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Mayer K, Ndrepepa G, Schroeter M, Emmer C, Bernlochner I, Schüpke S, Gewalt S, Hilz R, Coughlan JJ, Aytekin A, Heyken C, Morath T, Schunkert H, Laugwitz KL, Sibbing D, Kastrati A. High on-aspirin treatment platelet reactivity and restenosis after percutaneous coronary intervention: results of the Intracoronary Stenting and Antithrombotic Regimen-ASpirin and Platelet Inhibition (ISAR-ASPI) Registry. Clin Res Cardiol 2023; 112:1231-1239. [PMID: 36786829 PMCID: PMC10449652 DOI: 10.1007/s00392-023-02161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The aim of this study was to assess the association between high on-aspirin treatment platelet reactivity (HAPR) and the subsequent risk of restenosis after percutaneous coronary intervention (PCI) with predominantly drug-eluting stents. BACKGROUND The association between HAPR and subsequent risk of restenosis after PCI is unclear. METHODS This study included 4839 patients undergoing PCI (02/2007-12/2011) in the setting of the Intracoronary Stenting and Antithrombotic Regimen-ASpirin and Platelet Inhibition (ISAR-ASPI) registry. Platelet function was assessed with impedance aggregometry using the multi-plate analyzer immediately before PCI and after intravenous administration of aspirin (500 mg). The primary outcome was clinical restenosis, defined as target lesion revascularization at 1 year. Secondary outcomes included binary angiographic restenosis and late lumen loss at 6- to 8-month angiography. RESULTS The upper quintile cut-off of platelet reactivity measurements (191 AU × min) was used to categorize patients into a group with HAPR (platelet reactivity > 191 AU × min; n = 952) and a group without HAPR (platelet reactivity ≤ 191 AU × min; n = 3887). The primary outcome occurred in 94 patients in the HAPR group and 405 patients without HAPR (cumulative incidence, 9.9% and 10.4%; HR = 0.96, 95% CI 0.77-1.19; P = 0.70). Follow-up angiography was performed in 73.2% of patients. There was no difference in binary restenosis (15.2% vs. 14.9%; P = 0.79) or late lumen loss (0.32 ± 0.57 vs. 0.32 ± 0.59 mm; P = 0.93) between patients with HAPR versus those without HAPR. CONCLUSIONS This study did not find an association between HAPR, measured at the time of PCI, and clinical restenosis at 1 year after PCI.
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Affiliation(s)
- Katharina Mayer
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Mira Schroeter
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Christopher Emmer
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Isabell Bernlochner
- Medizinische Klinik and Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Senta Gewalt
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Raphaela Hilz
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - John Joseph Coughlan
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Alp Aytekin
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Clarissa Heyken
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Tanja Morath
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik and Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dirk Sibbing
- Klinik der Universität München, Cardiology, Ludwig-Maximilians-Universität, Munich, Germany
- Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf und Ludwig-Maximilians-Univerität, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Cardiology and Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Felbel D, Bozic F, Mayer B, Krohn-Grimberghe M, Paukovitsch M, d’Almeida S, Mörike J, Gonska B, Imhof A, Buckert D, Rottbauer W, Markovic S, Stephan T. Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease-a meta-analysis. Front Cardiovasc Med 2023; 10:1213992. [PMID: 37671137 PMCID: PMC10475729 DOI: 10.3389/fcvm.2023.1213992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. Methods Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. Results Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03-0.05 (DES) vs. 0.03-0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02-0.04) vs. 0.02 (0.01-0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02-0.05)] compared with 1% in the DCB group [0.01 (0.00-0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07-0.10) vs. 0.04 (0.02-0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. Conclusion This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.
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Affiliation(s)
- Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Filip Bozic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Marvin Krohn-Grimberghe
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sascha d’Almeida
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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Chen F, Lu J, Yang X, Liu D, Wang Q, Geng X, Xiao B, Zhang J, Liu F, Gu G, Cui W. Different hydration methods for the prevention of contrast-induced nephropathy in patients with elective percutaneous coronary intervention: a retrospective study. BMC Cardiovasc Disord 2023; 23:323. [PMID: 37355592 PMCID: PMC10290803 DOI: 10.1186/s12872-023-03358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Hydration is currently the main measure to prevent contrast-induced nephropathy (CIN). We aimed to compare the preventive effect of preprocedure and postprocedure hydration on CIN in patients with coronary heart disease undergoing elective percutaneous coronary intervention (PCI). METHODS A retrospective study included 198 cases of postprocedure hydration and 396 cases of preprocedure hydration using propensity score matching. The incidence of CIN 48 h after PCI and adverse events within 30 days after contrast media exposure were compared between the two groups. Logistic regression analysis was used to analyse the risk factors for CIN. RESULTS The incidence of CIN in the postprocedure hydration group was 3.54%, while that in the preprocedure hydration group was 4.8%. There was no significant difference between the two groups (p = 0.478). Multivariate logistic regression analysis showed that diabetes mellitus, baseline BNP and cystatin C levels, and contrast agent dosage were independent risk factors for CIN. There was no significant difference in the incidence of major adverse events between the two groups (3.03% vs. 2.02%, p = 0.830). CONCLUSIONS Postprocedure hydration is equally effective compared to preoperative hydration in the prevention of CIN in patients with coronary heart disease undergoing elective PCI.
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Affiliation(s)
- Fei Chen
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Jingchao Lu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Xiuchun Yang
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Demin Liu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Qian Wang
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Xue Geng
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Bing Xiao
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Jie Zhang
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Fan Liu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Guoqiang Gu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Wei Cui
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China.
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Råmunddal T, Holck EN, Karim S, Eftekhari A, Escaned J, Ioanes D, Walsh S, Spratt J, Veien K, Jensen LO, Tilsted HH, Terkelsen CJ, Havndrup O, Olsen NT, Kajander OA, Faurie B, Lanematt P, Jakobsen L, Christiansen EH. International randomized trial on the effect of revascularization or optimal medical therapy of chronic total coronary occlusions with myocardial ischemia - ISCHEMIA-CTO trial - rationale and design. Am Heart J 2023; 257:41-50. [PMID: 36423733 DOI: 10.1016/j.ahj.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Chronic total occlusions (CTO) are frequent among patients with coronary artery disease. Revascularization with percutaneous coronary intervention (PCI) is safe and feasible in experienced hands. However, randomized data are needed to demonstrate symptomatic as well as prognostic effect of CTO-PCI compared to optimal medical therapy alone. METHODS This trial aims to evaluate the effect of CTO PCI in patients with a CTO lesion and target vessel diameter ≥ 2.5 mm, and myocardial ischemia in the relevant territory. First, all patients are subjected to optimal medical therapy (OMT) for at least for 3 months and non-CTO lesions are managed according to guidelines. Subsequently, prior to randomization myocardial ischemia and quality of life (Seattle Questionnaire (SAQ)) is assessed. Patients are divided into two cohorts based on their SAQ score and randomized to either OMT alone or OMT and CTO-PCI. Cohort A is defined as Low- or asymptomatic patients with a quality-of-life score > 60 and/or CCS class < 2, and more than 10 % ischemia in the left ventricle (LV). Cohort B is symptomatic patients with a quality-of-life score < 60 or CCS class angina > 1 and at least ischemia in 5% of the LV. The primary end-point in cohort A is a composite of major adverse cardiac and cerebral events, hospitalization for heart failure and malignant ventricular arrhythmias. The primary endpoint in cohort B is difference in quality of life 6 months after randomization. IMPLICATIONS This trial is designed to investigate if CTO-PCI improves QoL and MACCE. Both positive and negative outcome of the trial will affect future guidelines and recommendations on how to treat patients with CTO.
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Affiliation(s)
| | | | - Salma Karim
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
| | - Ashkan Eftekhari
- Dept. of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Javier Escaned
- Hospital Universitario Clíníco San Carlos, Madrid, Spain
| | - Dan Ioanes
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Walsh
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, United Kingdom
| | - James Spratt
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | | | | | | | | | | | - Niels Thue Olsen
- Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Olli A Kajander
- Tays Heart Hospital and Tampere University, Tampere, Finland
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | - Lars Jakobsen
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
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5
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Rashid M, Stevens C, Wijeysundera HC, Curzen N, Khoo CW, Mohamed MO, Aktaa S, Wu J, Ludman P, Mamas MA. Rates of Elective Percutaneous Coronary Intervention in England and Wales: Impact of COURAGE and ORBITA Trials. J Am Heart Assoc 2022; 11:e025426. [DOI: 10.1161/jaha.122.025426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background
There are limited data about how COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) and ORBITA (Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) trials have impacted percutaneous coronary intervention (PCI) practices at regional or national level. We evaluated temporal trends in elective PCI rates for stable angina and, specifically, examined the impact of the COURAGE and ORBITA trials on PCI practices in England and Wales.
Methods and Results
We used national PCI data comprising >1.2 million patients undergoing PCI between January 2006 and December 2019. Patient demographics, procedural details, and clinical outcomes were analyzed, and temporal trends in PCI rates for stable angina were compared before and after the publication of the COURAGE and ORBITA trials. Of 1 245 802 PCI procedures, 430 248 (34.5%) were performed for stable angina. Over the study period, the number of elective PCI procedures per year (30 823 in 2006 to 34 103 in 2019) and per 100 000 population estimates (50.7 in 2006 to 58.4 in 2019) remained stable. The proportion of patients undergoing elective PCI without angina symptoms almost doubled from 5.1% to 9.7%. The incidence rate of elective PCI volume after the COURAGE trial, published in 2007, was not different from before the trial was published (incidence rate ratio, 1.06 [95% CI, 0.69–1.62]). It also remained stable after the publication of the ORBITA trial in 2017 (incidence rate ratio, 0.96 [95% CI, 0.74–1.23]).
