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Boerhout CKM, Vink CEM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Impact of sex on the assessment of the microvascular resistance reserve. Int J Cardiol 2024; 402:131832. [PMID: 38316189 DOI: 10.1016/j.ijcard.2024.131832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The microvascular resistance reserve (MRR) is an innovative index to assess the vasodilatory capacity of the coronary circulation while accounting for the presence of concomitant epicardial disease. The MRR has shown to be a valuable diagnostic and prognostic tool in the general coronary artery disease (CAD) population. However, considering the fundamental aspects of its assessment and the unique hemodynamic characteristics of women, it is crucial to provide additional considerations for evaluating the MRR specifically in women. AIM The aim of this study was to assess the diagnostic and prognostic applicability of the MRR in women and assess the potential differences across different sexes. METHODS From the ILIAS Registry, we enrolled all patients with a stable indication for invasive coronary angiography, ensuring complete physiological and follow-up data. We analyzed the diagnostic value by comparing differences between sexes and evaluated the prognostic value of the MRR specifically in women, comparing it to that in men. RESULTS A total of 1494 patients were included of which 26% were women. The correlation between MRR and CFR was good and similar between women (r = 0.80, p < 0.005) and men (r = 0.81, p < 0.005). The MRR was an independent and important predictor of MACE in both women (HR 0.67, 0.47-0.96, p = 0.027) and men (HR 0.84, 0.74-0.95, p = 0.007). The optimal cut-off value for MRR in women was 2.8 and 3.2 in men. An abnormal MRR similarly predicted MACE at 5-year follow-up in both women and men. CONCLUSION The MRR seems to be equally applicable in both women and men with stable coronary artery disease.
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Affiliation(s)
| | - C E M Vink
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | | | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, Daegu, South Korea
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Paul Knaapen
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, the Netherlands.
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Belmonte M, Paolisso P, Gallinoro E, Bertolone DT, Caglioni S, Leone A, De Colle C, Viscusi MM, Bermpeis K, Storozhenko T, Mileva N, Sonck J, Wyffels E, Vanderheyden M, Collet C, De Bruyne B, Andreini D, Penicka M, Barbato E. Predictors of percutaneous coronary intervention derived from CCTA in patients with chronic coronary syndrome. J Cardiovasc Comput Tomogr 2024; 18:154-161. [PMID: 38238196 DOI: 10.1016/j.jcct.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND To identify anatomical and morphological plaque features predictors of PCI and create a multiparametric score to increase the predictive yield. Moreover, we assessed the incremental predictive value of FFRCT (Fractional Flow Reserve derived from CCTA) trans-lesion gradient (ΔFFRCT) when integrated into the score. METHODS Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with FFRCT available, referred to invasive coronary angiogram and assessment of fractional flow reserve. Plaque analysis was performed using validated semi-automated software. Logistic regression was performed to identify anatomical and morphological plaque features predictive of PCI. Optimal thresholds were defined by area under the receiver-operating characteristics curve (AUC) analysis. A scoring system was developed in a derivation cohort (70 % of the study population) and tested in a validation cohort (30 % of patients). RESULTS The overall study population included 340 patients (455 vessels), among which 238 patients (320 vessels) were included in the derivation cohort. At multivariate logistic regression analysis, absence of left main disease, diameter stenosis (DS), non-calcified plaque (NCP) volume, and percent atheroma volume (PAV) were independent predictors of PCI. Optimal thresholds were: DS ≥ 50 %, volume of NCP>113 mm3 and PAV>17 %. A weighted score (CT-PCI Score) ranging from 0 to 11 was obtained. The AUC of the score was 0.80 (95%CI 0.74-0.86). The integration of ΔFFRCT in the CT-PCI score led to a mild albeit not significant increase in the AUC (0.82, 95%CI 0.77-0.87, p = 0.328). CONCLUSIONS Plaque anatomy and morphology derived from CCTA could aid in identifying patients amenable to PCI.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Niya Mileva
- Specialized Cardiovascular Hospital "Medica Cor", Ruse, Bulgaria; Medical University of Sofia, Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
| | - Emanuele Barbato
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy.
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Boden WE. Optimal medical therapy vs revascularization in chronic coronary syndromes: Does ISCHEMIA move the needle toward or away from revascularization?? Vascul Pharmacol 2024; 154:107253. [PMID: 38070758 DOI: 10.1016/j.vph.2023.107253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
The optimal management of chronic coronary syndrome (CCS) patients has been a source of debate for several decades. Herein, we describe the evidence base comprising several landmark clinical trials including the most recent ISCHEMIA Trial, which, in aggregate, does not demonstrate a conclusive, incremental benefit of revascularization combined with optimal medical therapy (OMT) versus OMT alone in reducing prognostically-important clinical outcomes during long-term follow-up. For CCS patients with symptoms or quality of life not deemed refractory or unacceptable on medical therapy, a conservative approach to the judicious and selective use of revascularization plus OMT remains a justifiable evidence-based management strategy.
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Affiliation(s)
- William E Boden
- VA New England Healthcare System, Boston University School of Medicine, and Harvard Medical School, Boston, MA, USA.
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Tang XF, Yuan DS, Zhu P, Xu N, Yao Y, Wang PZ, Chen Y, Gao LJ, Song L, Yang YJ, Gao RL, Zhao XY, Yuan JQ. Baseline high-sensitivity C-reactive protein and glycosylated hemoglobinA1c predict adverse outcomes in patients with chronic coronary syndromes undergoing percutaneous coronary intervention. Heliyon 2024; 10:e23900. [PMID: 38192767 PMCID: PMC10772714 DOI: 10.1016/j.heliyon.2023.e23900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/25/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction This study explored the ability of high-sensitivity C-reactive protein (hs-CRP) and glycosylated hemoglobin A1c (HbA1c) to predict adverse cardiac and cerebrovascular outcomes in patients with chronic coronary syndromes (CCS) undergoing percutaneous coronary intervention (PCI). Methods In total, 4083 consecutive patients with CCS undergoing PCI were investigated throughout 2013 at a single center. The primary endpoint was all-cause death at the 5-year follow-up. Hs-CRP and HbA1c data were collected on admission. Results The highest quartile of hs-CRP had a significantly increased the risk of all-cause death, with an adjusted HR of 1.747 (95 % CI 1.066-2.863), while, there was no difference in all-cause death among the groups of HbA1c after adjustment, with an adjusted HR of 1.383 (95 % CI 0.716-2.674). The highest quartiles for hs-CRP and HbA1c in the study population had a significantly increased risk of major adverse cardiac and cerebrovascular events (MACCE), with an adjusted hazard ratios (HR) of 1.263 (95 % confidence intervals [CI] 1.032-1.545) for hs-CRP and an adjusted HR of 1.417 (95 % CI 1.091-1.840) for HbA1c. Remarkably, the incidence of all-cause death and that of MACCE were significantly increased when both hs-CRP and HbA1c were elevated (HR 1.971, 95 % CI 1.079-3.601, P = 0.027 and HR 1.560, 95 % CI 1.191-2.042), P = 0.001, respectively). Addition of hs-CRP and HbA1c to conventional risk factors significantly improved prediction of the risk of all cause death (net reclassification index 0.492, P < 0.001; integrated discrimination improvement 0.007, P = 0.011) and MACCE (net reclassification index 0.160, P < 0.001; integrated discrimination improvement 0.006, P < 0.001). Conclusions Hs-CRP and HbA1c can serve as independent predictors of MACCE in patients with CCS undergoing PCI. Furthermore, a combination of hs-CRP and HbA1c could predict all cause death and MACCE better than each component individually.
