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Murad S, Khan K, Abdulelah Z, Leung J, Hsu YK, Shahid F, Ludman PF, Khan SQ. The 11-year outcome of PCI for treatment of left main stem disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1408] [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: 11/13/2022] Open
Abstract
Abstract
Background
Left Main Stem Disease (LMS) has historically been treated with coronary artery bypass surgery (CABG). However, not all patents with LMS are candidates for CABG due to co-morbidities. There is limited long-term follow-up of patients undergoing PCI in the real world. The primary objective of this study was to investigate the long-term mortality following LMS PCI.
Methods
We conducted a retrospective study of patients who had undergone PCI for LMS disease at our hospital over a 11-year period between July 2010-July 2021. Data was collected from electronic medical records and analyzed using Kaplain-Meier survival analysis. Follow-up was obtained through linkage with the Office of National Statistics.
Results
498 patients underwent LMS PCI (5.1% of the total PCI cases). The overall survival rate was 70%. Median survival following PCI was 1,196 days (IQR = 1,796). The mean age of the patients was 70.7 years; 70.5% were males. 70.9% of patients underwent PCI for Acute Coronary Syndrome (ACS), and 15.3% had STEMI. 33.7% of patients had a history of diabetes, 8% had stroke, 8.2% had COPD, and 8.8% had PVD. 51 patients went into cardiogenic shock, and 25 died prior to discharge.
Survival of the ACS group was significantly lower than the stable group (67% vs 77%, p<0.01); the STEMI group did not significantly differ from rest of the ACS group (62% vs 66%, p=0.87). Survival in those <60 years of age was significantly higher than in those >60 years (80% vs 68%; p<0.01). The presence of one or more co-morbidities was associated with higher survival compared to zero co-morbidities (74% vs 65%, p<0.01). Patients with a history of diabetes had a significantly lower survival rate than those without diabetes (63% vs 73%, p<0.01). Patients with an LV ejection fraction ≤35% had a significantly lower survival than those with an ejection fraction >35% (22% vs 29%, p<0.01); only 259 patients had data on LV function. Patients who developed cardiogenic shock had a significantly lower survival rate than those who did not develop shock (38% vs 70%; p<0.01). When these patients were excluded from the data set, the overall survival rate increased from 70% to 74%. Lastly, a multinomial analysis showed that the only independent predictors of mortality were age (p<0.01) and cardiogenic shock (p<0.01).
Conclusion
Our results show that the real world 10-year mortality rate following LMS PCI is influenced by multiple factors including age, shock, and LV function. The high mortality rate was potentially due to the significant number of acute cases (70.1%) in non-operable patients. While factors such as age and past medical history are considered in the decision-making process regarding CABG vs PCI, we saw that specific subgroups within these factors may have decreased the effectiveness of PCI as a treatment for LMS disease, suggesting that deeper analysis into these risk factors is required when deciding between CABG and PCI for LMS disease management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Murad
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - K Khan
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - Z Abdulelah
- King hussein medical center , Amman , Jordan
| | - J Leung
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - Y K Hsu
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - F Shahid
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - P F Ludman
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
| | - S Q Khan
- Queen Elizabeth Hospital Birmingham , Birmingham , United Kingdom
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Sheu SY, Hsu YK, Chuang MH, Chu CM, Lin PC, Liao JH, Lin SZ, Kuo TF. Enhanced Bone Formation in Osteoporotic Mice by a Novel Transplant Combined with Adipose-derived Stem Cells and Platelet-rich Fibrin Releasates. Cell Transplant 2021; 29:963689720927398. [PMID: 32648485 PMCID: PMC7563809 DOI: 10.1177/0963689720927398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Osteoporotic fracture is the main complication of osteoporosis (OP) and accounts for millions of injuries annually. Local intervention by intra-marrow injection has been a good option for preventing osteoporotic bone loss when the osteoporotic femoral fracture has been treated. In this study, tail vein transplantations were examined to evaluate the cell-based therapeutic approach for treating OP with adipose-derived stem cells (ADSCs) and platelet-rich fibrin releasates (PRFr) in an ovariectomized (OVX) mice model. Thirty-six 12-wk-old female ICR mice were randomly divided into six groups: untreated control; sham-operated; OVX-control; OVX-ADSCs; OVX-PRFr; and OVX-ADSCs+PRFr. Starting 8 wk after ovariectomy, the OVX mice received tail vein injections once each week for four consecutive weeks, then were evaluated radiographically and histopathologically 8 wk after the first injection. We also assessed changes to bone trabeculae in the proximal tibial growth plate. In OVX mice treated with ADSCs or PRFr alone, or with a combination of ADSCs and PRFr, the trabecular bone mineral density (BMD), bone volume ratios (BV/TV), and numbers (Tb.N) in the proximal tibia areas were significantly higher than that in the OVX-control group. Significant differences between OVX-treated mice and OVX controls were found for trabecular separation, but not for trabecular thickness. These results indicate that ADSCs or PRFr treatment enhances bone microarchitecture in OP. The treatment of bone loss of OVX mice with ADSCs+PRFr induced greater bone consolidation with bone tissue production (P < 0.01) when compared to the others. Thus, we conclude that the transplantation of ADSCs combined with PRFr might provide an alternative strategy for the treatment of various bone disorders in OP with an unlimited source of cells and releasates.