Conclusions
In this nationwide analysis, rates of elective PCI for stable angina remained stable over 14 years. Publication of the COURAGE and ORBITA trials had no impact on elective PCI activity.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, School of Medicine, Keele University Stoke‐on‐Trent UK
- Department of Academic Cardiology Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Chris Stevens
- Keele Cardiovascular Research Group, School of Medicine, Keele University Stoke‐on‐Trent UK
| | | | - Nick Curzen
- Faculty of Medicine, University of Southampton & Department of Cardiology University Hospital NHS Trust Southampton UK
| | - Chee Wah Khoo
- Department of Academic Cardiology Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, School of Medicine, Keele University Stoke‐on‐Trent UK
| | - Suleman Aktaa
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine Leeds UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine Leeds UK
- School of Dentistry University of Leeds UK
| | - Peter F. Ludman
- Department of Cardiology Queen Elizabeth University Hospital Birmingham UK
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, School of Medicine, Keele University Stoke‐on‐Trent UK
- Department of Academic Cardiology Royal Stoke University Hospital Stoke‐on‐Trent UK
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Romagnoli E, Ramazzotti V, Burzotta F, Gatto L, Marco V, Paoletti G, Biondi-Zoccai G, Alfonso F, Crea F, Trani C, Prati F. Definition of Optimal Optical Coherence Tomography-Based Stent Expansion Criteria: In-Stent Minimum Lumen Area Versus Residual Stent Underexpansion. Circ Cardiovasc Interv 2022; 15:e011496. [PMID: 36126136 DOI: 10.1161/circinterventions.121.011496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mismatch between in-stent minimum lumen area (sMLA) and reference vessel lumen area, defined as stent underexpansion (SU), could be an important determinant of stent failure. We tested the clinical predictive value of absolute sMLA in comparison to relative SU in the context of the CLI-OPCI (Centro Per La Lotta Contro L'Infarto-Optimisation of Percutaneous Coronary Intervention) project registry. METHODS We retrospectively analyzed end procedural optical coherence tomography findings in 1211 patients (1422 lesions) undergoing percutaneous coronary intervention, assessing the prevalence and magnitude of residual SU and exploring correlation with outcome in comparison with sMLA. RESULTS In our series, both sMLA and SU were related to vessel size and anatomic lesion complexity. When compared with patients without adverse event at follow-up, those experiencing device-oriented cardiovascular events (composite of cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis) showed a lower sMLA (5.6±2.1 versus 6.1±2.1 mm2; P=0.011) but a comparable degree of SU (11.6±14.1% versus 11.2±13.3%; P=0.734). The prespecified cutoff value of sMLA <4.5 mm2, documented in 23.8% of cases, was confirmed as independent outcome predictor for device-oriented cardiovascular events (hazard ratio [HR], 2.05 [95% CI, 1.5-2.9]) including target lesion revascularization (HR, 2.43 [95% CI, 1.7-3.5]) and stent thrombosis (HR, 3.23 [95% CI, 1.7-6.3]). A residual SU of 10%, 20%, and 30% was observed in 38.0%, 18.2%, and 7.6% of cases, respectively. No grade of residual SU significantly increased the risk of stent failure, unless if an SU >20% was associated with an sMLA <4.5 mm2 (HR, 3.11 [95% CI, 1.7-5.6]). Finally, an association between stent overexpansion (ie, >110%) and device-oriented cardiovascular events was also observed (HR, 1.60 [95% CI, 1.1-2.3]). CONCLUSIONS Final absolute sMLA and not relative SU was associated with an increased risk of stent failure. A variable grade of SU was common, but it resulted in being clinically relevant only when associated with an sMLA <4.5 mm2.
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Affiliation(s)
- Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (E.R.)
| | | | | | - Laura Gatto
- San Giovanni Addolorata Hospital, Rome, Italy (V.R., L.G.).,Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (L.G., V.M., G.P., F.P.)
| | - Valeria Marco
- Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (L.G., V.M., G.P., F.P.)
| | - Giulia Paoletti
- Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (L.G., V.M., G.P., F.P.)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.-Z.).,Mediterranea Cardiocentro, Napoli, Italy (G.B.-Z.)
| | | | - Filippo Crea
- Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., F.C., C.T.)
| | - Carlo Trani
- Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., F.C., C.T.)
| | - Francesco Prati
- Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (L.G., V.M., G.P., F.P.).,UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy (F.P.)
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7
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Lee SY, Cho YK, Kim SW, Hong YJ, Koo BK, Bae JW, Lee SH, Yang TH, Park HS, Choi SW, Lim DS, Kim SJ, Jeong YH, Lee HJ, Lee KY, Shin ES, Kim U, Kim MH, Nam CW, Hur SH, Kim DI. Clinical Results of Drug-Coated Balloon Treatment in a Large-Scale Multicenter Korean Registry Study. Korean Circ J 2022; 52:444-454. [PMID: 35491479 PMCID: PMC9160640 DOI: 10.4070/kcj.2021.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to demonstrate the efficacy and safety of treatment with drug-coated balloon (DCB) in a large real-world population. METHODS Patients treated with DCBs were included in a multicenter observational registry that enrolled patients from 18 hospitals in Korea between January 2009 and December 2017. The primary outcome was target lesion failure (TLF) defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically indicated target lesion revascularization at 12 months. RESULTS The study included 2,509 patients with 2,666 DCB-treated coronary artery lesions (1,688 [63.3%] with in-stent restenosis [ISR] lesions vs. 978 [36.7%] with de novo lesions). The mean age with standard deviation was 65.7±11.3 years; 65.7% of the patients were men. At 12 months, the primary outcome, TLF, occurred in 179 (6.7%), 151 (8.9%), 28 (2.9%) patients among the total, ISR, and de novo lesion populations, respectively. A history of hypertension, diabetes, acute coronary syndrome, previous coronary artery bypass graft, reduced left ventricular ejection fraction, B2C lesion and ISR lesion were independent predictors of 12 months TLF in the overall study population. CONCLUSIONS This large multicenter DCB registry study revealed the favorable clinical outcome of DCB treatment in real-world practice in patient with ISR lesion as well as small de novo coronary lesion.
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Affiliation(s)
- Sang Yeub Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Yun-Kyeong Cho
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sang-Wook Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Joon Hong
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Hwan Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Tae Hyun Yang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Do-Sun Lim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo-Joong Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | | | | | - Eun-Seok Shin
- Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Ung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea.
| | - Doo-Il Kim
- Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine, Busan, Korea.
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8
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Blumenfeld O, Dichtiar R, Sharoni E, Leviner DB. Outcomes of cardiac surgery in patients with end-stage renal disease: Insights from the Israel national registries. J Card Surg 2022; 37:760-768. [PMID: 35112395 DOI: 10.1111/jocs.16254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/17/2021] [Accepted: 11/02/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) has been shown to be associated with increased mortality in patients undergoing cardiac surgery. We aimed to compare the short- and mid-term mortality after cardiac surgery of patients with dialysis-dependent ESRD (DD-ESRD) to patients with normal renal function (NRF), using national registries: the ESRD registry, the adult cardiac surgery registry (ACSR), and the National Mortality Registry. METHODS The study population comprised 8207 adult patients who underwent either isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), isolated mitral valve replacement (MVR), or CABG + valve-related procedure, between January 2017 and April 2019. Data were retrospectively extracted and reported to the ACSR by the department of medical records of each medical center. RESULTS One hundred and four DD-ESRD patients (mean age 63.2 ± 8.8 years, 83.7% males) were compared with 8103 NRF patients (mean age 64.9 ± 9.8 years, 77.6% males). Median follow-up for the total cohort was of 32.0 months (IQR; 25.0, 40.0). In DD-ESRD compared to NRF patients, 30-day mortality was higher (14.4% vs. 2.3%, respectively, p = 0.0001) and 4-year survival was significantly lower (44% ± 0.06 vs. 91% ± 0.04, respectively, p = 0.0001). Fifty-three percent of DD-ESRD 30-day mortality was caused by sepsis. Risk factors associated with reduced midterm survival included: DD-ESRD patients (HR = 4.7, 95% CI; 1.2-18.2), MVR procedure (HR = 1.5, 95% CI; 1.04-2.1) and combined CABG + valve-related procedure (HR = 1.6, 95% CI; 1.2-2.04). CONCLUSIONS Preoperative DD-ESRD was associated with a significant increase in 30-day and mid-term mortality after cardiac surgery. The highest mortality rate was observed in valvular and combined procedures.
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Affiliation(s)
- Orit Blumenfeld
- Israel Center for Disease Control, Ministry of Health, Jerusalem, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Ministry of Health, Jerusalem, Israel
| | - Erez Sharoni
- Cardiac surgery department, Carmel Medical center, Haifa, Israel
| | - Dror B Leviner
- Cardiac surgery department, Carmel Medical center, Haifa, Israel
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9
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Mansour HH, Alajerami YS, Abushab KM, Quffa KM. The diagnostic accuracy of coronary computed tomography angiography in patients with and without previous coronary interventions. J Med Imaging Radiat Sci 2022; 53:81-86. [PMID: 34987013 DOI: 10.1016/j.jmir.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Invasive coronary angiography (ICA) is the gold standard for imaging coronary arteries and the severity of coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) has undergone remarkable progress in the diagnosis of CAD. OBJECTIVES To evaluate the effect of prior vs no previous coronary interventions on the diagnostic accuracy of CCTA as an alternative to ICA to improve health outcomes for patients with suspected CAD. METHODS A prospective cohort study was carried out among patients suspected of CAD and for evaluation of grafts and stents to investigate recurrent ischemic symptoms. 120 patients imaged by CCTA were then referred to ICA, which is considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CCTA were assessed relative to ICA. RESULTS Based on a per-patient analysis, the comparison with ICA reveals variations in sensitivity, specificity, PPV, NPV and accuracy of CCTA. In patients without any previous coronary interventions, the sensitivity was 97.8%, and specificity was 95.6%. The PPV and NPV were 97.8% and 95.5%, respectively. Regarding patients with coronary artery bypass grafts (CABG), the sensitivity was 95% and specificity 100%. The PPV and NPV were 100% and 90.9%, respectively. Regarding patients with prior percutaneous coronary intervention (PCI), the results were a sensitivity of 84.6%, specificity of 77.8%, PPV of 84.6% and NPV of 77.8%. CONCLUSION CCTA is a powerful diagnostic tool, especially for the evaluation of the major coronary arteries and evaluation of patients with prior CABG. ICA is recommended for evaluation of patients with an intracoronary stent.