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Affiliation(s)
- Xiao-Fang Tang
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - De-Shan Yuan
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Zhu
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Xu
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei-Zhi Wang
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Chen
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Jian Gao
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan Zhao
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Qing Yuan
- Department of Cardiology, Centre for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Akkaif MA, Daud NAA, Noor DAM, Sha'aban A, Kader MASA, Ibrahim B. The Impact of CYP2C19 Genotype on the Platelet Reactivity Index (PRI) among Chronic Coronary Syndromes (CCS) Patients Undergoing Percutaneous Coronary Intervention (PCI): Affectability of Rapid Genetic Testing. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07544-6. [PMID: 38224415 DOI: 10.1007/s10557-024-07544-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND In the Asian population, the presence of the CYP2C19 loss-of-function (LOF) allele is a known genetic variation. This allele is associated with a reduced capacity to metabolize clopidogrel into its active forms through the CYP2C19 enzyme, resulting in diminished platelet inhibition and an elevated risk of recurrent cardiovascular events. Regulatory authorities have recommended an alternative P2Y12 inhibitor, ticagrelor, for individuals carrying the LOF allele. Consequently, this study seeks to assess the impact of the CYP2C19 genotype on the Platelet reactivity index (PRI) using a rapid genetic testing approach in Asian patients with chronic coronary syndromes (CCS) who undergo percutaneous coronary intervention (PCI). METHODS This prospective study employed a parallel design, single-center design, and randomized approach. Genotyping for the CYP2C19*2 and *3 polymorphisms was conducted using the Nested Allele-Specific Multiplex PCR (NASM-PCR) technique. Patients meeting the inclusion criteria underwent genotyping for CYP2C19 polymorphisms. Following PCI, patients were randomly assigned to receive either ticagrelor or clopidogrel. PRI assessments were performed four hours after loading dose administration. The trial was registered with ClinicalTrials.gov under the identifier NCT05516784. RESULTS Among the 94 patients recruited for the study, 40 (42.55%) were identified as carriers of the LOF allele for CYP2C19*2 and *3 (*1/*2, *2/*2, *1/*3). Out of the 84 patients evaluated for PRI (44 receiving clopidogrel and 40 receiving ticagrelor), 21 (47.7%) of the clopidogrel group and 39 (97.5%) of the ticagrelor group exhibited a favorable response to antiplatelet therapy (PRI < 50). Patients treated with ticagrelor demonstrated superior antiplatelet responses compared to those receiving clopidogrel, regardless of LOF carrier status (P = 0.005 and < 0.001 for non-LOF and LOF carriers, respectively). CONCLUSION NASM-PCR as a rapid genetic test holds promise for personalizing antiplatelet therapy in Asian CCS patients.
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Affiliation(s)
- Mohammed Ahmed Akkaif
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201700, People's Republic of China.
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia.
| | | | | | - Abubakar Sha'aban
- School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | | | - Baharudin Ibrahim
- Faculty of Pharmacy, University of Malaya, Federal Territory Malaysia, Kuala Lumpur, 50603, Malaysia.
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Panuccio G, Carabetta N, Torella D, De Rosa S. Clinical impact of coronary revascularization over medical treatment in chronic coronary syndromes: A systematic review and meta-analysis. Hellenic J Cardiol 2023:S1109-9666(23)00194-X. [PMID: 37949356 DOI: 10.1016/j.hjc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To provide a quantitative comparison between myocardial revascularization (REVASC) and optimal medical treatment (OMT) alone in patients with chronic coronary syndrome (CCS). METHODS Pertinent studies were searched for in PubMed/Medline until 12/03/2023. Randomized controlled trials that compare REVASC to OMT reporting clinical outcomes were selected according to PRISMA guidelines. The primary outcome was cardiovascular death. Two investigators independently assessed the study quality and extracted data. RESULTS Twenty-eight randomized controlled studies (RCTs) including 20692 patients were included in this meta-analysis. The rate of cardiovascular mortality was significantly lower among patients treated with myocardial revascularization [risk ratio (RR) 0.79, 95% CI 0.69-0.90]. Age (p = 0.03), multivessel disease (p < 0.001), and follow-up duration (p = 0.001) were significant moderators of CV mortality. Subgroup analyses showed a larger benefit in patients treated with drug-eluting stents and those without chronic total occlusion. Among secondary outcomes, myocardial infarction was less frequent in the REVASC group (RR = 0.74; p < 0.001), while no significant difference was found for all-cause mortality (p = 0.09) nor stroke (p = 0.26). CONCLUSIONS The present analysis showed lower rates of CV mortality and myocardial infarction in CCS patients treated with myocardial revascularization compared to OMT. This benefit was larger with increasing follow-up duration. Personalized treatment based on patient characteristics and lesion complexity may optimize clinical outcomes in patients with CCS.
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Affiliation(s)
| | | | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.
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Alifu J, Xiang L, Zhang W, Qi P, Chen H, Liu L, Yin G, Mohammed AQ, Lv X, Shi T, Abdu FA, Che W. Association between the atherogenic index of plasma and adverse long-term prognosis in patients diagnosed with chronic coronary syndrome. Cardiovasc Diabetol 2023; 22:255. [PMID: 37735427 PMCID: PMC10515024 DOI: 10.1186/s12933-023-01989-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The Atherogenic Index of Plasma (AIP) is a newly identified biomarker associated with lipid metabolism, demonstrating significant prognostic capabilities in individuals diagnosed with cardiovascular disease. However, its impact within the context of chronic coronary syndromes (CCS) remains unexplored. Thus, the present investigation sought to examine the potential association between AIP levels and long-term clinical outcomes in patients diagnosed with CCS. METHODS A total of 404 patients diagnosed with CCS and who underwent coronary angiography were included in this study. The AIP index was calculated as log (triglycerides / high-density lipoprotein-cholesterol). The patients were categorized into four groups based on their AIP values: Q1 (< -0.064), Q2 (-0.064 to 0.130), Q3 (0.130 to 0.328), and Q4 (> 0.328). The occurrence of major adverse cardiovascular events (MACE) was monitored during the follow-up period for all patients. Cox regression analysis and Kaplan-Meier curve analysis were employed to examine the relationship between AIP and MACE. Furthermore, ROC analysis was utilized to determine the optimal cut-off value of AIP for predicting clinical MACE. RESULTS During the median 35 months of follow-up, a total of 88 patients experienced MACE. Notably, the group of patients with higher AIP values (Q4 group) exhibited a significantly higher incidence of MACE compared to those with lower AIP values (Q1, Q2, and Q3 groups) (31.7% vs. 16.8%, 15.7%, and 23.0% respectively; P = 0.023). The Kaplan-Meier curves illustrated those patients in the Q4 group had the highest risk of MACE relative to patients in the other groups (log-rank P = 0.014). Furthermore, the multivariate Cox regression analysis demonstrated that individuals in the Q4 group had a 7.892-fold increased risk of MACE compared to those in the Q1 group (adjusted HR, 7.892; 95% CI 1.818-34.269; P = 0.006). Additionally, the ROC curve analysis revealed an optimal AIP cut-off value of 0.24 for predicting clinical MACE in patients with CCS. CONCLUSION Our data indicate, for the first time, that AIP is independently associated with poor long-term prognosis in patients suffering from CCS. The optimal AIP cut-off value for predicting clinical MACE among CCS patients was 0.24.
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Affiliation(s)
- Jiasuer Alifu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Lanqing Xiang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
- Department of Cardiology, Clinical Medical College of Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China
| | - Wen Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Penglong Qi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Huiying Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Tingting Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
- Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
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Parker WAE, Angiolillo DJ, Rollini F, Franchi F, Bonaca MP, Bhatt DL, Steg PG, Orme RC, Thomas MR, Judge HM, Sabatine MS, Storey RF. Influence of body weight and body mass index on the chronic pharmacokinetic and pharmacodynamic responses to clinically available doses of ticagrelor in patients with chronic coronary syndromes. Vascul Pharmacol 2023; 149:107145. [PMID: 36720377 DOI: 10.1016/j.vph.2023.107145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
Ticagrelor has multiple indications, including for some patients with chronic coronary syndromes (CCS) at high risk of ischaemic events. Body mass can potentially affect pharmacodynamics (PD) and pharmacokinetics (PK). We investigated the influence of body mass (range 53-172 kg, 20.8-46.9 kg/m2) on PD/PK in 221 CCS patients receiving ticagrelor 60 mg or 90 mg twice-daily (BD) during two randomised-controlled trials. Correlations between body weight (BW) or body mass index (BMI) and PD/PK measurements obtained during maintenance treatment at trough ('pre-dose') and peak effect ('post-dose') were assessed. BW and BMI correlated with P2Y12 reactivity units at pre-dose (e.g. BW:R = 0.26, p = 0.008) but not post-dose timepoints. BW affected ticagrelor active metabolite (TAM) levels (e.g. 60 mg BD, post-dose:R = -0.39, p < 0.0001) and there was evidence of an inverse power law relationship between BW and TAM-to-ticagrelor ratio. PK with ticagrelor 60 mg correlated significantly with BMI. BW and BMI did not affect the chance of high platelet reactivity, which remained very low across the whole cohort. There was no difference in PRU between the two doses of ticagrelor within each weight or BMI group. Body mass has modest effects on the PK/PD response to ticagrelor in patients with CCS but currently-used regimens appear adequate across the range of BW/BMI studied.
