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Jones DB, Pivato C, Cao D, Sartori S, Nicolas J, Beerkens F, Razuk V, Feldman D, Satish M, Snyder C, Giustino G, Krishnan P, Barman N, Sweeny JM, Baber U, Dangas GD, Sharma SK, Kini AS, Mehran R. PROGNOSTIC VALUE OF HIGH SENSITIVITY C-REACTIVE PROTEIN AMONG CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chiarito M, Cao D, Baber U, Pivato C, Briguori C, Sardella G, Stefanini G, Dangas G, Pocock S, Mehran R. 291 Ticagrelor monotherapy after percutaneous coronary intervention in high-risk patients with prior myocardial infarction: a prespecified twilight substudy. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Patients with history of myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) remain at risk of recurrent ischaemic events. The optimal antithrombotic strategy for this cohort remains debated.
Methods and results
In this prespecified analysis of the TWILIGHT trial, we evaluated the impact of prior MI on treatment effect of ticagrelor monotherapy vs. ticagrelor plus aspirin in patients undergoing PCI with at least one clinical and one angiographic high-risk feature and free from adverse events at 3 months after the index PCI. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5, the key secondary endpoint was the composite of all-cause death, MI, or stroke, both at 12 months after randomization. 1937 (29.7%) patients with and 4595 (70.3%) without prior MI were randomized to ticagrelor and placebo or ticagrelor and aspirin. Patients with prior MI had increased rates of death, MI or stroke (5.7 vs. 3.2%, P < 0.001) but similar BARC 2–5 bleeding (5.0 vs. 5.5%, P = 0.677). Ticagrelor monotherapy reduced the risk of BARC 2–5 bleeding in patients with [3.4% vs. 6.7%; hazard ratio (HR): 0.50; 95% confidence interval (CI): 0.33–0.76] and without prior MI [4.2% vs. 7.0%; HR: 0.58; 95% CI: 0.45–0.76; pinteraction = 0.54). Rates of the key secondary ischaemic outcome were similar between treatment groups irrespective of history of MI (prior MI: 6.0% vs. 5.5%; HR: 1.09; 95% CI: 0.75–1.58; no prior MI: 3.1% vs. 3.3%; HR: 0.92; 95% CI: 0.67–1.28; pinteraction = 0.52).
Conclusions
Ticagrelor monotherapy is associated with significantly lower risk of bleeding events as compared to ticagrelor plus aspirin without any compromise in ischaemic prevention among high-risk patients with history of MI undergoing PCI.
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Affiliation(s)
- Mauro Chiarito
- Humanitas University, Italy
- Icahn School of Medicine at Mount Sinai, USA
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, USA
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, USA
| | - Carlo Pivato
- Humanitas University, Italy
- Icahn School of Medicine at Mount Sinai, USA
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Razuk V, Chiarito M, Cao D, Nicolas J, Camaj A, Power D, Beerkens F, Tavenier A, Pivato C, Mehran R, Dangas G. SGLT-2 inhibitors in patients with and without a history of heart failure: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sodium-glucose co-transporter 2 (SGLT-2) inhibitors emerged as a new groundbreaking therapy for patients with heart failure. Recent evidence showed significant benefits in patients with heart failure with reduced ejection fraction (HFrEF), regardless of diabetic status. Whether these medications also improve outcomes in patients without a history of heart failure or with heart failure with preserved ejection fraction (HFpEF) remains unknown.
Purpose
We sought to perform an updated meta-analysis of randomized controlled trials to evaluate the effects of SGLT-2 inhibitors on cardiovascular (CV) outcomes according to the history and type of heart failure.
Methods
All randomized, placebo-controlled trials of SGLT-2 inhibitors reporting similar CV outcomes were evaluated for inclusion. PubMed was searched from January 1, 2010 to February 1, 2021. Articles were independently reviewed and selected by two reviewers. The primary outcome was the composite of first hospitalization for heart failure and CV death. Secondary outcomes included its single components and all-cause mortality. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were used as effect estimates and calculated with a random-effects model. Heterogeneity was assessed with the I2 index, and random-effects meta-regression was used to assess the interaction between treatment effect and history of heart failure and type of heart failure (HFrEF vs. HFpEF).
Results
Data from eight trials and a total of 56,665 patients (n=31,609 in SGLT-2 group, n=25,056 in placebo group) were included. Five studies enrolled high-risk patients with diabetes mellitus, while 3 studies enrolled patients with symptomatic heart failure. SGLT-2 inhibitors reduced the risk of first hospitalization for heart failure and CV death in patients with (HR 0.75 95% CI 0.70–0.81) and without (HR 0.78 95% CI 0.67–0.90; Figure 1) a history of heart failure. Similarly, patients with (HR 0.85 95% CI 0.78–0.93) or without (HR 0.85 95% CI 0.74–0.98) a history of heart failure treated with SGLT-2 inhibitors had a significant reduction in all-cause mortality. SGLT-2 inhibitors reduced the risk of CV death regardless of the history of heart failure, although the reduction was border-line statistically significant in patients without a history of heart failure (HR 0.81 95% CI 0.66–1.00; Figure 2). All subgroup interaction testing between patients with and without a history of heart failure was negative for all the above endpoints. Among patients with HFpEF, SGLT-2 inhibitors were associated with a nonsignificant trend towards reduced risk of the primary outcome (HR 0.80 95% CI 0.63–1.02).
Conclusions
SGLT-2 inhibitors significantly improve CV outcomes in patients with or without history of heart failure, and this effect seems to be consistent among those with HFrEF and HFpEF.