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Affiliation(s)
- Husam H Mansour
- Radiology Department, Al-Shifa Hospital, Gaza-Palestine, Palestine; Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine.
| | - Yasser S Alajerami
- Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine
| | - Khaled M Abushab
- Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine
| | - Khetam M Quffa
- Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine
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10
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Outcomes in Multivessel Coronary Disease Stratified by Society for Thoracic Surgery Risk. Ann Thorac Surg 2021; 114:442-449. [PMID: 34801475 DOI: 10.1016/j.athoracsur.2021.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Surgical risk stratified outcomes following contemporary revascularization strategies have not been well described. We report these outcomes in patients undergoing Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) for multivessel coronary disease. METHODS 5836 patients with multivessel disease who underwent CABG (4420) or PCI (1416) were included in this retrospective observational analysis. Data was stratified based on Society of Thoracic Surgeons risk score. Score <4% was considered low risk and ≥4% was intermediate-high risk. Outcomes included mortality, inpatient readmissions and repeat revascularizations. RESULTS In the CABG population, 3863 (87.3%) were low surgical risk and 557 (12.6%) were intermediate-high risk. The 5-year mortality for the low risk cohort was 10.9% (95% CI 9.83-12.05) and for the intermediate-high risk cohort, it was 40.1% (95% CI 35.76-44.54). Among those undergoing PCI, 1163 (82.1%) were low risk while 249 (17.6%) were intermediate-high risk. The 5-year mortality for the low risk cohort was 21.6% (95% CI 19.10-24.26) and for the intermediate-high risk cohort, it was 61.8% (95% CI 54.72-68.70). CONCLUSIONS This study reports outcomes stratified by surgical risk after PCI or CABG in patients with multivessel coronary disease. This data can help guide revascularization strategy choice for individual patients.
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11
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NT-proBNP and Major Adverse Cardiovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Primary Percutaneous Coronary Intervention: A Prospective Cohort Study. Cardiol Res Pract 2021; 2021:9943668. [PMID: 34765262 PMCID: PMC8577951 DOI: 10.1155/2021/9943668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/08/2021] [Accepted: 09/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background The prognostic significance of the amino-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) has not been fully elucidated. Major adverse cardiovascular events (MACEs) are clinically viable indicators for the accurate, rapid, and safe evaluation of patients with STEMI. This study was designed to investigate the relationship between NT-proBNP levels and the occurrence of short-term MACEs in patients with STEMI who underwent emergency PCI. Methods This prospective cohort study included 405 patients with STEMI aged 20–90 years who underwent emergency PCI at the First People's Hospital of Changde City from April 6, 2017, to May 31, 2019. Stent thrombosis, reinfarction, congestive heart failure, unstable angina, and cardiac death were considered as MACEs in this study. The target-independent and -dependent variables were NT-proBNP at baseline and MACE, respectively. Results There were 28.25% of MACEs. Age, number of implanted stents, Killip class, infarction-related artery, applied intra-aortic balloon pump (IABP), creatine kinase (CK) peak value, CK-MB peak value, TnI peak value, and ST-segment resolution were independently associated with MACE (P < 0.05). In a multivariate model, after adjusting all potential covariates, Log2 NT-proBNP levels remained significantly associated with MACE, with an inflection point of 11.66. The effect sizes and confidence intervals of the left and right sides of the inflection point were 1.07 and 0.84–1.36 (P=0.5730) and 3.47 and 2.06–5.85 (P < 0.0001), respectively. Conclusions In patients with STEMI who underwent PCI, Log2 NT-proBNP was positively correlated with MACE within 1 month when the Log2 NT-proBNP was >11.66 (NT-proBNP >3.236 pg/mL).
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Sebastian G, Pillai V, Manzil A, Damodara R, Kalra I, Abdul Z, Mathew O. Comparison of multiple risk scores in assessing medium-to long-term clinical outcomes in unstable angina / non-ST-elevation myocardial infarction patients undergoing multi vessel percutaneous coronary intervention: An observational, registry-based study in India. Indian Heart J 2021; 73:555-560. [PMID: 34627568 PMCID: PMC8514402 DOI: 10.1016/j.ihj.2021.08.001] [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: 01/31/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Post-revascularization mortality in multivessel coronary artery disease (MVCAD) has been explored via several risk scores. Here, we assessed and compared various risk scores in predicting medium to long-term clinical outcomes in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) patients with MVCAD undergoing percutaneous coronary intervention (PCI). Methods We analyzed a cohort of a tertiary care center registry enrolling patients in South India, Kerala, with MVCAD (N = 200) who had undergone PCI between 2010 and 2018. The outcomes evaluated were all-cause mortality and major adverse cardiac events (MACE). The risk scores assessed included SYNTAX score (SS), residual SYNTAX score (rSS), SYNTAX revascularization index (SRI), age, creatinine, and ejection fraction (ACEF) score, clinical SYNTAX score (cSS), and SYNTAX score II (SSII). Results Of the analyzed risk scores, SSII had the best predictive capability with the area under the curve (AUC) of 0.79 in c-statistics, followed by ACEF score and cSS with AUCs of 0.74 and 0.65, respectively for all-cause mortality (p < 0.01). Kaplan–Meier survival curves and multivariate analysis by Cox regression showed SSII with cut-offs of >35.15 and > 29.55 to be the only score associated with higher mortality and MACE, respectively. Conclusions In UA/NSTEMI patients with relatively less complex MVCAD treated by PCI, the SSII, ACEF and cSS risk scores could predict the outcomes better. The SSII showed the best predictive performance for all-cause mortality and MACE. Scores based on baseline and residual atherosclerotic burden (SS, rSS, and SRI) performed poorly in predicting the mortality and MACE.
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Affiliation(s)
- Gailin Sebastian
- Department of Cardiology, Government Medical College, Kannur, Kerala, India.
| | - Vivek Pillai
- Department of Cardiology, Government Medical College, Kannur, Kerala, India.
| | - Ashraf Manzil
- Department of Cardiology, Government Medical College, Kannur, Kerala, India.
| | | | - Ish Kalra
- Department of Cardiology, Government Medical College, Kannur, Kerala, India.
| | - Zameel Abdul
- Department of Cardiology, Government Medical College, Kannur, Kerala, India.
| | - Oommen Mathew
- Population Research Center, University of Kerala, Thiruvananthapuram, Kerala, India.
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Jurga J, Szummer KE, Lewinter C, Mellbin L, Götberg M, Zwackman S, Nilsson J, Völz S, Erlinge D, Persson J, Omerovic E, Jernberg T, Venetsanos D. Pretreatment With P2Y12 Inhibitors in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Report From the Swedish Coronary Angiography and Angioplasty Registry. Circ Cardiovasc Interv 2021; 14:e010849. [PMID: 34592825 DOI: 10.1161/circinterventions.121.010849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with chronic coronary syndrome undergoing percutaneous coronary intervention, the optimal timing of P2Y12 inhibitors' administration is uncertain. We compared pretreatment versus treatment in the catheterization laboratory (In-Cathlab) in a real-world population. METHODS In Swedish Coronary Angiography and Angioplasty Registry, all patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, between 2006 and 2017 were identified. Pretreatment was defined as P2Y12 inhibitor administration before coronary angiography, outside the catheterization laboratory. Outcomes were net adverse clinical events including death, myocardial infarction, stroke, or bleeding within 30 days of the index procedure and in-hospital bleeding. RESULTS We included 26 814 patients, 8237 in the In-Cathlab, and 18 577 in the pretreatment group. In-Cathlab treatment compared with pretreatment was associated with lower risk for net adverse clinical event (4.2 versus 5.1%, adjusted hazard ratio 0.79 [0.63-0.99]), bleeding (2.3 versus 2.6%, adjusted hazard ratio, 0.76 [0.57-1.01]). and in-hospital bleeding (1.9 versus 2.1%, adjusted odds ratio, 0.70 [0.51-0.96]). The risk for death, myocardial infarction, or stroke did not significantly differ between the groups. Among the In-Cathlab treated patients, 41% received ticagrelor or prasugrel and 59% clopidogrel. Treatment with ticagrelor or prasugrel was associated with higher risk for net adverse clinical events (5.4% versus 3.4%, adjusted hazard ratio, 1.66 [1.12-2.48]), bleeding (3.4 versus 1.6%, adjusted hazard ratio, 2.14 [1.34-3.42]), and in-hospital bleeding (2.9 versus 1.2%, adjusted odds ratio, 2.24 [1.29-3.90]) but similar risk for death, myocardial infarction, or stroke, compared with clopidogrel. CONCLUSIONS In patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, pretreatment with P2Y12 inhibitors, before arrival to the catheterization laboratory, was not associated with improved clinical outcomes but was associated with increased risk for bleeding. Our data support clopidogrel administration in the catheterization laboratory as the standard of care. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Juliane Jurga
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
| | - Karolina Elizabeth Szummer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden (K.E.S.)
| | - Christian Lewinter
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
| | - Linda Mellbin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
| | - Matthias Götberg
- Department of Cardiology, Lund University Hospital, Skåne, Sweden (M.G., D.E.)
| | - Sammy Zwackman
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Sweden (S.Z.)
| | - Johan Nilsson
- Department of Cardiology, Umeå University and Umeå University Hospital, Sweden (J.N.)
| | - Sebastian Völz
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden (S.V., E.O.)
| | - David Erlinge
- Department of Cardiology, Lund University Hospital, Skåne, Sweden (M.G., D.E.)
| | - Jonas Persson
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden (J.P., T.J.)
| | - Elmir Omerovic
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden (S.V., E.O.)
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden (J.P., T.J.)
| | - Dimitrios Venetsanos
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
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Akil S, Hedeer F, Oddstig J, Olsson T, Jögi J, Erlinge D, Carlsson M, Arheden H, Hindorf C, Engblom H. Appropriate coronary revascularization can be accomplished if myocardial perfusion is quantified by positron emission tomography prior to treatment decision. J Nucl Cardiol 2021; 28:1664-1672. [PMID: 31705424 PMCID: PMC8421314 DOI: 10.1007/s12350-019-01938-y] [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] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Many patients undergo percutaneous coronary intervention (PCI) without the use of non-invasive stress testing prior to treatment. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention. METHODS AND RESULTS Thirty-three patients (10 females) with suspected or established CAD who had been referred for a clinical coronary angiography (CA) with possibility for PCI were included. Adenosine stress and rest 13N-NH3 PET, cardiac magnetic resonance (CMR), and cardiopulmonary exercise test were performed 4 ± 3 weeks before and 5 ± 1 months after CA. The angiographer was blinded to the PET and CMR results. Myocardial flow reserve (MFR) < 2.0 by PET was considered abnormal. A PCI was performed in 19/33 patients. In 41% (11/27) of the revascularized vessel territories, a normal regional MFR was found prior to the PCI and no improvement in MFR was found at follow-up (P = 0.9). However, vessel territories with regional MFR < 2.0 at baseline improved significantly after PCI (P = 0.003). Of the 14 patients not undergoing PCI, four had MFR < 2.0 in one or more coronary territories. CONCLUSION Assessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of CA when managing patients with stable CAD.