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Affiliation(s)
- William A E Parker
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Marc P Bonaca
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ph Gabriel Steg
- Université Paris-Cité, INSERM UMR1148/LVTS, AP-HP, Hôpital Bichat, Paris, France
| | - Rachel C Orme
- Department of Cardiology, St John of God Hospital, Southwest Health Campus, Bunbury, WA, Australia
| | - Mark R Thomas
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Heather M Judge
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Marc S Sabatine
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Kurup R, Wijeysundera HC, Bagur R, Ybarra LF. Complete Versus Incomplete Percutaneous Coronary Intervention-Mediated Revascularization in Patients With Chronic Coronary Syndromes. Cardiovasc Revasc Med 2023; 47:86-92. [PMID: 36266152 DOI: 10.1016/j.carrev.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023]
Abstract
Multivessel coronary artery disease (CAD) is associated with worse outcomes across the spectrum of clinical presentations. The prognostic implications of completeness of revascularization in CAD patients, especially those with chronic coronary syndromes (CCS), remain highly debated. This is largely due to the use of non-standardized definitions for complete revascularization (CR) and incomplete revascularization (ICR) within previously published studies, lack of randomized clinical data, varying revascularization methods and heterogenous study populations. In particular, the utility and effectiveness of PCI-mediated CR for CCS remains unknown. In this review, we discuss the various definitions used for CR vs. ICR, highlight the rationale for pursuing CR and summarise the current literature regarding the effects of PCI-mediated CR on clinical outcomes in patients with CCS.
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Affiliation(s)
- Rahul Kurup
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Rodrigo Bagur
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Luiz F Ybarra
- Chronic Total Occlusion Program, London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
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10
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Neglia D, Liga R, Gimelli A, Podlesnikar T, Cvijić M, Pontone G, Miglioranza MH, Guaricci AI, Seitun S, Clemente A, Sumin A, Vitola J, Saraste A, Paunonen C, Sia CH, Paleev F, Sade LE, Zamorano JL, Maroz-Vadalazhskaya N, Anagnostopoulos C, Macedo F, Knuuti J, Edvardsen T, Cosyns B, Petersen SE, Magne J, Laroche C, Berlè C, Popescu BA, Delgado V. Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry. Eur Heart J 2023; 44:142-158. [PMID: 36452988 DOI: 10.1093/eurheartj/ehac640] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 09/20/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). METHODS Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). RESULTS The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. CONCLUSIONS In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.
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Affiliation(s)
- Danilo Neglia
- Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Riccardo Liga
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell' Area Critica, University of Pisa, Via Savi 10, 56126 Pisa, Italy
- Dipartimento Cardiotoraco Vascolare, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy
| | - Alessia Gimelli
- Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Tomaž Podlesnikar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Marta Cvijić
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Carlo Parea, 4, 20138 Milano, Italy
| | - Marcelo Haertel Miglioranza
- EcoHaertel-Mae de Deus Hospital, R. José de Alencar, 286 - Menino Deus, Porto Alegre - RS, 90880-481, Brazil
- Federal University of Health Sciences of Porto Alegre (UFCSPA), R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - RS, 90050-17, Brazil
- Institute of Cardiology-University Foundation of Cardiology, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - RS, 90050-170, Brazil
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Sara Seitun
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Largo Rosanna Benzi, 10, 16132 Genova, Italy
| | - Alberto Clemente
- Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Alexey Sumin
- Federal State Budgetary Scientific Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy Blvd., 6, 650002 Kemerovo, Russian Federation
| | - João Vitola
- Quanta Diagnostico por Imagem, R. Alm. Tamandaré, 1000 - Alto da XV, Curitiba - PR, 80045-170, Brazil
| | - Antti Saraste
- Heart Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Christian Paunonen
- Heart Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Ching-Hui Sia
- National University Heart Centre Singapore, 5 Lower Kent Ridge Rd, 119074 Singapore, Singapore
| | - Filipp Paleev
- National Medical Research Center of Cardiology, 3-Ya Cherepkovskaya Ulitsa, 15A, 121552 Moscow, Russian Federation
| | - Leyla Elif Sade
- Department of Cardiology, University of Baskent, Yukarı Bahçelievler, Mareşal Fevzi Çakmak Cd. No: 45, 06490 Çankaya/Ankara, Turkey
| | - Jose Luis Zamorano
- Department of Cardiology, Ramon Y Cajal University Hospital, M-607, 9, 100, 28034 Madrid, Spain
| | - Natallia Maroz-Vadalazhskaya
- Department of General Practice, Division of Postgraduate Education, Belarusian State Medical University, Dzerzhinski Ave 83, 220083 Minsk, Belarus
| | - Constantinos Anagnostopoulos
- PET-CT Department & Preclinical Imaging Unit, Centre for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece
| | - Filipe Macedo
- Cardiology Department, S João University Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, c/o Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Kirkeveien 166, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten, Universtair Ziekenhuis Brussel, Av. du Laerbeek 101, 1090 Bruxelles, Belgium
- In Vivo Molecular and Cellular Imaging Center, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Steffen E Petersen
- Barts Heart Center, St. Bartholomew's Hospital, West Smithfield, W Smithfield, London EC1A 7BE, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Julien Magne
- Inserm Unit 1094 and IRD, Faculty of Medicine, Limoges University, 2 rue du Dr Marcland, 87025 Limoges, France
- Centre of Epidemiology, Biostatistic and Methodology of Research, University Hospital, Limoges, 2 Av. Martin Luther King, 87000 Limoges, France
- Department of Cardiology, Dupuytren-2 University Hospital, 16 rue Bernard Descottes, 87042 Limoges, France
| | - Cecile Laroche
- The European Society of Cardiology, The European Heart House, Sophia Antipolis Cedex, 2035 Rte des Colles, 06410 Biot, France
| | - Clara Berlè
- The European Society of Cardiology, The European Heart House, Sophia Antipolis Cedex, 2035 Rte des Colles, 06410 Biot, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bulevardul Eroii Sanitari 8, 050474 București, Romania
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Heart Institute, Hospital University Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
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11
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Galvão Braga C, Araújo Gonçalves P, Cardoso P, Fiarresga A, Santos L, Domingues A, Costa M, Ferreira R, Duarte J, Seixo F, Campante Teles R, Pereira H, Silva JC, Fernandes R, Baptista J, Braga P, Costa J, Farto e Abreu P, Costa Ferreira P, Caires G, Martins D, Sousa P, Brum da Silveira J. Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal. Rev Port Cardiol 2023; 42:1-6. [PMID: 36043164 PMCID: PMC9411142 DOI: 10.1016/j.repc.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. OBJECTIVES To quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. METHODS Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017-2019). RESULTS The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (-36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, -25% (p<0.019), -20% (p<0.068) and -59% (p<0.001). CONCLUSIONS Compared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.
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Affiliation(s)
| | | | - Pedro Cardoso
- Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | | | - Lino Santos
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Ana Domingues
- Associação Portuguesa de Intervenção Cardiovascular, Lisboa, Portugal
| | - Marco Costa
- Centro Hospitalar e Universitário de Coimbra EPE, Lisboa, Portugal
| | - Rui Ferreira
- Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - José Duarte
- Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | - Filipe Seixo
- Centro Hospitalar de Setúbal EPE, Setúbal, Portugal
| | | | - Hélder Pereira
- Garcia de Orta Hospital: Hospital Garcia de Orta EPE, Almada, Portugal
| | | | | | | | - Pedro Braga
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | | | | | | | | | - Dinis Martins
- Hospital do Divino Espírito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Paulino Sousa
- Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, Vila Real, Portugal
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Manolis A, Kallistratos M, Poulimenos L, Zamfir T, Thomopoulos C. Effects of ranolazine on various outcomes in patients with stable angina: an updated meta-analysis. Hellenic J Cardiol 2022:S1109-9666(22)00176-2. [PMID: 36481415 DOI: 10.1016/j.hjc.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We determined the effect of ranolazine vs. placebo in angina patients on 1) selective measures of the ischemic burden, 2) cardiovascular outcomes, including atrial fibrillation incidence, 3) the in-treatment glycohemoglobin levels and the permanent discontinuations because of side effects, and 4) the achieved between-arms blood pressure and heart rate difference. METHODS PubMed and Cochrane Collaboration Library databases were searched for eligible trials until end of September 2020. Trial quality was assessed by the Rob2 tool. Risk ratios or achieved mean differences during follow-up and 95% confidence interval (CI) of categorical or continuous outcomes, respectively, were calculated (random-effects model). The relationship between discontinuation rates and ranolazine's mean dose was investigated by meta-regression analysis. RESULTS We selected 18 trials (n = 12,995 patients in patients with macro or microvascular coronary heart disease. Achieved blood pressure and heart rate at rest were not different between randomized arms. Ranolazine administration compared to placebo was associated with an increase of 1) total exercise duration by 30 seconds (95% CI, 18-42), 2) time to 1 mm ST-segment depression by 44 seconds (95% CI, 30-54), and 3) time to angina onset by 40 seconds (95% CI, 30-54). On average, the incidence of atrial fibrillation was reduced by 25% following ranolazine treatment compared to placebo, while glycohemoglobin showed a mean decrease of 0.4% (95% CI, 0.3-0.5%). DISCUSSION Ranolazine remains an effective anti-ischemic drug, increases the angina-free exercise duration, delays the onset of ST-segment depression. The beneficial effects of ranolazine are extended to atrial fibrillation reduction rates and better glycemic control.