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Affiliation(s)
- Shi-Yuan Sheu
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan.,Department of Chinese Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yuan-Kai Hsu
- Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Ming-Hsi Chuang
- Ph.D. Program of Technology Management, Chung Hwa University, Hsinchu, Taiwan.,Gwo Xi Stem Cell Applied Technology Co., Ltd, Hsinchu, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Po-Cheng Lin
- Gwo Xi Stem Cell Applied Technology Co., Ltd, Hsinchu, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Jeng-Hao Liao
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Shinn-Zong Lin
- Bioinnovation Center, Tzu Chi foundation; Department of Neurosurgery, Buddhist Tzu Chi General hospital, Tzu Chi University, Hualien, Taiwan
| | - Tzong-Fu Kuo
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan.,Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung, Taiwan
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Hsu YK, Sheu SY, Wang CY, Chuang MH, Chung PC, Luo YS, Huang JJ, Ohashi F, Akiyoshi H, Kuo TF. The effect of adipose-derived mesenchymal stem cells and chondrocytes with platelet-rich fibrin releasates augmentation by intra-articular injection on acute osteochondral defects in a rabbit model. Knee 2018; 25:1181-1191. [PMID: 30420268 DOI: 10.1016/j.knee.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/25/2018] [Accepted: 10/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to investigate the efficacy of adipose-derived mesenchymal stem cells (ADSCs), platelet-rich fibrin releasates (PRFr), and chondrocyte transplantation in rabbit acute osteochondral defects. METHODS Thirty rabbits were randomly assigned to five groups: untreated controls; ADSCs alone; PRFr alone; PRFr + ADSCs; and PRFr + chondrocytes. The critical size osteochondral defects in right knee femoral condyles were injected intra-articularly according to the groups, as listed. The experimental rabbits received treatments once a week for two weeks postoperatively. All evaluations were conducted for 14 weeks following surgery, and the regenerated cartilages were assessed by gross inspection and histological examination. RESULTS There were no complications encountered in any of the rabbits. The size of the defect decreased and the volume of repaired cartilage increased in the medial femoral condyles of the PRFr + ADSCs group. Relative to the ADSCs or PRFr group, histological examination demonstrated that the PRFr + ADSCs group had thicker hyaline cartilage-specific extracellular matrix. Grading scores revealed that PRFr + ADSCs injection had better matrix, cell distribution, and surface indices than other groups (P < 0.05). However, the histological scores reported for PRFr + chondrocytes on cartilage repair were similar to those of PRFr, and there were no significant between-group differences. CONCLUSIONS These findings showed that intra-articular injections of PRFr + ADSCs into the knee can reduce cartilage defects by regenerating hyaline-like cartilage without complications. This approach may provide an alternative method for functional reconstruction of acute osteochondral defects with an unlimited source of cells and releasates.
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Affiliation(s)
- Yuan-Kai Hsu
- Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Shi-Yuan Sheu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Integrated Chinese and Western Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Yih Wang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Hsi Chuang
- Ph.D. Program of Technology Management, Chung Hwa University, Hsinchu, Taiwan; Gwo Xi Stem Cell Applied Technology Co., Ltd., Hsinchu, Taiwan
| | - Pei-Chun Chung
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Siang Luo
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Jun-Jie Huang
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan; Animal Experimental Research Center/Institute of Comparative Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fumihito Ohashi
- Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Hideo Akiyoshi
- Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Tzong-Fu Kuo
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan; Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung, Taiwan.
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Hsu YK, Rosenshein NB, Parmley TH, Woodruff JD, Elberfeld HT. Leiomyomatosis in pelvic lymph nodes. Obstet Gynecol 1981; 57:91S-3S. [PMID: 7243134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A decidual reaction may occur in the pelvic lymph nodes during normal pregnancy. This reaction may be replaced by the same type of benign metaplastic reaction that gives rise to leiomyomatosis peritonealis disseminata. The occurrence of this apparent smooth muscle in the pelvic lymph nodes may result in an erroneous diagnosis of metastatic leiomyosarcoma, or of benign metastasizing leiomyoma.
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Hsu YK, Parmley TH, Rosenshein NB, Bhagavan BS, Woodruff JD. Neoplastic and non-neoplastic mesothelial proliferations in pelvic lymph nodes. Obstet Gynecol 1980; 55:83-8. [PMID: 7352068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Knowledge of gland-like inclusions in pelvic lymph nodes has existed since 1897. The histogeneses proposed to explain such alterations have included congenital rests, endometriosis, metastatic neoplasia, and mesothelial metaplasia. The correct interpretation of the lymph node involvement is important in order to institute appropriate therapy. In the present study, there were 12 examples of benign mesothelial inclusions found in routine sections from pelvic lymph nodes removed in the treatment of 337 cases of gynecologic cancer. In an additional 4 cases, an intraabdominal neoplasm was present. The variations in the histologic patterns are described as is the clinical course of the disease.
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