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Affiliation(s)
- Shahnaz Akil
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Fredrik Hedeer
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Jenny Oddstig
- Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Thomas Olsson
- Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | | | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
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Pelewicz K, Wolny R, Bednarczuk T, Miśkiewicz P. Prevention of Iodinated Contrast Media-Induced Hyperthyroidism in Patients with Euthyroid Goiter. Eur Thyroid J 2021; 10:306-313. [PMID: 34395302 PMCID: PMC8314765 DOI: 10.1159/000515126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Iodinated contrast media (ICM)-induced hyperthyroidism is an underestimated, potentially severe condition; however, its prevention has not been sufficiently investigated. The aim of this study was to evaluate the influence of ICM on thyroid status, the advantages of prophylactic therapy for iodine-induced hyperthyroidism (IIH) in patients with euthyroid goiter and cardiovascular comorbidities, and the association between the incidence of IIH and thyroid volume. METHODS Thirty-six euthyroid patients undergoing procedures involving ICM administration were divided into 2 groups: the first group (n = 13) received prophylactic treatment with thiamazole or thiamazole combined with sodium perchlorate during ICM exposure; the second group (n = 23) did not receive prophylaxis. Thyroid-stimulating hormone levels were evaluated before and after ICM, and thyroid hormone levels were assessed after ICM at different points in time. The morphology of the thyroid was evaluated by ultrasonography. RESULTS Twenty-one patients (58%) developed hyperthyroidism after ICM. Hyperthyroidism was observed more frequently in the group without prophylactic treatment than in the group with prophylaxis (65 vs. 15%, respectively; p = 0.006). No cases of overt hyperthyroidism were observed in the group receiving thiamazole with sodium perchlorate. IIH persisted for a median time of 52.5 days. Larger thyroid volume was associated with a significantly higher occurrence of ICM-induced hyperthyroidism (p = 0.04). CONCLUSIONS Patients with euthyroid goiter receiving ICM are at risk of developing hyperthyroidism. The occurrence of hyperthyroidism after ICM in euthyroid patients with goiter is higher in those with larger thyroid volume. The frequency of ICM-induced hyperthyroidism in euthyroid patients with goiter is lower in those receiving prophylactic therapy with thiamazole in monotherapy or in combination with sodium perchlorate than in those not receiving prophylactic treatment.
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Affiliation(s)
- Katarzyna Pelewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
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16
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Thuesen AL, Riber LP, Veien KT, Christiansen EH, Jensen SE, Modrau I, Andreasen JJ, Borregaard B, Junker A, Mortensen PE, Jensen LO. Health-Related Quality of Life and Angina in Fractional Flow Reserve- Versus Angiography-Guided Coronary Artery Bypass Grafting: FARGO Trial (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization). Circ Cardiovasc Qual Outcomes 2021; 14:e007302. [PMID: 34078097 DOI: 10.1161/circoutcomes.120.007302] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND In coronary artery bypass grafting (CABG), the use of fractional flow reserve (FFR) is insufficiently investigated. Stenosis assessment usually relies on visual estimates of lesion severity. This study evaluated health-related quality of life (HRQoL) and angina after FFR- versus angiography-guided CABG. METHODS One hundred patients referred for CABG were randomized to FFR- or angiography-guided CABG. In the FFR group, lesions with FFR>0.80 were deferred, while the surgeon was blinded to the FFR values in the angiography group. Before and 6 months after CABG, HRQoL was assessed by the health state classifier EQ-5D of the EuroQoL 5-level instrument and angina status based on the Canadian Cardiovascular Society classification system were registered. RESULTS Six-month angiography included FFR evaluations of deferred lesions. In total, completed EQ-5D of the EuroQoL 5-level instrument questionnaires were available in 86 patients (43 in the FFR versus 43 in the angiography-guided group). HRQoL was significantly improved and angina significantly decreased from baseline to 6 months after CABG with no difference between the randomization groups. Graft failure rates and clinical outcomes were similar in both groups. Patients with graft failure or FFR<0.80 of the previous deferred lesions had significantly lower visual analogue scale scores (78.7±14.2 versus 86.8±14.7, P=0.004) and more angina compared with patients without graft failure or FFR≥0.80 at 6-month follow-up. CONCLUSIONS FFR- versus angiography-guided CABG demonstrated similar improvements in HRQoL and angina 6 months after CABG. Graft failure or low FFR in deferred lesions were associated with low HRQoL and angina. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02477371.
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Affiliation(s)
- Anne Langhoff Thuesen
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark.,Department of Cardiothoracic Surgery (A.L.T., L.P.R., P.E.M.), Odense University Hospital, Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery (A.L.T., L.P.R., P.E.M.), Odense University Hospital, Denmark
| | - Karsten Tange Veien
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark
| | | | | | - Ivy Modrau
- Department of Cardiothoracic Surgery (I.M.), Aarhus University Hospital, Skejby, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark (J.J.A.).,Department of Clinical Research, Aalborg University, Denmark (J.J.A.)
| | - Britt Borregaard
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark (B.B., L.O.J.)
| | - Anders Junker
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark
| | - Poul Erik Mortensen
- Department of Cardiothoracic Surgery (A.L.T., L.P.R., P.E.M.), Odense University Hospital, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark (B.B., L.O.J.)
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17
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Drug-Coated Balloon versus Drug-Eluting Stent in Patients with Small-Vessel Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials. Cardiol Res Pract 2021; 2021:1647635. [PMID: 33953973 PMCID: PMC8057900 DOI: 10.1155/2021/1647635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/14/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) of small-vessel coronary artery disease (SVD) is related to an increased risk of in-stent restenosis (ISR) and stent thrombosis (ST). The application of the drug-coated balloon (DCB) for patients with SVD remains controversial. Objectives Assess the outcomes of DCB in the treatment of SVD compared with DES in patients with SVD. Methods A meta-analysis of randomized controlled trials (RCTs) published up to June 2020, reporting the outcomes of DCB versus DES in the treatment of SVD, was performed. Results Four RCTs with 1227 patients were included. The results indicated that DCB was associated with the decreased risk for myocardial infarction (MI) compared with the DES, but the difference showed no significance (OR 0.50, 95% CI 0.24-1.03, P=0.06). And, there was no significant difference in death (OR 0.76, 95% CI 0.17-3.43, P=0.72), cardiac death (OR 1.92, 95% CI 0.74-4.98, P=0.18), target vessel revascularization (TVR) (OR 0.81, 95% CI 0.51-1.28, P=0.36), target lesion revascularization (TLR) (OR 1.29, 95% CI 0.66-2.52, P=0.46), and major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61-1.38, P=0.69) between the DCB group and DES group. Conclusion Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. The application of DCB in SVD is associated with comparable outcomes of death, TVR, and MACE when compared with DES.
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Pereira MM, Torrado J, Sosa C, Zócalo Y, Bia D. Shedding light on the pathophysiology of preeclampsia-syndrome in the era of Cardio-Obstetrics: Role of inflammation and endothelial dysfunction. Curr Hypertens Rev 2021; 18:17-33. [DOI: 10.2174/1573402117666210218105951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
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Preeclampsia (PE) is a worldwide pregnancy complication with serious maternal and neonatal consequences. Our understanding of PE pathophysiology has significantly evolved over the last decades by recognizing that endothelial dysfunction and systemic inflammation, with an associated angiogenic imbalance, are key pieces of this still incomplete puzzle. In the present era, where no single treatment to cure or treat this obstetric condition has been developed so far, PE prevention and early prediction poses the most useful clinical approach to reduce the PE burden. Although most PE episodes occur in healthy nulliparous women, the identification of specific clinical conditions that increase dramatically the risk of PE provides a critical opportunity to improve outcomes by acting on potential reversible factors, and also contribute to better understand this pathophysiologic enigma. In this review, we highlight major clinical contributors of PE and shed light about their potential link with endothelial dysfunction and inflammation.
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Affiliation(s)
- María M. Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology “C”, Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
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Zhu Y, Lingala B, Wang H, Woo YJ. Bilateral vs Single Internal Mammary Artery Grafts for Coronary Artery Bypass in the United States. Ann Thorac Surg 2021; 111:629-635. [PMID: 32599051 DOI: 10.1016/j.athoracsur.2020.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/29/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The use of the bilateral internal mammary artery (BIMA) in coronary artery bypass grafting remains controversial. The objective of this study was to investigate the long-term outcomes using the BIMA vs the single internal mammary artery (SIMA) in the United States. METHODS Medicare beneficiaries who underwent primary isolated coronary artery bypass surgery using the SIMA or BIMA from 1999 to 2010 were included in this retrospective study, with follow-up through 2014. Greedy matching algorithms were used for 1:4 matching on propensity score based on age, gender, year of surgery, and comorbidities. Kaplan-Meier survival analyses were performed. The primary outcome was death from any cause. RESULTS A total of 1,156,339 and 25,005 patients who were 72 ± 7.6 years of age and 70.3 ± 7.9 years of age underwent primary isolated coronary artery bypass surgery using SIMA and BIMA, respectively. Matching created comparable groups with 95,780 SIMA and 24,160 BIMA patients. Matched median survival using SIMA vs BIMA was 11.8 vs 12.4 years (P < .001) and 9.6 vs 10 years in diabetic patients (P = .006), respectively. At 10 years of follow-up, the respective survival rates of using SIMA vs BIMA were 58.3% vs 61.1%, respectively. The stratified matched median survival using SIMA vs BIMA with 1, 2, 3, and 4 or more aortocoronary bypasses were 11.8 vs 12.3 years (P = .005), 11.7 vs 12.5 years (P < .001), 11.9 vs 12.3 years (P = .01), and 11.4 vs 12 years (P = .02), respectively. CONCLUSIONS Primary isolated coronary artery bypass surgery using the BIMA rather than the SIMA was associated with improved long-term survival. This survival advantage was independent of aortocoronary bypass grafts or patient diabetes status.