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13
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Sanguineti F, Duhamel S, Garot P, Garot J. [The role of Cardiovascular Magnetic Resonance in Interventional Cardiology]. Ann Cardiol Angeiol (Paris) 2022; 71:362-367. [PMID: 36229237 DOI: 10.1016/j.ancard.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cardiovascular magnetic resonance has emerged as a very helpful tool for the interventional cardiologists not only in the assessment and treatment of coronary artery disease, but also in the evaluation of various structural cardiac diseases. The main pulse sequences are standardised, acquired during short breath-holds, and include steady-state free precession cines, dynamic myocardial first-pass perfusion imaging during contrast injection, and late enhancement imaging for the identification of myocardial substrates. Less than 30-minute CMR studies are now available for the most common clinical indications. More recently, T1 and T2 parametric myocardial maps are promising for detailed myocardial tissue characterisation (edema, replacement fibrosis, diffuse interstitial fibrosis). Technical aspects will not be addressed with particular emphasis on clinical applications.
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Affiliation(s)
- Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France; Institut Cardiovasculaire Paris Sud, Cardiologie Interventionnelle, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France
| | - Suzanne Duhamel
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France; Institut Cardiovasculaire Paris Sud, Cardiologie Interventionnelle, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
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14
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Maaniitty T, Knuuti J, Saraste A. Stress myocardial blood flow and revascularization in chronic coronary artery disease. J Nucl Cardiol 2022; 29:1900-1902. [PMID: 34105039 DOI: 10.1007/s12350-021-02687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland.
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20520, Turku, Finland.
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15
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Palma C, David C, Fernandes RM, Pinto FJ, Costa J, Ferreira JJ, Caldeira D. The sham effect of invasive interventions in chronic coronary syndromes: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:223. [PMID: 35568808 PMCID: PMC9107755 DOI: 10.1186/s12872-022-02658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/04/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Some patients with chronic coronary syndromes undergo invasive procedures but the efficacy of such interventions remains to be robustly established by randomised sham-controlled trials (RCTs). PURPOSE To determine the sham effect in patients with chronic coronary syndromes enrolled in RCTs by performing a systematic review and meta-analysis. METHODS In April 2022, we performed a literature search for published patient-blind RCTs (CENTRAL, MEDLINE®, PsycINFO, and reference lists) with sham procedures, reporting the pre-post effects in the invasive sham arm among patients with Canadian cardiovascular society (CCS) angina or angina equivalents. RESULTS 16 RCTs were included with 546 patients in the sham arm. Pooled results showed that sham interventions were associated with: improvement of 7% (95% CI 2-11%; I2 = 0%) in exercise time; decrease of 0.78 (95% CI - 1.10 to - 0.47; I2 = 75%) in CCS angina class; decrease of 53% (95% CI 24-71%; I2 = 96%) and 25% (95% CI 20-29%; I2 = 0%) in anginal episodes and nitroglycerine (NTG) use, respectively. Pooled results also showed an improvement in the physical functioning, angina frequency, treatment satisfaction, and disease perception domains of the Seattle Angina Questionnaire (SAQ). CONCLUSION Sham interventions in patients with chronic coronary syndromes were associated with a significant decrease in anginal episodes, NTG use, and CCS angina class and increased SAQ quality of life and exercise time. These results highlight the need for previous non sham-controlled trials to be interpreted with caution, and the importance of new invasive interventions to be evaluated versus a sham procedure.
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Affiliation(s)
- Catarina Palma
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cláudio David
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo M Fernandes
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Pediatrics, Santa Maria Hospital, Centro Hospitalar Univesitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Univesitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Univesitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal.
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De Luca L, Rubboli A, Lettino M, Tubaro M, Leonardi S, Casella G, Valente S, Rossini R, Sciahbasi A, Natale E, Trambaiolo P, Navazio A, Cipriani M, Corda M, De Nardo A, Francese GM, Napoletano C, Tizzani E, Nardi F, Roncon L, Caldarola P, Riccio C, Gabrielli D, Oliva F, Massimo Gulizia M, Colivicchi F. ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes. Eur Heart J Suppl 2022; 24:C254-C271. [PMID: 35663586 PMCID: PMC9155223 DOI: 10.1093/eurheartj/suac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/16/2022]
Abstract
Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand, antithrombotic therapy should reduce the risk related to recurrent ischaemic events and/or stent thrombosis; on the other hand, care must be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper, we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge, and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.
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Affiliation(s)
- Leonardo De Luca
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Andrea Rubboli
- Cardiology, Cardiovascular Department, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Maddalena Lettino
- Department of Cardiology, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Marco Tubaro
- CCU, Intensive and Interventional Cardiology Department, P.O. San Filippo Neri, Roma, Italy
| | - Sergio Leonardi
- University of Pavia and IRCCS S. Matteo Foundation General Hospital, Pavia, Italy
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, Azienda USL di Bologna, Bologna, Italy
| | - Serafina Valente
- Cardio-Thoracic Department, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena, Italy
| | - Roberta Rossini
- Emergency Department and Critical Areas, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | - Enrico Natale
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Paolo Trambaiolo
- Cardiology Department, Ospedale Sandro Pertini, ASL RM2, Roma, Italy
| | - Alessandro Navazio
- Hospital Cardiology Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Alfredo De Nardo
- Cardiology-ICU Department, Ospedale Civile "G. Jazzolino", Vibo Valentia, Italy
| | - Giuseppina Maura Francese
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Cosimo Napoletano
- Cardiology-ICU Department-Cath Lab, Presidio Ospedaliero "G. Mazzini", Teramo, Italy
| | | | - Federico Nardi
- Cardiology Department, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | - Loris Roncon
- Cardiology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Carmine Riccio
- Follow-up of the Post-Acute Patient, Cardio-Vascular Department, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Domenico Gabrielli
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Fabrizio Oliva
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
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Orsini E, Marzilli M, Zito GB, Carbone V, Latina L, Oliviero U, Rizzo U. Clinical outcomes of newly diagnosed, stable angina patients managed according to current guidelines. The ARCA (Arca Registry for Chronic Angina) Registry: A prospective, observational, nationwide study. Int J Cardiol 2022; 352:9-18. [PMID: 35120946 DOI: 10.1016/j.ijcard.2022.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinical outcomes of stable angina patients treated according to guidelines recommendations (medical therapy first, selective revascularization in high risk or unresponsive patients) are not fully known. METHODS AND RESULTS Eight hundred thirty-three patients with newly diagnosed, stable angina were enrolled in a prospective, observational, nationwide registry and followed for 1 year. Symptoms and quality of life were evaluated with the CCS angina grading, with a self-assessment scale and with the SAQ-7. A composite end-point of MACEs (all-cause death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for unstable angina) at 1 year was considered. Upon enrollment, all patients were prescribed guidelines directed medical therapy. After one month of therapy, angina relieved or improved in 47% of the overall population. Patients in CCS class I significantly increased from 28.4% at enrollment to 67.1% at 12 months, and the SAQ-7 score from 58.4 ± 20 to 85.9 ± 14. The rate of MACEs was low (2.9%) in the overall population. After one month of medical therapy, 40.6% of patients were referred for coronary angiography and revascularization for resistant symptoms (invasive strategy). Among these, 38.2% had normal coronary arteries and 47% actually underwent revascularization. No difference between invasive and medical groups was found at 12 months in symptoms, quality of life and MACEs, except for a greater improvement in self-assessed symptoms in the invasive group. Combined medical and invasive strategies left 28.5% of patients still symptomatic at the end of the study. CONCLUSIONS The study confirms the efficacy and safety of a tailored approach to stable angina, as recommended by guidelines, with medical therapy first followed by selective revascularization when needed.