Funding Acknowledgement
Type of funding sources: None. Figure 1. CV death or HF hospitalizationFigure 2. Meta-analysis CV death
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Affiliation(s)
- V Razuk
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Camaj
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Power
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - F Beerkens
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A.H Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Nicolas J, Cao D, Giustino G, Sartori S, Snyder C, Tavenier A, Chiarito M, Nardin M, Pivato C, Razuk V, Baber U, Windecker S, Stone G, Dangas G, Mehran R. Impact of left ventricular ejection fraction on clinical outcomes in females undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reduced left ventricular ejection fraction (LVEF) is associated with increased risk of adverse events among patients undergoing percutaneous coronary intervention (PCI). Due to under-enrollment of females in randomized trials, there is limited data on the impact of LVEF on post-PCI outcomes in female patients.
Purpose
To evaluate the impact of varying degrees of LVEF impairment on 3-year outcomes in female patients undergoing PCI with drug-eluting stents (DES).
Methods
We pooled patient-level data of female patients from 26 randomized trials of coronary stents. The study population was stratified into three groups according to the 2016 European Society of Cardiology Heart Failure guidelines: LVEF ≥50% (normal), LVEF 40–49% (mid-range), and LVEF <40% (reduced). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), or stent thrombosis (ST) at 3-year follow-up. The Kaplan-Meier method was used for time-to-event analyses, with comparative risks being assessed using Cox regression.
Results
Out of 5672 female patients with available LVEF values at baseline, 4427 (78.1%) had normal LVEF, 602 (10.6%) had mid-range LVEF, and 643 (11.3%) had reduced LVEF. Patients with reduced LVEF were older and had a higher prevalence of smoking, prior MI, and multi-vessel disease. There was a stepwise increase in 3-year event rates moving from normal, to mid-range and reduced LVEF (Figure 1). After multivariable adjustment, hazard ratio (HR) for MACE was 1.45 (95% CI: 1.10–1.92) in patients with mid-range LVEF and 2.43 (95% CI: 1.84–3.22) in patients with reduced LVEF (trend p-value <0.0001). The risk of ST was more than doubled in both mid-range LVEF (HR 2.30, 95% CI: 1.30–4.06, p=0.004) and reduced LVEF patients (HR 2.18, 95% CI: 1.11–4.28, p=0.02), as compared with normal LVEF.
Conclusion
The presence of an even mild degree of LVEF impairment confers an increased risk of ischemic events, including ST, among females undergoing PCI with DES.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Giustino
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Snyder
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Nardin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - V Razuk
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Windecker
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Stone
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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D'Ascenzo F, Elia E, Marengo G, Wańha W, González Ferreiro R, Truffa A, Trabattoni D, Figini F, Verardi R, Di Palma G, Infusino F, Pivato C, Ochała A, Omedè P, Milewski M, Estevez R, Raporeiras Roubin S, De Filippo O, Conrotto F, Montefusco A, Gili S, Cortese B, Dusi V, Gallone G, Manfredi R, Mancone M, Biondi Zoccai G, Casella G, Templin C, Stefanini G, Wojakowski W, Sheiban I, De Ferrari GM. Long-term (≥15 years) Follow-up of Percutaneous Coronary Intervention of Unprotected Left Main (From the GRAVITY Registry). Am J Cardiol 2021; 156:72-78. [PMID: 34325877 DOI: 10.1016/j.amjcard.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
Long term survival and its determinants after Percutaneous Coronary Intervention (PCI) on Unprotected Left Main Coronary Artery (ULMCA) remain to be appraised. In 9 European Centers 470 consecutive patients performing PCI on ULMCA between 2002 and 2005 were retrospectively enrolled. Survival from all cause and cardiovascular (CV) death were the primary end points, while their predictors at multivariate analysis the secondary ones. Among the overall cohort 81.5% of patients were male and mean age was 66 ± 12 years. After 15 years (IQR 13 to 16), 223 patients (47%) died, 81 (17.2%) due to CV etiology. At multivariable analysis, older age (HR 1.06, 95%CI 1.02 to 1.11), LVEF < 35% (HR 2.97, 95%CI 1.24 to 7.15) and number of vessels treated during the index PCI (HR 1.75, 95%CI 1.12 to 2.72) were related to all-cause mortality, while only LVEF <35% (HR 4.71, 95%CI 1.90 to 11.66) to CV death. Repeated PCI on ULMCA occurred in 91 (28%) patients during the course of follow up and did not significantly impact on freedom from all-cause or CV mortality. In conclusion, in a large, unselected population treated with PCI on ULMCA, 47% died after 15 years, 17% due to CV causes. Age, number of vessels treated during index PCI and depressed LVEF increased risk of all cause death, while re-PCI on ULMCA did not impact survival.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy.
| | - Edoardo Elia
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Giorgio Marengo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Filippo Figini
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Roberto Verardi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy; U.O.C. Cardiologia, Ospedale Maggiore, Bologna, Italy
| | - G Di Palma
- Cardiovascular Research Team, San Carlo Clinic, Milan, Italy
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Pivato
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Pierluigi Omedè
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Marek Milewski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Roi Estevez
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - O De Filippo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Federico Conrotto
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Antonio Montefusco
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | | | | | - Veronica Dusi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Guglielmo Gallone
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Roberto Manfredi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - G Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; Mediterranea Cardiocentro, Naples, Italy
| | | | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Stefanini
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - G M De Ferrari
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
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