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Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
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20
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Rashid M, Nagaraja V, Shoaib A, Curzen N, Ludman PF, Kapadia SR, Palmer N, Elgendy IY, Kalra A, Vachharajani TJ, Anderson HV, Kwok CS, Mohamed M, Banning AP, Mamas MA. Outcomes Following Percutaneous Coronary Intervention in Renal Transplant Recipients: A Binational Collaborative Analysis. Mayo Clin Proc 2021; 96:363-376. [PMID: 33358453 DOI: 10.1016/j.mayocp.2020.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the clinical and procedural characteristics in patients with a history of renal transplant (RT) and compare the outcomes with patients without RT in 2 national cohorts of patients undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS Data from the National Inpatient Sample (NIS) and British Cardiovascular Intervention Society (BCIS) were used to compare the clinical and procedural characteristics and outcomes of patients undergoing PCI who had RT with those who did not have RT. The primary outcome of interest was in-hospital mortality. RESULTS Of the PCI procedures performed in 2004-2014 (NIS) and 2007-2014 (BCIS), 12,529 of 6,601,526 (0.2%) and 1521 of 512,356 (0.3%), respectively, were undertaken in patients with a history of RT. Patients with RT were younger and had a higher prevalence of congestive cardiac failure, hypertension, and diabetes but similar use of drug-eluting stents, intracoronary imaging, and pressure wire studies compared with patients who did not have RT. In the adjusted analysis, patients with RT had increased odds of in-hospital mortality (NIS: odds ratio [OR], 1.90; 95% CI, 1.41-2.57; BCIS: OR, 1.60; 95% CI, 1.05-2.46) compared with patients who did not have RT but no difference in vascular or bleeding events. Meta-analysis of the 2 data sets suggested an increase in in-hospital mortality (OR, 1.79; 95% CI, 1.40-2.29) but no difference in vascular (OR, 1.24; 95% CI, 0.77-2.00) or bleeding (OR, 1.21; 95% CI, 0.86-1.68) events. CONCLUSION This large collaborative analysis of 2 national databases revealed that patients with RT undergoing PCI are younger, have more comorbidities, and have increased mortality risk compared with the general population undergoing PCI.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Vinayak Nagaraja
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Nick Curzen
- Department of Cardiology, University Hospital Southampton, and University of Southampton, Southampton, UK
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Nick Palmer
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Tushar J Vachharajani
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - H Vernon Anderson
- Department of Internal Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK; Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA.
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21
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Quin JA, Noubani M, Rove JY, Krstacic JE, Hattler B, Collins JF, Grover FL, Almassi GH, Shroyer AL. Coronary Artery Bypass Grafting Transit Time Flow Measurement: Graft Patency and Clinical Outcomes. Ann Thorac Surg 2020; 112:701-707. [PMID: 33359134 DOI: 10.1016/j.athoracsur.2020.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND This subanalysis of the Randomized On-Off Bypass (ROOBY) trial examined transit time flow measurement (TTFM) use and its impact on graft patency and long-term clinical outcomes after coronary artery bypass graft surgery. METHODS Use of TTFM for ROOBY centers and surgeons was assessed. Comparative patient outcomes based on TTFM use included 1-year graft patency and 1-year and 5-year major adverse cardiac events: all-cause mortality, nonfatal myocardial infarction, and revascularization (percutaneous coronary intervention or repeat coronary artery bypass graft surgery). RESULTS Transit time flow measurement was used in 1067 patients (TTFM group) and not used in 501 patients (non-TTFM group); of the TTFM group, median percentage TTFM use was 79% (interquartile range, 41% to 98%) among 18 Veterans Affairs Medical Centers, and 74% (interquartile range, 13% to 98%) among 48 surgeons. Patients were comparable in age (63 ± 8.5 years TTFM vs 62 ± 8 years non-TTFM, P = .30) and estimated 30-day mortality risk (1.8 ± 1.7 TTFM vs 1.9 non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988 grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM assessed grafts (P < .01). Fewer TTFM patients had an occluded graft (29%, vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients, 5-year major adverse cardiac event rates were 30% vs 25% (P = .06). Individual component rates were 14% vs 11% for death (P = .06), 12% vs 8.8% for myocardial infarction (P = .07), and 13% vs 12% for revascularization (P = .62). CONCLUSIONS The association of TTFM use with graft patency and clinical outcome is uncertain. Future randomized studies that account for patient risk factors and practice variation would help address this knowledge gap.
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Affiliation(s)
- Jacquelyn A Quin
- VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Mohammad Noubani
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
| | - Jessica Y Rove
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John E Krstacic
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
| | - Brack Hattler
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Frederick L Grover
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - G Hossein Almassi
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Laurie Shroyer
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
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Yamamoto T, Sawada T, Uzu K, Takaya T, Kawai H, Yasaka Y. Possible mechanism of late lumen enlargement after treatment for de novo coronary lesions with drug-coated balloon. Int J Cardiol 2020; 321:30-37. [PMID: 32710988 DOI: 10.1016/j.ijcard.2020.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) treatment for de novo coronary artery disease has demonstrated late lumen enlargement (LLE) in mid-term follow-up and it was considered as clinical benefit; however, its mechanism and the predictive factor remains unclear. METHODS This study enrolled 46 consecutive patients (54 lesions) treated with DCB, using intravascular ultrasound (IVUS) at the index procedure and at the 9-month follow-up. We measured IVUS parameters at 1-mm intervals and calculated the mean volume of the external elastic membrane (EEM), lumen, and plaque. We calculated the dissection index (DI) defined as summation of the following points, 2: dissection over EEM, 1: intra-EEM dissection, 0: no dissection at every 1-mm interval, and divided by lesion length. RESULTS IVUS showed that there was no flow limiting dissection just after DCB treatment, the mean EEM and lumen volume (LV) had significantly increased while mean plaque volume had significantly decreased at 9 months, and 74.1% lesions exhibited LLE. We divided the patients into three groups according to delta mean LV. Mean EEM volume significantly increased and mean plaque volume significantly decreased in the larger and smaller LLE groups, but not in the non-LLE group. The DI was higher in a descending order in the three groups. The multiple regression analysis demonstrated that the DI was the strongest predictor of the change in mean LV. CONCLUSIONS LLE after DCB treatment may be caused by vessel enlargement and plaque regression. The non-flow limiting larger dissection just after DCB treatment may strongly associate with the intending LLE.
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Affiliation(s)
- Tetsuya Yamamoto
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Takahiro Sawada
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan.
| | - Kenzo Uzu
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Tomofumi Takaya
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Hiroya Kawai
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Yoshinori Yasaka
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
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Kim BK, Nah DY, Choi KU, Bae JH, Rhee MY, Jang JS, Moon KW, Lee JH, Kim HY, Kang SH, Song WH, Lee SU, Shim BJ, Chung H, Hyon MS. Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2020; 50:1026-1036. [PMID: 33118336 PMCID: PMC7596209 DOI: 10.4070/kcj.2020.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/21/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. METHODS We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. RESULTS Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. CONCLUSIONS Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.
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Affiliation(s)
- Byong Kyu Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Deuk Young Nah
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea.
| | - Kang Un Choi
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jun Ho Bae
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Moo Yong Rhee
- Department of Internal Medicine, Cardiovascular Center, Dongguk University Illsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jae Sik Jang
- Division of Cardiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keon Woong Moon
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jun Hee Lee
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hee Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Seung Ho Kang
- Division of Cardiology, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea
| | - Woo Hyuk Song
- Department of Cardiology, Korea University Ansan Hospital, Ansan, Korea
| | - Seung Uk Lee
- Division of Cardiology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Byung Ju Shim
- Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea
| | - Hangjae Chung
- Division of Cardiology, Department of Internal Medicine, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Min Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
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24
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Rha SW. Is Hospital Percutaneous Coronary Intervention Volume-In-hospital Outcome Relation an Issue in Acute Myocardial Infarction? Korean Circ J 2020; 50:1037-1039. [PMID: 33118337 PMCID: PMC7596213 DOI: 10.4070/kcj.2020.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
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25
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Ono M, Kawashima H, Hara H, Katagiri Y, Takahashi K, Kogame N, Wykrzykowska JJ, Piek JJ, Doshi M, Sharif F, Onuma Y, Colombo A, Serruys PW, Cortese B. A Prospective Multicenter Randomized Trial to Assess the Effectiveness of the MagicTouch Sirolimus-Coated Balloon in Small Vessels: Rationale and Design of the TRANSFORM I Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:29-35. [PMID: 33109476 DOI: 10.1016/j.carrev.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
AIMS The objective of the study is to assess the efficacy and safety of the novel Magic Touch sirolimus coated-balloon (SCB) when compared to the SeQuent Please Neo paclitaxel coated balloon (PCB) for the treatment of de-novo small vessel coronary artery diseases (SVD). STUDY DESIGN The TRANSFORM I study is a randomized, multicenter, non-inferiority trial with the intent to enroll a total of 114 patients with a de-novo SVD (≤2.5 mm). Vessel size will be pre-screened by on-line QCA. After successful pre-dilatation without major coronary dissections (type C-F) nor Thrombolysis In Myocardial Infarction trial [TIMI] grade flow ≤2, patients will be enrolled in a 1:1 randomization to receive treatment with either the novel SCB balloon or the comparative PCB balloon. The balloon sizing will be selected according to the lumen-based approach derived from optical coherence tomography (OCT). The primary endpoint is 6-month mean net lumen diameter gain (6-month minimum lumen diameter [MLD] minus baseline MLD) assessed by quantitative coronary analysis (QCA) with non-inferiority margin of 0.3 mm in per-protocol analysis. The clinical follow-up will be conducted up to 1 year. The enrollment started in September 2020 and will complete in April 2021. CONCLUSIONS The TRANSFORM I trial will assess the efficacy of novel SCB in terms of non-inferiority to conventional PCB with a novel OCT measurement approach in patients with a de-novo SVD. Clinical Trial Registration URL: https://clinicaltrials.gov. Unique identifier: NCT03913832.
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Affiliation(s)
- Masafumi Ono
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yuki Katagiri
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Kuniaki Takahashi
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Norihiro Kogame
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Joanna J Wykrzykowska
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Manish Doshi
- Concept Medical Research Private Limited & Envision Scientific Private Limited, Surat, India
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Bernardo Cortese
- San Carlo Clinic, Milan, Italy; Monasterio Foundation, Tuscany Region, CNR, Pisa, Italy
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Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent: Multimodality Imaging Through 3 Years. JACC Cardiovasc Interv 2020; 13:116-127. [PMID: 31918929 DOI: 10.1016/j.jcin.2019.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging. BACKGROUND Serial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported. METHODS In the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT). RESULTS Luminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting stent (mean angiographic minimal luminal diameter 2.04 ± 0.63 mm vs. 2.40 ± 0.56 mm, mean difference -0.37 mm [95% confidence interval: -0.50 to -0.24 mm]; p < 0.001), mainly because of smaller device area (6.13 ± 2.03 mm2 vs. 7.15 ± 2.16 mm2, mean difference -1.04 mm2 [95% confidence interval: -1.66 to -0.42 mm2]; p < 0.001), and larger neointimal area (2.10 ± 0.61 mm2 vs. 1.86 ± 0.64 mm2, mean difference 0.24 mm2 [95% confidence interval: 0.06 to 0.43 mm2]; p = 0.01) by OCT. BVS-treated vessels did not show previously reported favorable vessel responses, such as positive vessel remodeling, late luminal enlargement, and restoration of vasomotion, although the OCT-based healing score was on average zero (interquartile range: 0.00 to 0.00). At 3 years, intraluminal scaffold dismantling (ISD) was observed in 14% of BVS. On serial OCT, ISD was observed in 6 lesions at 2 years, where the struts had been fully apposed at post-procedure, while ISD was observed in 12 lesions at 3 years, where 8 lesions were free from ISD on 2-year OCT. In 5 cases of very late scaffold thrombosis, strut discontinuities were detected in all 4 cases with available OCT immediately before reintervention. CONCLUSIONS In this multimodality serial imaging study, luminal dimension at 3 years was smaller with the BVS than with the cobalt-chromium everolimus-eluting stent. ISD, suspected to be one of the mechanisms of very late BVS thrombosis, was observed in a substantial proportion of cases at 3 years, which developed between post-procedure and 2 years and even beyond 2 years. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb™ BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284).