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Affiliation(s)
- Enrico Orsini
- University Division of Cardiology, Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | - Mario Marzilli
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | | | - Vincenzo Carbone
- Outpatient Cardiology, ASL Napoli 3 Sud, ARCA Campania, Napoli, Italy
| | - Loredana Latina
- Center for the Prevention of Cardiovascular Disease, ARCA Trentino Alto Adige, Bolzano, Italy
| | - Ugo Oliviero
- Department of Translational Medical Sciences, University Federico II, ARCA Campania, Napoli, Italy
| | - Umberto Rizzo
- Outpatient Cardiology, ASL Bari, ARCA Puglia, Bari, Italy
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18
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De Luca L, Gulizia MM, Gabrielli D, Meessen J, Mattei L, D'Urbano M, Colivicchi F, Temporelli PL, Borghi C, Desideri G. Impact of serum uric acid levels on cardiovascular events and quality of life in patients with chronic coronary syndromes: Insights from a contemporary, prospective, nationwide registry. Nutr Metab Cardiovasc Dis 2022; 32:393-401. [PMID: 34893417 DOI: 10.1016/j.numecd.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/05/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Hyperuricemia is a metabolic disorder that has been associated with adverse cardiovascular (CV) events. Using the data from a nationwide, prospective registry on patients with chronic coronary syndromes (CCS), we assessed the impact of serum uric acid (SUA) levels on quality of life (QoL) and major adverse CV events (MACE), a composite of CV death and hospitalization for myocardial infarction, heart failure (HF), angina or revascularization at 1-year. METHODS AND RESULTS Among the 5070 consecutive CCS patients enrolled in the registry, levels of SUA were available for 2394 (47.2%). Patients with SUA levels available at baseline were grouped as low tertile (n = 860; 4.3 [3.7-4.7] mg/dL), middle tertile (n = 739; 5.6 [5.3-5.9] mg/dL) and high tertile (n = 795; 7.1 [6.7-7.9] mg/dL). At 1 year, the incidence of MACE was 3.7%, 4.1% and 6.8% for low, middle and high tertiles, respectively (p = 0.005 for low vs high tertile). Patients in the high tertile of SUA had a significantly higher rate of CV mortality (1.4% vs 0.4%; p = 0.05) and hospital admission for HF (2.8% vs 1.6%; p = 0.03) compared to the low tertile. However, hyperuricemia did not result as an independent predictor of MACE at multivariable analysis [hazard ratio: 1.27; 95% confidence intervals: 0.81-2.00; p = 0.3]. CONCLUSIONS In this contemporary, large cohort of CCS, those in the high tertile of SUA had a greater burden of CV disease and worse QoL. However, SUA did not significantly influence the higher rate of CV mortality, hospitalization for HF and MACE observed in these patients during 1-year follow-up.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy.
| | | | - Domenico Gabrielli
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Jennifer Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Luisa Mattei
- Division of Cardiology, Ospedale Monfalcone-Gorizia, Italy
| | | | | | - Pier L Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Novara, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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19
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Stehli J, Jakob P, Michel J, Kasel M, Ruschitzka F, Templin C, Stähli BE. [Personalized Therapeutic Concepts in Chronic Coronary Syndromes]. Praxis (Bern 1994) 2022; 111:141-147. [PMID: 35232260 DOI: 10.1024/1661-8157/a003802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Personalized Therapeutic Concepts in Chronic Coronary Syndromes Abstract. Chronic coronary syndromes (CCS) are related to substantial morbidity and mortality. Myocardial ischemia in CCS is caused by either obstructive or non-obstructive alterations of the coronary arteries, including both morphological and functional changes of epicardial vessels and the coronary microvasculature. Diagnostic algorithms of patients with suspected CCS include non-invasive and invasive imaging and functional testing. Therapeutic management comprises lifestyle changes, optimal medical therapy, and coronary revascularization when indicated. This review summarizes the contemporary management of patients with CCS, focusing on the role of invasive assessment and treatment.
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Affiliation(s)
- Julia Stehli
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
| | - Philipp Jakob
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
| | - Jonathan Michel
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
| | - Markus Kasel
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
| | - Frank Ruschitzka
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
| | - Christian Templin
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
| | - Barbara E Stähli
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich, Zürich
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20
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Gowdak LHW. The Role of Ivabradine in Managing Symptomatic Patients with Chronic Coronary Syndromes: A Clinically Oriented Approach. Cardiol Ther 2021. [PMID: 34860357 DOI: 10.1007/s40119-021-00247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
Angina is a significant contributor to disability and impairment in quality of life in patients with chronic coronary syndromes (CCS). An elevated heart rate (HR) may trigger myocardial ischemia by increasing oxygen consumption and decreasing the diastolic time, compromising the coronary flow. HR-lowering strategies offer symptom control and prevent cardiovascular events in subgroups of patients with CCS. However, the best therapeutic approach to achieve the desired HR in patients with CCS can be challenging based on efficacy and tolerability. Guidelines usually propose β-blockers and/or non-dihydropyridine calcium channel blockers (CCB) for angina patients with elevated HR. Nonetheless, there is no clear evidence of greater antianginal efficacy of this strategy versus an alternative HR-lowering agent. Ivabradine reduces the HR by blocking the If current in the sinoatrial node without affecting myocardial contractility or vascular tone. The magnitude of the HR reduction by ivabradine is proportional to the initial HR, which decreases the risk of significant bradycardia. Ivabradine increases the diastolic time and the coronary flow reserve to a greater extent than β-blockers and favors collateralization, improving the regional blood flow. We present two clinical cases of patients with symptomatic CCS in whom HR control with ivabradine was fundamental for symptom control and improvement in left ventricular (LV) function. An earlier combination of ivabradine plus β-blockers would have provided more rapid symptom control and improved LV function in the first case. In the second case, the primary mechanism responsible for angina was most likely a coronary vasomotor abnormality, in which the use of β-blockers aggravated the discomfort. The combination of a dihydropyridine CCB plus ivabradine was highly influential in symptom control. Due to its effects beyond HR reduction and good tolerability, ivabradine should be considered an essential ally in managing patients with angina and high HR with or without LV dysfunction. Talking Head Video (MP4 77394 kb)
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21
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Cook CM, Howard JP, Ahmad Y, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, Stathogiannis KE, de Waard GA, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary syndromes. Int J Cardiol 2021; 342:7-14. [PMID: 34358553 DOI: 10.1016/j.ijcard.2021.07.064] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Adenosine hyperemia is an integral component of the physiological assessment of obstructive coronary artery disease in patients with chronic coronary syndrome (CCS). The aim of this study was to compare systemic, coronary and microcirculatory hemodynamics between intravenous (IV) adenosine hyperemia versus physical exercise stress in patients with CCS and coronary stenosis. METHODS Twenty-three patients (mean age, 60.6 ± 8.1 years) with CCS and single-vessel coronary stenosis underwent cardiac catheterization. Continuous trans-stenotic coronary pressure-flow measurements were performed during: i) IV adenosine hyperemia, and ii) physical exercise using a catheter-table-mounted supine ergometer. Systemic, coronary and microcirculatory hemodynamic responses were compared between IV adenosine and exercise stimuli. RESULTS Mean stenosis diameter was 74.6% ± 10.4. Median (interquartile range) FFR was 0.54 (0.44-0.72). At adenosine hyperemia versus exercise stress, mean aortic pressure (Pa, 91 ± 16 mmHg vs 99 ± 15 mmHg, p < 0.0001), distal coronary pressure (Pd, 58 ± 21 mmHg vs 69 ± 24 mmHg, p < 0.0001), trans-stenotic pressure ratio (Pd/Pa, 0.63 ± 0.18 vs 0.69 ± 0.19, p < 0.0001), microvascular resistance (MR, 2.9 ± 2.2 mmHg.cm-1.sec-1 vs 4.2 ± 1.7 mmHg.cm-1.sec-1, p = 0.001), heart rate (HR, 80 ± 15 bpm vs 85 ± 21 bpm, p = 0.02) and rate-pressure product (RPP, 7522 ± 2335 vs 9077 ± 3200, p = 0.0001) were all lower. Conversely, coronary flow velocity (APV, 23.7 ± 9.5 cm/s vs 18.5 ± 6.8 cm/s, p = 0.02) was higher. Additionally, temporal changes in Pa, Pd, Pd/Pa, MR, HR, RPP and APV during IV adenosine hyperemia versus exercise were all significantly different (p < 0.05 for all). CONCLUSIONS In patients with CCS and coronary stenosis, invasive hemodynamic responses differed markedly between IV adenosine hyperemia versus physical exercise stress. These differences were observed across systemic, coronary and microcirculatory hemodynamics.
