav M, Palmerini T, Caixeta A, Madhavan MV, Sanidas E, Kirtane AJ, Stone GW, Généreux P. Prediction of Coronary Risk by SYNTAX and Derived Scores. J Am Coll Cardiol 2013; 62:1219-1230. [DOI: 10.1016/j.jacc.2013.06.047] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/05/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
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