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Heckle MR, Brooksbank JA, Agarwal MA, Ibebuogu UN. Outcomes of Early Versus Delayed Transcatheter Closure of Post-Myocardial Infarction Ventricular Septal Defect. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1093-1096. [PMID: 32089512 DOI: 10.1016/j.carrev.2020.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post myocardial infarction ventricular septal defect (VSD) is a rare, but devastating complication which carries a poor prognosis if left untreated. Optimal therapy remains unclear and surgical repair is associated with high mortality. OBJECTIVE The aim of our study is to compare 30-day survival in patients with early versus late primary transcatheter repair of post myocardial infarction ventricular septal defect. METHODS We performed a comprehensive search of published data through SCOPUS and identified published reports of primary transcatheter closure of post myocardial infarction VSD. We included case reports and series that reported timing of VSD closure and 30-day survival and excluded those with prior surgical repair. Early repair was defined as transcatheter closure within 14 days of diagnosis of VSD while late repair was defined as transcatheter closure after 14 days of diagnosis of VSD. RESULTS A total 27 publications describing 193 patients were identified in the SCOPUS search. We excluded 8 publications with no reported timing of VSD repair or 30-day outcome. Of the 193 patients initially included, a total of 126 patients fulfilled all the criteria and were included in the final analysis. The overall 30-day survival rate was found to be 62.7% (79 patients). In the early repair group, only 36.2% of the patients were still alive at 30 days compared to 85.3% in the delayed repair group, P < .01. No significant difference in age, gender, presence of shock, VSD size, presence of significant residual shunt, location of VSD or infarction was observed. The early repair group was found to have a significantly larger Qp: Qs ratio as well as larger occluder size and lower rate of successful repair. CONCLUSION Compared to the late repair group, the early transcatheter VSD repair group had a larger pre-procedure Qp:Qs and worse 30-day survival. Further studies are needed to determine the optimal timing of transcatheter repair of a post myocardial infarction VSD.
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Affiliation(s)
- Mark R Heckle
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Jeremy A Brooksbank
- Department of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Manyoo A Agarwal
- Division of Cardiovascular Medicine, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States of America
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America.
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Valle JA, Tamez H, Abbott JD, Moussa ID, Messenger JC, Waldo SW, Kennedy KF, Masoudi FA, Yeh RW. Contemporary Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in the United States: An Analysis of the National Cardiovascular Data Registry Research to Practice Initiative. JAMA Cardiol 2020; 4:100-109. [PMID: 30601910 DOI: 10.1001/jamacardio.2018.4376] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Recent data support percutaneous revascularization as an alternative to coronary artery bypass grafting in unprotected left main (ULM) coronary lesions. However, the relevance of these trials to current practice is unclear, as patterns and outcomes of ULM percutaneous coronary intervention (PCI) in contemporary US clinical practice are not well studied. Objective To define the current practice of ULM PCI and its outcomes and compare these with findings reported in clinical trials. Design, Setting, and Participants This cross-sectional multicenter analysis included data collected from 1662 institutions participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry between April 2009 and July 2016. Data were collected from 33 128 patients undergoing ULM PCI and 3 309 034 patients undergoing all other PCI. Data were analyzed from June 2017 to May 2018. Main Outcomes and Measures Patient and procedural characteristics and their temporal trends were compared between ULM PCI and all other PCI. In-hospital major adverse clinical events (ie, death, myocardial infarction, stroke, and emergent coronary artery bypass grafting) were compared using hierarchical logistic regression. Characteristics and outcomes were also compared against clinical trial cohorts. Results Of the 3 342 162 included patients, 2 223 570 (66.5%) were male, and the mean (SD) age was 64.2 (12.1) years. Unprotected left main PCI represented 1.0% (33 128 of 3 342 162) of all procedures, modestly increasing from 0.7% to 1.3% over time. The mean (SD) annualized ULM PCI volume was 0.5 (1.5) procedures for operators and 3.2 (6.1) procedures for facilities, with only 1808 of 10 971 operators (16.5%) and 892 of 1662 facilities (53.7%) performing an average of 1 or more ULM PCI annually. After adjustment, major adverse clinical events occurred more frequently with ULM PCI compared with all other PCI (odds ratio, 1.46; 95% CI, 1.39-1.53). Compared with clinical trial populations, patients in the CathPCI Registry were older with more comorbid conditions, and adverse events were more frequent. Conclusions and Relevance Use of ULM PCI has increased over time, but overall use remains low. These findings suggest that ULM PCI occurs infrequently in the United States and in an older and more comorbid population than that seen in clinical trials.
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Affiliation(s)
- Javier A Valle
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado.,University of Colorado School of Medicine, Aurora
| | - Hector Tamez
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - J Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Issam D Moussa
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Stephen W Waldo
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado.,University of Colorado School of Medicine, Aurora
| | | | | | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Nonemergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported with Impella® Heart Pump in Patients Ineligible for Surgical Revascularization. J Interv Cardiol 2019; 2019:9691753. [PMID: 31772553 PMCID: PMC6739763 DOI: 10.1155/2019/9691753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 03/07/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella® heart pump support. Background ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. Methods Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) rates as well as 30-day survival and MACCE rates between CABG ineligible and CABG eligible patients. Results A total of 331 patients were included (293 Impella 2.5®, 38 Impella CP®); 227 were ineligible for CABG and 104 were eligible. Baseline characteristics were remarkable for a trend toward higher rate of chronic obstructive pulmonary disease in the ineligible patients. In-hospital mortality (3.52% vs. 5.77%; p=0.383) and MACCE (6.61% vs. 7.69%; p=0.816) rates as well as 30-day survival (92.0% vs. 93.4%; Log-Rank p-value =0.781) and MACCE (88.1% vs. 90.1%; Log-Rank p-value=0.648) rates were not different between the two groups. Conclusions The results of our study suggest that prophylactic Impella support appears to mitigate the risks inherent to surgical ineligibility in patients undergoing a nonemergent ULMCA PCI. Our results require further investigation.
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Lee JH, Eom SY, Kim U, Lee CH, Son JW, Jeon DW, Bae JH, Oh SK, Cha KS, Suh Y, Koh YY, Yang TH, Shim DK, Bae JW, Park JS. Effect of Operator Volume on In-Hospital Outcomes Following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Based on the 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2019; 50:133-144. [PMID: 31845555 PMCID: PMC6974659 DOI: 10.4070/kcj.2019.0206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/27/2019] [Accepted: 10/23/2019] [Indexed: 01/20/2023] Open
Abstract
Background and Objectives The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI. Methods Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10–30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed. Results The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes. Conclusions In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry.
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Affiliation(s)
- Jung Hee Lee
- Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Yong Eom
- Department of Preventive Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ung Kim
- Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Chan Hee Lee
- Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jang Won Son
- Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service (NHIS) Ilsan Hospital, Goyang, Korea
| | - Jang Ho Bae
- Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Seok Kyu Oh
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kwang Soo Cha
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yongsung Suh
- Department of Cardiology, Myongji Hospital, Goyang, Korea
| | - Young Youp Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Tae Hyun Yang
- Department of Cardiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Dae Keun Shim
- Division of Cardiovascular, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, Korea
| | - Jang Whan Bae
- Department of Internal Medicine, Chungbuk National University, Cheongju, Korea. ,
| | - Jong Seon Park
- Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
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Wu M, Li L, Li S, Cui Y, Hu D, Song J, Lee C, Chen H. Identifying patients with refusal of percutaneous coronary intervention for acute myocardial infarction: a classification and regression tree analysis. Intern Emerg Med 2019; 14:1251-1258. [PMID: 30949829 DOI: 10.1007/s11739-019-02079-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 11/25/2022]
Abstract
The purpose of the present study is to develop and validate a prediction tool to identify patients who refuse to receive percutaneous coronary intervention (PCI) rapidly. We developed a risk stratification model using the derivation cohort of 288 patients with ST segment elevation myocardial infarction (STEMI) in our hospital and validated it in a prospective cohort of 115 patients. There were 52 (18.1%) patients and 18 (15.7%) patients who refused PCI among derivation and validation cohort, respectively. A classification and regression tree (CART) analysis and multivariate logistic regression were used for statistical analysis. The decision-making factors for refusal of PCI were also investigated. The CART analysis and logistic regression both showed that self-rated mild symptom was the most significant predictor of not choosing PCI. The model generated three risk groups. The high-risk group included: self-rated mild symptoms; self-rated severe symptom, glomerular filtration rate < 60 ml/min/1.73m2. The intermediate-risk group included: self-rated severe symptom, glomerular filtration rate ≥ 60 ml/min/1.73m2 and age ≥ 75 years. The low-risk group included: self-rated severe symptom, glomerular filtration rate ≥ 60 ml/min/1.73m2 and age < 75 years. The prevalence for refusal of PCI of the three groups were 45%-44%, 18% and 4%, respectively. The sensitivity was 88% and the negative predictive value was 96%. And similar results were obtained when this prediction tool was applied prospectively to the validation cohort. Patients at low and high risk can be easily identified for refusal of PCI by the prediction tool using common clinical data. This practical model might provide useful information for rapid recognition and early response for this kind of crowd.
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Affiliation(s)
- Manyan Wu
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Long Li
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Sufang Li
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Yuxia Cui
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Dan Hu
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Junxian Song
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Chongyou Lee
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China
| | - Hong Chen
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, Xizhimen South Rd No.11, Xicheng District, Beijing, 100044, China.