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Affiliation(s)
- Christopher M Cook
- Imperial College London, London, UK; Essex Cardiothoracic Centre, Basildon, UK.
| | | | | | | | | | - Gerald J Clesham
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | - Kare H Tang
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | | | | | - John R Davies
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | | | | | | | | | | | - Firas Al-Janabi
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | | | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | - Reto Gamma
- Essex Cardiothoracic Centre, Basildon, UK
| | | | | | | | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
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Boerhout CKM, Feenstra RGT, Somsen GA, Appelman Y, Ong P, Beijk MAM, Hofstra L, van de Hoef TP, Piek JJ. Coronary computed tomographic angiography as gatekeeper for new-onset stable angina. Neth Heart J 2021; 29:551-556. [PMID: 34676522 PMCID: PMC8556428 DOI: 10.1007/s12471-021-01639-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/16/2023] Open
Abstract
Patients with new-onset stable angina constitute a substantial part of the population seen by cardiologists. Currently, the diagnostic workup of these patients depends on the pre-test probability of having obstructive coronary artery disease. It consists of either functional testing for myocardial ischaemia or anatomical testing by using coronary computed tomographic angiography (CCTA) or invasive coronary angiography. In case the pre-test probability is > 5%, the current guidelines for the management of chronic coronary syndromes do not state a clear preference for one of the noninvasive techniques. However, based on the recently published cost-effectiveness analysis of the PROMISE trial and considering the diagnostic yield in patients with angina and nonobstructive coronary artery disease, we argue a more prominent role for CCTA as a gatekeeper for patients with new-onset stable angina.
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Affiliation(s)
- C K M Boerhout
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - R G T Feenstra
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - G A Somsen
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - P Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - M A M Beijk
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - L Hofstra
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - T P van de Hoef
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - J J Piek
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
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23
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De Luca L, Gabrielli D, Gonzini L, Riccio C, Arena G, Miserrafiti B, Mortara A, Colivicchi F, Gulizia MM, Temporelli PL. Comparing the Prognostic Impact of Prediabetes with Diabetes in a Nationwide Cohort of Patients with Chronic Coronary Syndromes: An Analysis of the START Registry. Cardiology 2021; 146:547-555. [PMID: 34233326 DOI: 10.1159/000517122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/27/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
AIMS Using data from the nationwide prospective START registry that enrolled a large cohort of patients with chronic coronary syndromes (CCS), we aimed to investigate whether the presence of diabetes mellitus (DM) and pre-DM independently affected the risk of cardiovascular events at 1-year follow-up. METHODS We assessed the impact of DM and pre-DM on all-cause mortality and a composite of all-cause mortality and hospitalization for cardiovascular causes at 1-year follow-up. RESULTS Among the 3,778 patients with available fasting plasma glucose data at study entry, 37% were classified as DM, 25% as pre-DM, and 38% as no DM. At 1 year, patients with DM had higher rates of all-cause death (p = 0.004) and death/cardiovascular hospitalization (p = 0.003) than those with pre-DM or without DM. Conversely, no significant differences in the adverse event rate were found between patients with pre-DM and those without DM. At unadjusted Cox analysis, DM resulted as a predictor of both death for any cause (hazard ratio [HR]: 2.41; 95% confidence intervals [CI]: 1.34-4.34; p = 0.003) and all-cause death/hospitalization for cardiovascular causes (HR: 1.29; 95% CI: 1.02-1.62; p = 0.03). However, DM did not result as an independent predictor of either endpoint at multivariate analysis. CONCLUSIONS The risk of 1-year major events among patients with CCS and pre-DM is comparable to that of patients with CCS and normoglycemic status and is lower than that of patients with DM.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Domenico Gabrielli
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | | | - Carmine Riccio
- Division of Cardiology, Azienda Ospedaliera Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Bruna Miserrafiti
- Division of Cardiology, Ospedale Tiberio Evoli, Melito Porto Salvo, Italy
| | - Andrea Mortara
- Division of Cardiology, Policlinico di Monza (MI), Monza, Italy
| | | | | | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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24
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Davies A, Fox K, Galassi AR, Banai S, Ylä-Herttuala S, Lüscher TF. Management of refractory angina: an update. Eur Heart J 2021; 42:269-283. [PMID: 33367764 DOI: 10.1093/eurheartj/ehaa820] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/29/2020] [Revised: 04/17/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the use of anti-anginal drugs and/or percutaneous coronary interventions (PCI) or coronary artery bypass grafting, the proportion of patients with coronary artery disease who have daily or weekly angina ranges from 2% to 24%. Refractory angina refers to long-lasting symptoms (for >3 months) due to established reversible ischaemia, which cannot be controlled by escalating medical therapy with the use of 2nd- and 3rd-line pharmacological agents, bypass grafting, or stenting. While there is uncertain prognostic benefit, the treatment of refractory angina is important to improve the quality of life of the patients affected. This review focuses on conventional pharmacological approaches to treating refractory angina, including guideline directed drug combination and dosages. The symptomatic and prognostic impact of advanced and novel revascularization strategies such as chronic total occlusion PCI, transmyocardial laser revascularization, coronary sinus occlusion, radiation therapy for recurrent restenosis, and spinal cord stimulation are also covered and recommendations of the 2019 ESC Guidelines on the Diagnosis and Management of Chronic Coronary Syndromes discussed. Finally, the potential clinical use of current angiogenetic and stem cell therapies in reducing ischaemia and/or pain is evaluated.