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Yamazaki D, Shimura Y, Enjoji Y, Nishinaga M, Kanmatuse K, Endo M. Pilot study of bisoprolol 8mg transdermal patch at bedtime before coronary computed tomography angiography. J Cardiol 2019; 75:394-399. [PMID: 31627998 DOI: 10.1016/j.jjcc.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is recommended for first-line evaluation of stable coronary artery disease, and there is a standard protocol to control heart rate (HR) in guidelines. However, time is required to decrease HR to the recommended ≤60 beats per minute (bpm). We investigated whether the bisoprolol 8mg transdermal patch at bedtime on the day before CCTA can achieve a target HR and simplify the CCTA process. METHODS We randomly assigned 63 patients with an HR of ≥70 bpm and systolic blood pressure ≥120mmHg to a standard protocol group (n=33) or a group (n=30) that applied a bisoprolol 8mg transdermal patch (Bis) at bedtime on the day before CCTA evaluation. The primary endpoint was a change in HR between enrollment in the study and the time of CCTA evaluation. The secondary endpoints were elapsed time from arrival at the CCTA suite to starting CCTA image acquisition, and the rates of oral metoprolol and intravenous landiolol administration (UMIN00035246). RESULTS Baseline characteristics did not significantly differ between two groups. HR was significantly lower upon arrival at the CCTA suite in Bis, than standard protocol group (67.5±7.8 bpm vs. 75.0±10.6 bpm; p=0.00002), and the amount of elapsed time from arrival to the start of CCTA evaluation was also significantly decreased in Bis group (76.9±34.9min vs. 94.8±29.2min; p=0.0356). Rates of oral metoprolol and intravenous landiolol administration did not significantly differ between two groups (63.3% vs. 83.3%, p=0.143 and 36.7% vs. 60.0%, p=0.12, respectively). CONCLUSIONS The bisoprolol 8mg transdermal patch lowered HR and decreased the amount of time needed for CCTA, thus streamlining the evaluation process.
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Affiliation(s)
- Daisuke Yamazaki
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan.
| | - Yumi Shimura
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
| | - Yoshihisa Enjoji
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
| | - Masanori Nishinaga
- Department of Cardiovascular Medicine, Saitama Memorial Hospital, Saitama City, Saitama, Japan
| | - Katuo Kanmatuse
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
| | - Masahiro Endo
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
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Zur deutsch-österreichischen S3‑Leitline „Infarkt-bedingter kardiogener Schock – Diagnose, Monitoring und Therapie“. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-019-0311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ameloot K, B Bastos M, Daemen J, Schreuder J, Boersma E, Zijlstra F, Van Mieghem NM. New-generation mechanical circulatory support during high-risk PCI: a cross-sectional analysis. EUROINTERVENTION 2019; 15:427-433. [PMID: 30741638 DOI: 10.4244/eij-d-18-01126] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to establish the value of new-generation mechanical circulatory support (MCS) devices such as HeartMate PHP, Impella CP and PulseCath iVAC2. METHODS AND RESULTS We retrospectively analysed all consecutive elective high-risk PCI procedures performed in the Erasmus Medical Center (2011-2018) in order to compare MCS protected and unprotected patients. The primary endpoint was a composite of procedure-related adverse events including death (<24 hours), cardiac arrest, need for vasopressors, rescue MCS, endotracheal intubation and limb ischaemia with need for surgery. Secondary endpoints included 30-day survival. A total of 198 elective high-risk PCI patients were included (69 [35%] MCS protected, 129 [65%] MCS unprotected). When compared with unprotected patients, MCS protected patients had a significantly worse left ventricular ejection fraction (LVEF) (25±10 vs 33±8%, p<0.01) and higher SYNTAX I score (33±11 vs 24±8, p<0.01). The primary endpoint occurred in 26 (20%) of the unprotected patients and in 6 (9%) of the MCS protected patients (OR 0.38, 95% CI: 0.15-0.97, p=0.04). Patients under 75 years of age, with a SYNTAX I score above 32 and with an LVEF below 30% showed most potential benefit from MCS. Survival during the first 24 hours after the procedure and at 30 days was significantly higher in MCS protected patients (100% vs 95%, p=0.04 at 24 hours, and 98% vs 87%, OR 10.32, 95% CI: 1.34-79.31, p=0.006 at 30 days). CONCLUSIONS In a consecutive real-world cohort of high-risk PCI patients, protection with new-generation MCS resulted in better procedural outcomes despite worse EF and more complex coronary artery disease at baseline. Larger prospective studies are needed to confirm these findings.
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Affiliation(s)
- Koen Ameloot
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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Collet C, Capodanno D, Onuma Y, Banning A, Stone GW, Taggart DP, Sabik J, Serruys PW. Left main coronary artery disease: pathophysiology, diagnosis, and treatment. Nat Rev Cardiol 2019; 15:321-331. [PMID: 29599504 DOI: 10.1038/s41569-018-0001-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The advent of coronary angiography in the 1960s allowed for the risk stratification of patients with stable angina. Patients with unprotected left main coronary artery disease have an increased risk of death related to the large amount of myocardium supplied by this vessel. Although coronary angiography remains the preferred imaging modality for the evaluation of left main coronary artery stenosis, this technique has important limitations. Angiograms of the left main coronary artery segment can be difficult to interpret, and almost one-third of patients can be misclassified when fractional flow reserve is used as the reference. In patients with clinically significant unprotected left main coronary artery disease, surgical revascularization was shown to improve survival compared with medical therapy and has been regarded as the treatment of choice for unprotected left main coronary artery disease. Two large-scale clinical trials published in 2016 support the usefulness of catheter-based revascularization in selected patients with unprotected left main coronary artery disease. In this Review, we describe the pathophysiology of unprotected left main coronary artery disease, discuss diagnostic approaches in light of new noninvasive and invasive imaging techniques, and detail risk stratification models to aid the Heart Team in the decision-making process for determining the best revascularization strategy for these patients.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University, Rotterdam, Netherlands
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Gregg W Stone
- New York Presbyterian Hospital and Columbia University Medical Center, New York, NY, USA
| | - David P Taggart
- Department of Cardiology, John Radcliffe Hospital, Oxford, UK
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Zhao X, Wu H, Xu H, Shen L, Fan B, Ge J. Association Between Residual Platelet Reactivity on Clopidogrel Treatment and Severity of Coronary Atherosclerosis: Intrinsic Hypercoagulability as a Mediator. Adv Ther 2019; 36:2296-2309. [PMID: 31372962 DOI: 10.1007/s12325-019-01032-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION High on-treatment residual platelet reactivity (HRPR) was associated with greater atherosclerosis burden. We examined whether intrinsic hypercoagulability (IHC) could be attributed to that association in patients treated by drug-eluting stents. METHODS This retrospective observation enrolled a total of 891 coronary artery disease (CAD) subjects. Platelet and coagulant reactivity was measured by thrombelastography. At least 24 h after a 300-mg dose of clopidogrel, adenosine diphosphate (ADP)-induced maximum amplitude of clot strength (MAadp) > 47 mm represented HRPR. Thrombin-induced platelet-fibrin clot strength (MAthrombin) and blood fibrinogen surrogated intrinsic coagulability. Using mediation analysis to evaluate the effect of IHC on the relationship between the number of narrowed coronaries and HRPR on clopidogrel. RESULTS More HRPR on clopidogrel and higher intrinsic coagulability were observed in more severe coronary atherosclerosis, especially in the three-vessel disease. After adjustment for confounding factors, the number of narrowed coronaries (ORadj = 1.343, 95% CI 1.063-1.695, p = 0.013), MAthrombin (ORadj = 1.106, 95% CI 1.058-1.157, p < 0.001), and fibrinogen (ORadj = 1.003, 95% CI 1.001-1.005, p = 0.012) were all independent positive predictors for HRPR. MAthrombin and fibrinogen were meaningful mediators for the significant positive association of the number of narrowed vessels and HRPR on clopidogrel, which were enhanced by around 30% and 43%, respectively, for this effect. CONCLUSIONS This is the first study to demonstrate that the positive correlation between the number of stenotic coronaries and HRPR on clopidogrel may be partly attributed to IHC, which may enhance the risk stratification, guide more precise coagulation in multi-vessel disease after drug-eluting stents, and therefore deserve further study.
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Affiliation(s)
- Xin Zhao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongyi Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huajie Xu
- Department of Cardiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Li Shen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Fan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
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Fox KAA, Metra M, Morais J, Atar D. The myth of ‘stable’ coronary artery disease. Nat Rev Cardiol 2019; 17:9-21. [DOI: 10.1038/s41569-019-0233-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
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Abstract
Although cardiogenic shock is uncommon in the emergency department, it is associated with high mortality. Most cardiogenic shock is caused by ischemia, but nonischemic etiologies are essential to recognize. Clinicians should optimize preload, contractility, and afterload. Volume-responsive patients should be resuscitated in small aliquots, although some patients may require diuresis to improve cardiac output. Vasopressors are important to restore end-organ perfusion, and inotropes improve contractility. Intubation and positive pressure ventilation impact hemodynamics, which, depending on volume status, may be beneficial or deleterious. Knowing indications for mechanical circulatory support is important for timely consultation or transfer as indicated.
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Affiliation(s)
- Susan R Wilcox
- Division of Critical Care, Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA.
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Li M, Guo C, Lv YH, Zhang MB, Wang ZL. Drug-coated balloon versus drug-eluting stent in de novo small coronary vessel disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15622. [PMID: 31124941 PMCID: PMC6571399 DOI: 10.1097/md.0000000000015622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.
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Affiliation(s)
- Min Li
- The First Clinical Medical College of Lanzhou University
| | - Chen Guo
- The First Clinical Medical College of Lanzhou University
| | - Yong-Hui Lv
- The First Clinical Medical College of Lanzhou University
| | - Ming-Bo Zhang
- The First Clinical Medical College of Lanzhou University
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, China
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Karlsson S, Anesäter E, Fransson K, Andell P, Persson J, Erlinge D. Intracoronary near-infrared spectroscopy and the risk of future cardiovascular events. Open Heart 2019; 6:e000917. [PMID: 30997122 PMCID: PMC6443121 DOI: 10.1136/openhrt-2018-000917] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 01/23/2023] Open
Abstract
Objectives The objectives of this study were to investigate if findings by intracoronary near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) are associated with future cardiovascular events and if NIRS can differentiate culprit from non-culprit segments in patients with coronary artery disease. Methods The study included 144 patients with coronary artery disease undergoing percutaneous coronary intervention and combined NIRS-IVUS imaging at two Swedish hospitals. The NIRS-derived lipid core burden index (LCBI), the 4 mm segment with maximum LCBI (MaxLCBI4mm) and the IVUS-derived maximum plaque burden (MaxPB) were analysed within the culprit segment and continuous 10 mm non-culprit segments of the index culprit vessels. The association with future major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, acute coronary syndrome requiring revascularisation and cerebrovascular events during follow-up was evaluated using multivariable Cox regressions. A receiver operating characteristic (ROC) analysis was performed to test the ability of NIRS to discriminate culprit against non-culprit segments. Results A non-culprit maxLCBI4mm ≥400 (HR: 3.67, 95% CI 1.46 to 9.23, p=0.006) and a non-culprit LCBI ≥ median (HR: 3.08, 95% CI 1.11 to 8.56, p=0.031) were both significantly associated with MACCE, whereas a non-culprit MaxPB ≥70% (HR: 0.61, 95% CI 0.08 to 4.59, p=0.63) was not. The culprit segments had larger lipid cores compared with non-culprit segments (MaxLCBI4mm 425 vs 74, p<0.001), and the ROC analysis showed that NIRS can differentiate culprit against non-culprit segments (c-statistics: 0.85, 95% CI 0.81 to 0.89). Conclusion A maxLCBI4mm ≥400 and LCBI ≥ median, assessed by NIRS in non-culprit segments of a culprit artery, were significantly associated with patient-level MACCE. NIRS furthermore adequately discriminated culprit against non-culprit segments in patients with coronary disease.
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Affiliation(s)
- Sofia Karlsson
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Anesäter
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Klara Fransson
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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Aksu U, Gulcu O, Aksakal E, Kalkan K, Öztürk M, Korkmaz AF, Uslu A, Demirelli S. The association between CRP / Albumin ratio and in-stent restenosis development in patients with ST-segment elevation myocardial infarction. J Clin Lab Anal 2019; 33:e22848. [PMID: 30737841 PMCID: PMC6528603 DOI: 10.1002/jcla.22848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although interventional methods are the first-line treatment options in ST-segment elevation myocardial infarction (STEMI), the incidence of stent restenosis (SR) is frequent. We investigated the relationship between CRP/albumin ratio (CAR), a novel indicator of inflammatory response, and SR in this study. METHOD This study was carried out on the patients who underwent coronary angiography in our clinic between January 2017 and September 2017. Two groups were generated according to restenosis status (group 1: restenosis (-), group 2: restenosis (+)), and clinical biochemical and angiographical features were compared. As baseline demographic and angiographic characteristics are slightly different in two groups, propensity score matching analysis was performed to reduce bias. 45 SR patients were matched on a 1:1 basis were enrolled final cohort. RESULTS The mean age of the patients was 55 ± 5.1 and 80% were male; Cox regression model was performed to demonstrate independent predictor of restenosis development; and during the one-year follow-up period, CAR (P < 0.001) was found an independent predictor of SR CONCLUSION: In this study, we demonstrate that there may be a strong relationship between SR development and CAR. We implied that inflammatory reaction may be an important diagnostic tool for prediction of SR development in STEMI patients.
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Affiliation(s)
- Uğur Aksu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Emrah Aksakal
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Öztürk
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Ali Fuat Korkmaz
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
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Neumann A, Vöhringer L, Fischer J, Mustafi M, Schneider W, Krüger T, Schlensak C. Off-Pump Coronary Artery Bypass Grafting in Acute Coronary Syndrome: Focus on Safety and Completeness of Revascularization. Thorac Cardiovasc Surg 2019; 68:679-686. [DOI: 10.1055/s-0039-1677834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abstract
Background Emergency coronary artery bypass grafting (CABG) in the setting of acute coronary syndrome (ACS) has been associated with increased morbidity and mortality. Avoiding cardiopulmonary bypass might be advantageous, but the role of off-pump CABG (OPCAB) remains controversial, as it has been associated with incomplete revascularization in several studies. The objective of this study was to evaluate the feasibility, efficacy, and outcome of OPCAB surgery in ACS patients.
Methods We performed a retrospective review of ACS patients who underwent on-pump CABG (ONCAB) or OPCAB, either emergently or delayed, at our institution.
Results Between January 2015 and December 2016, a total of 205 consecutive ACS patients underwent either ONCAB (109 patients, 53.2%) or OPCAB surgery (96 patients, 46.8%). EuroSCORE II levels (5.6 ± 7.2 vs 4.9 ± 6.5, p = 0.226) and demography were comparable between groups.A trend towards lower postoperative mortality was observed in OPCAB patients (2.1 vs 5.5%). The incidence of postoperative stroke and low cardiac output syndrome, as well as the duration of inotropic support and the need for re-sternotomy, was significantly lower in the OPCAB group (p < 0.05).CABG performed instantly in an emergency situation was not associated with increased mortality or morbidity when compared with delayed procedures, and OPCAB surgery in emergency patients was associated with lower postoperative morbidity and shorter stays in the intensive care unit (p < 0.05).There were no differences in completeness of revascularization between groups (median 1 [1–1.33;0.33–1.67] OPCAB versus median 1 (1–1.33;0.67–2) ONCAB, p = 0.617), even in the emergency setting.
Conclusion OPCAB surgery is safe and effective in ACS and may be considered in hemodynamically stable patients in the emergency setting.
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Affiliation(s)
- Anneke Neumann
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Luise Vöhringer
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Julia Fischer
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Wilke Schneider
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Tobias Krüger
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
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Best Revascularization Strategies in Patients With CKD and DM: Still Uncertain. J Am Coll Cardiol 2019; 73:412-414. [PMID: 30704572 DOI: 10.1016/j.jacc.2018.12.015] [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: 11/26/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
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45
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Djohan AH. A focused review on optimal coronary revascularisation in patients with chronic kidney disease: Coronary revascularisation in kidney disease. ASIAINTERVENTION 2019; 5:32-40. [PMID: 34912972 PMCID: PMC8525713 DOI: 10.4244/aij-d-18-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 12/04/2018] [Indexed: 04/20/2023]
Abstract
Concomitant chronic kidney disease (CKD) and coronary artery disease (CAD) is known to have poor outcomes. With a thorough literature review, we discuss the pathophysiological basis behind accelerated atherosclerosis in CKD, and the role of percutaneous coronary intervention (PCI) in these patients, focusing on drug-eluting stents, coronary artery bypass grafting, and adverse outcomes. We discuss factors contributing to poor outcomes in these patients, and the need for more work in this subgroup.
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Affiliation(s)
- Andie H. Djohan
- Department of Medicine, National University Health System, Level 10, 1E Kent Ridge Road, Singapore 119228. E-mail:
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Glineur D, Wijns W. The 2010-2014-2018 trilogy of ESC–EACTS Guidelines on myocardial revascularisation: we cannot jump three steps this way and then return to where we began. EUROINTERVENTION 2019; 14:1429-1433. [DOI: 10.4244/eijv14i14a258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Culprit versus multivessel coronary intervention in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. Coron Artery Dis 2019; 29:151-160. [PMID: 29120880 DOI: 10.1097/mca.0000000000000578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The 2015 American College of Cardiology/American Heart Association update on primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) recommended PCI of the non-infarct-related artery at the time of primary PCI (class IIb recommendation). Despite evidence supporting complete revascularization in STEMI, its benefit on mortality rates is uncertain. METHODS We searched all available databases for randomized controlled trials comparing complete multivessel percutaneous coronary intervention (CMV PCI) with infarct-artery-only revascularization in patients with STEMI. Summary risk ratios and 95% confidence intervals (CIs) were calculated for both the efficacy and safety outcomes. RESULTS Nine randomized controlled trials fulfilled the inclusion criteria, yielding 2991 patients. Follow-up periods ranged from 6 to 36 months. Compared with infarct-related artery-only PCI, CMV PCI was associated with significantly lower rates of major adverse cardiac events [relative risk (RR)=0.54, 95% CI=0.41-0.71; P<0.00001], cardiovascular mortality (RR=0.48, 95% CI=0.28-0.80; P=0.005), and repeat revascularization (RR=0.38, 95% CI=0.30-0.47; P<0.00001). Although, contrast-induced nephropathy and major bleed rates were comparable between both groups, CMV PCI failed to show any reduction in all-cause mortality (RR=0.75, 95% CI=0.53-1.07; P=0.11) and nonfatal myocardial infarction (RR=0.69, 95% CI=0.43-1.10; P=0.12). CONCLUSION Our results suggest that in patients with STEMI and multivessel disease, complete revascularization is safe, and is associated with reduced risks of major adverse cardiac events and cardiac death along with a reduced need for repeat revascularization. However, it showed no beneficial effect on all-cause mortality and nonfatal myocardial infarction.
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Thuesen AL, Riber LP, Veien KT, Christiansen EH, Jensen SE, Modrau I, Andreasen JJ, Junker A, Mortensen PE, Jensen LO. Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery Bypass Grafting. J Am Coll Cardiol 2018; 72:2732-2743. [DOI: 10.1016/j.jacc.2018.09.043] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/17/2023]
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Hauptstammstenose: perkutane koronare Intervention vs. chirurgische Koronarrevaskularisation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Megaly M, Rofael M, Saad M, Rezq A, Kohl LP, Kalra A, Shishehbor M, Soukas P, Abbott JD, Brilakis ES. Outcomes with drug‐coated balloons in small‐vessel coronary artery disease. Catheter Cardiovasc Interv 2018; 93:E277-E286. [DOI: 10.1002/ccd.27996] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/17/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Michael Megaly
- Minneapolis Heart InstituteAbbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
- Division of Cardiovascular MedicineHennepin HealthCare Minneapolis MN
| | - Michael Rofael
- Division of Cardiovascular MedicinePalmetto Health Columbia, University of South Carolina South Carolina
| | - Marwan Saad
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Arkansas Little Rock Arkansas
| | - Ahmed Rezq
- Department of Cardiovascular MedicineAin Shams University Cairo Egypt
| | - Louis P. Kohl
- Division of Cardiovascular MedicineHennepin HealthCare Minneapolis MN
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Department of MedicineCase Western Reserve University School of Medicine Cleveland Ohio
| | - Mehdi Shishehbor
- Division of Cardiovascular Medicine, Department of MedicineCase Western Reserve University School of Medicine Cleveland Ohio
| | - Peter Soukas
- Division of Cardiovascular Medicine, Department of MedicineWarren Alpert Medical School of Brown University Providence Rhode Island
| | - JD Abbott
- Division of Cardiovascular Medicine, Department of MedicineWarren Alpert Medical School of Brown University Providence Rhode Island
| | - Emmanouil S. Brilakis
- Minneapolis Heart InstituteAbbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
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