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Affiliation(s)
- Allan Davies
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK
| | - Kim Fox
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK
| | | | - Shmuel Banai
- Slezak Super Centre for Cardiac Research, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Medical Centre, Tel Aviv, Israel
| | | | - Thomas F Lüscher
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK.,University of Zurich, Center for Molecular Cardiology, University of Zurich, Switzerland
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25
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Abstract
Purpose of Review Recent studies have demonstrated an important role for inflammation in the pathogenesis of atherosclerotic cardiovascular disease. Several studies have investigated the efficacy of colchicine (a widely used and safe anti-inflammatory drug) in patients with atherosclerosis. This review explains the rationale for the use of colchicine in this setting and critically appraises recent outcome trials. Recent Findings Two large randomised-controlled trials LoDoCo2 (included patients with chronic coronary syndromes) and COLCOT (acute coronary syndromes) have demonstrated reductions in atherosclerotic cardiovascular events, but not mortality. A smaller study (COPS) found no beneficial effect of colchicine but was probably underpowered. Summary Colchicine is effective at reducing cardiovascular events in chronic and acute coronary syndromes, although reductions in all-cause mortality have not been demonstrated during the period of follow-up in trials to date. Mild gastrointestinal symptoms are the most commonly reported adverse effects, although in well-designed randomised controlled trials these are relatively uncommon.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338, Lodz, Poland. .,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland. .,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre For Cardiovascular Science, Liverpool, UK
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Maloberti A, Bossi I, Tassistro E, Rebora P, Racioppi A, Nava S, Soriano F, Piccaluga E, Piccalò G, Oreglia J, Vallerio P, Pirola R, De Chiara B, Oliva F, Moreo A, Valsecchi MG, Giannattasio C. Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter. Nutr Metab Cardiovasc Dis 2021; 31:1501-1508. [PMID: 33810962 DOI: 10.1016/j.numecd.2021.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation. METHODS AND RESULTS 231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function. CONCLUSIONS In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
| | - Irene Bossi
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Angelo Racioppi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Stefano Nava
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Francesco Soriano
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emanuela Piccaluga
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giacomo Piccalò
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Jacopo Oreglia
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Paola Vallerio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Roberto Pirola
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Benedetta De Chiara
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Fabrizio Oliva
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Antonella Moreo
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
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Alfonso F, Gonzalo N, Rivero F, Escaned J. The year in cardiovascular medicine 2020: interventional cardiology. Eur Heart J 2021; 42:985-1003. [PMID: 33448291 PMCID: PMC7928953 DOI: 10.1093/eurheartj/ehaa1096] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fernando Alfonso
- Cardiology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria IIS-IP, Universidad Autónoma de Madrid, CIBERCV, C/Diego de León 62, Madrid 28006, Spain
| | - Nieves Gonzalo
- Cardiology Department, Hospital Clinico San Carlos, IdISSC, Universidad Complutense de Madrid. C/ Martín Lagos s/n 28042 Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria IIS-IP, Universidad Autónoma de Madrid, CIBERCV, C/Diego de León 62, Madrid 28006, Spain
| | - Javier Escaned
- Cardiology Department, Hospital Clinico San Carlos, IdISSC, Universidad Complutense de Madrid. C/ Martín Lagos s/n 28042 Madrid, Spain
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28
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Demir OM, Schrieken C, Curio J, Rahman H. Behavioural determinants impacting the adoption rate of coronary physiology. Int J Cardiol 2021; 330:12-14. [PMID: 33571564 DOI: 10.1016/j.ijcard.2021.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/12/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite international revascularisation guidelines strongly recommending functional assessment of coronary artery stenosis using pressure-wire derived indices, the adoption rate of coronary physiology remains low. METHODS An online questionnaire was designed to evaluate behavioural determinants impacting the adoption rate of coronary physiology. Factor analysis was performed to combine multiple items of a common behavioural domain into one explanatory factor. Regression analysis was performed to evaluate the influence of resulting factors on the variance of the coronary physiology adoption rate. Additionally, the influence of experience, demographics and provider structures was assessed. RESULTS 104 interventional cardiologists, from 21 countries, completed the questionnaire. Mean adoption rate of coronary physiology was 26.9%. Regression analysis revealed that factors ease-of-use (Coefficient = 0.58, p = 0.01), financial and/or time constraints (Coefficient = -0.22, p = 0.01) and knowledge about guideline recommendations (Coefficient = 0.21, p = 0.06) had the greatest influence on coronary physiology adoption rate variance (R2 = 0.3, p < 0.001), with ease-of-use and guideline recommendations positively influencing greater uptake and constraints influencing lesser uptake of adoption of coronary physiology. CONCLUSION Ease-of-use, financial and/or time constraints, and knowledge about guideline recommendations were the most relevant behavioural factors impacting the adoption rate of coronary physiology. Ease-of-use was identified as the most influential factor, highlighting the importance of cardiac catheterisation laboratory teams being adequately trained to perform coronary physiology assessment seamlessly.
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Affiliation(s)
- Ozan M Demir
- Department of Cardiology, St Thomas' Hospital, London, UK.
| | | | - Jonathan Curio
- Charité University Medical Care, Department of Cardiology, Campus Benjamin Franklin, Berlin, Germany
| | - Haseeb Rahman
- Department of Cardiology, St Thomas' Hospital, London, UK
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29
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De Luca L, Temporelli PL, Amico AF, Gonzini L, Uguccioni M, Varani E, Brunetti ND, Colivicchi F, Gabrielli D, Gulizia MM. Impact of history of depression on 1-year outcomes in patients with chronic coronary syndromes: An analysis of a contemporary, prospective, nationwide registry. Int J Cardiol 2021; 331:273-80. [PMID: 33422564 DOI: 10.1016/j.ijcard.2020.12.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Depression is common in patients with acute cardiovascular conditions and it is associated with adverse clinical events. METHODS Using the data from a nationwide, prospective registry on patients with chronic coronary syndromes (CCS), we assessed the impact of depression on major adverse cardiovascular events (MACE), a composite of all-cause death and hospitalization for myocardial infarction, revascularization, heart failure or stroke, and quality of life (QoL) at 1-year follow-up. RESULTS From the 5070 consecutive CCS patients enrolled in the registry, 531 (10.5%) presented a history of depression and the remaining 4539 (89.5%) did not. At 1 year (median 369; IQR 362-378 days) from enrolment, the incidence of the primary composite outcome was 9.8% for patients with a history of depression and 7.2% for non-depressed patients (p = 0.03). Patients with history of depression had a significantly higher rate of all-cause mortality (3.0% vs 1.4%; p = 0.004) and hospital admission for heart failure (3.4% vs 1.3%; p = 0.0002) compared to the group without depression. However, history of depression did not result as an independent predictor of MACE at multivariable analysis [hazard ratio 1.17, 95% confidence interval (0.87-1.58), p = 0.31]. Depressed patients had worse QoL according to all domains of the EQ. 5D-5L questionnaire as compared to non-depressed patients (all p < 0.001), at both enrolment and follow-up. CONCLUSIONS In this contemporary, large cohort of consecutive patients with CCS, patients with a history of depression experienced a two-fold rate of mortality, a higher incidence of MACE and a worse QoL at 1-year follow-up, compared to non-depressed patients.
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Sanderson NC, Parker WAE, Storey RF. Ticagrelor: clinical development and future potential. Rev Cardiovasc Med 2021; 22:373-394. [PMID: 34258905 DOI: 10.31083/j.rcm2202044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022] Open
Abstract
Platelets participate centrally in atherothrombosis, resulting in vessel occlusion and ischaemia. Consequently, optimisation of antiplatelet regimens has the potential to further reduce the residual burden of morbidity and mortality associated with atherosclerosis. Ticagrelor is a potent oral platelet P2Y12 receptor antagonist that (1) inhibits a central amplification pathway of platelet activation directly as well as via an active metabolite, (2) has a rapid onset and offset of antiplatelet action that remains consistent in the circulation during twice-daily administration and is amenable to reversal, (3) has inverse agonist properties, and (4) demonstrates pleiotropic effects that contribute to anti-thrombotic, anti-inflammatory and vasodilatory properties. These advantageous characteristics of ticagrelor have translated to beneficial clinical outcomes in patients with acute coronary syndromes or ischaemic stroke, during prolonged maintenance therapy in specific high-risk populations, and following percutaneous coronary intervention but not definitively following coronary artery bypass graft surgery or in peripheral artery disease patients. Novel innovative strategies aim to reduce the risk of bleeding during dual antiplatelet therapy via shortening the duration of treatment and replacing the standard-of-care with ticagrelor monotherapy. In cases where aspirin is an essential component in secondary prevention, dose modification when combined with ticagrelor may hypothetically provide desirable clinical outcomes following appropriate clinical assessment as predicted by pharmacological studies. Overall, the future management of acute coronary syndromes could potentially involve the dichotomisation of antithrombotic therapies, whereby only those with high-risk of ischaemia, without a high-risk of bleeding, receive ticagrelor plus very-low-dose aspirin, while ticagrelor monotherapy is administered to the remaining majority.
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Affiliation(s)
- Nicholas C Sanderson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, S10 2RX Sheffield, UK
| | - William A E Parker
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, S10 2RX Sheffield, UK.,South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU Sheffield, UK
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, S10 2RX Sheffield, UK.,South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU Sheffield, UK
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31
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Tognola C, Alessandro M, Milani M, Cartella I, Tavecchia G, Grasso E, Sun J, Giannattasio C. Nutraceuticals in Chronic Coronary Syndromes: Preclinical Data and Translational Experiences. High Blood Press Cardiovasc Prev 2021; 28:13-25. [PMID: 33125662 PMCID: PMC7864844 DOI: 10.1007/s40292-020-00416-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Non-pharmacological treatments have always been considered important in the management of Chronic Coronary Syndromes. Nutraceuticals ("Nutrition" + "Pharmaceutical") could fall both under the definition of non-pharmacological treatment and pharmacological one or, probably more correctly, in the middle of these two kinds of therapies. However, the word "nutraceuticals" never appears in the latest guidelines on this issue. This is probably determined by the fact that evidences on this topic are scarce and most of the published articles are based on preclinical data while translational experiences are available only for some molecules. In this review we will focus on nutraceutical strategies that act on the ischemic myocardium itself and not only on the cardiovascular risk factors. As demonstrated by the important number of papers published in recent years, this is an evolving topic and evaluated substances principally act on two mechanisms (cardiac energetics and ischemia-reperfusion damage) that will be also reviewed.
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Affiliation(s)
- Chiara Tognola
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Maloberti Alessandro
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
| | - Martina Milani
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Iside Cartella
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Giovanni Tavecchia
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Enzo Grasso
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Jinwey Sun
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
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32
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Harjulahti E, Maaniitty T, Nammas W, Stenström I, Biancari F, Bax JJ, Knuuti J, Saraste A. Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [ 15O] water positron emission tomography study. Eur J Nucl Med Mol Imaging 2020; 48:1434-1444. [PMID: 33174090 PMCID: PMC8113164 DOI: 10.1007/s00259-020-05093-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/26/2020] [Indexed: 12/31/2022]
Abstract
Purpose We evaluated the value of reduced global and segmental absolute stress myocardial blood flow (sMBF) quantified by [15O] water positron emission tomography (PET) for predicting cardiac events in patients with suspected obstructive coronary artery disease (CAD). Methods Global and segmental sMBF during adenosine stress were retrospectively quantified in 530 symptomatic patients who underwent [15O] water PET for evaluation of coronary stenosis detected by coronary computed tomography angiography. Results Cardiovascular death, myocardial infarction, or unstable angina occurred in 28 (5.3%) patients at a 4-year follow-up. Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538–0.707, p = 0.006). Reduced global sMBF (< 2.2 ml/g/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271–21.396, p = 0.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030–10.257, p = 0.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118–0.879, p = 0.010, and 0.583, 95% CI 0.203–0.963, p = 0.002, respectively). Conclusion In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [15O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk.
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Affiliation(s)
- Esa Harjulahti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Wail Nammas
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Iida Stenström
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Fausto Biancari
- Department of Surgery, University of Turku, Turku, Finland
- Department of Surgery, University of Oulu, Oulu, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
- Heart Center, Turku University Hospital, Turku, Finland.
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Abstract
During the past decade, the treatment of choice for chronic coronary syndromes (CCS) has been a contentious issue. Whether revascularisation, either percutaneous or surgical, or optimal medical therapy, offers better prognosis in terms of mortality, MI, and symptom relief, has yet to be confirmed. The long-awaited and recently published International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial randomised more than 5,000 patients into a revascularisation plus optimal medical therapy group and an optimal medical therapy alone group. The authors analyse the trial, with particular emphasis on the incidence of MI. They propose a patient-centred approach to incorporate the results of the ISCHEMIA trial into daily practice and determine the best treatment strategy for patients with CCS.
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Affiliation(s)
- Eduardo A Arias
- Department of Interventional Cardiology, National Institute of Cardiology Mexico City, Mexico.,The American British Cowdray Medical Center Mexico City, Mexico
| | - Félix Damas-de Los Santos
- Department of Interventional Cardiology, National Institute of Cardiology Mexico City, Mexico.,The American British Cowdray Medical Center Mexico City, Mexico
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Cransac-Miet A, Zeller M, Chagué F, Faure AS, Bichat F, Danchin N, Boulin M, Cottin Y. Impact of COVID-19 lockdown on lifestyle adherence in stay-at-home patients with chronic coronary syndromes: Towards a time bomb. Int J Cardiol 2021; 323:285-7. [PMID: 32889019 DOI: 10.1016/j.ijcard.2020.08.094] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/06/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed to evaluate the impact of coronavirus disease 2019 (COVID-19)-related lockdown on adherence to lifestyle and drug regimens in stay-at-home chronic coronary syndromes patients living in urban and rural areas. METHODS A cross-sectional population-based study was perfomed in patients with chronic coronary syndromes. A sample of 205 patients was randomly drawn from the RICO (Observatoire des infarctus de Côte d'Or) cohort. Eight trained interviewers collected data by phone interview during week 16 (April 13 to April 19), i.e. 4 weeks after implementation of the French lockdown (start March 17, 2020). RESULTS Among the 195 patients interviewed (of the 205, 3 had died, 1 declined, 6 lost), mean age was 65.5 ± 11.1 years. Only six patients (3%) reported drug discontinuation, mainly driven by media influence or family members. All 166 (85%) patients taking aspirin continued their prescribed daily intake. Lifestyle rules were less respected since almost half (45%) declared >25% reduction in physical activity, 26% of smokers increased their tobacco consumption by >25%, and 24% of patients increased their body weight > 2 kg. The decrease in physical activity and the increase in smoking were significantly greater in urban patients (P < .05). CONCLUSIONS The COVID-19-related lockdown had a negative impact on lifestyle in a representative sample of stay-at-home CCS patients.
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Marzilli M, Crea F, Morrone D, Bonow RO, Brown DL, Camici PG, Chilian WM, DeMaria A, Guarini G, Huqi A, Merz CNB, Pepine C, Scali MC, Weintraub WS, Boden WE. Myocardial ischemia: From disease to syndrome. Int J Cardiol 2020; 314:32-35. [PMID: 32348810 DOI: 10.1016/j.ijcard.2020.04.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/20/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/16/2023]
Abstract
Although current guidelines on the management of stable coronary artery disease acknowledge that multiple mechanisms may precipitate myocardial ischemia, recommended diagnostic, prognostic and therapeutic algorithms are still focused on obstructive epicardial atherosclerotic lesions, and little progress has been made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia. The purpose of this consensus paper is three-fold: 1) to marshal scientific evidence that obstructive atherosclerosis can co-exist with other mechanisms of ischemic heart disease (IHD); 2) to explore how the awareness of multiple precipitating mechanisms could impact on pre-test probability, provocative test results and treatment strategies; and 3) to stimulate a more comprehensive approach to chronic myocardial ischemic syndromes, consistent with the new understanding of this condition.
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Affiliation(s)
- Mario Marzilli
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Doralisa Morrone
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Robert O Bonow
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - David L Brown
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA
| | - Paolo G Camici
- Vita salute University and San Raffaele Hospital, Milan, Italy
| | - William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States of America
| | - Anthony DeMaria
- Division of Cardiology, University of California, San Diego, San Diego, CA, USA
| | - Giacinta Guarini
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Alda Huqi
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Carl Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, USA
| | - Maria Chiara Scali
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - William S Weintraub
- Outcomes Research, MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, USA
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Komajda M, Cosentino F, Ferrari R, Kerneis M, Kosmachova E, Laroche C, Maggioni AP, Rittger H, Steg PG, Szwed H, Tavazzi L, Valgimigli M, Gale CP. Profile and treatment of chronic coronary syndromes in European Society of Cardiology member countries: The ESC EORP CICD-LT registry. Eur J Prev Cardiol 2020; 28:432-445. [PMID: 33966083 DOI: 10.1177/2047487320912491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/01/2019] [Accepted: 02/21/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND International guidelines recommend pharmacotherapy combinations for chronic coronary syndromes (CCSs) but medical management remains suboptimal. DESIGN The CICD-LT registry is investigating short- and long-term outcomes and management in patients in European Society of Cardiology (ESC) member countries, in a longitudinal ESC EURObservational Research Programme aimed at improving CCS management. METHODS Between 1 May 2015 and 31 July 2018, 9174 patients with previous ST-elevation myocardial infarction (STEMI), non-STEMI or coronary revascularisation, or other CCS, were recruited during a routine ambulatory visit or elective revascularisation procedure. Baseline clinical data were recorded and prescribed medications analysed at initial contact and discharge, and according to patient gender and age (<75 vs. ≥75 years). RESULTS Poorly controlled cardiovascular risk factors, including current smoking (18.5%), obesity (33.9%), diabetes (25.8%), raised low-density lipoprotein cholesterol (73.3%) and persistent hypertension (24.7%), were common across all cohorts. At ambulatory visit or admission, the guidelines-recommended combination of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aspirin, statin and any antiplatelet agent was prescribed to 57.8% of patients with STEMI/NSTEMI. Differences in prescribing rates, including for combination therapies, were observed based on age and gender and persisted after adjustment for demographic factors. CONCLUSIONS Cardiovascular risk factors were common in contemporary CCS patients and secondary prevention prescribing was suboptimal. Patients aged ≥75 years and, to some extent, female patients were less likely to receive guidelines-recommended drug combinations than younger and male patients. One- and two-year follow-up will study prescribing changes and associations between baseline characteristics/prescribing and subsequent clinical outcomes.
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Affiliation(s)
| | - Francesco Cosentino
- Unit of Cardiology, Karolinska Institutet and Karolinska University Hospital Solna, Sweden
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Italy
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), France
| | - Elena Kosmachova
- Scientific Research Clinical hospital, # 1 Kuban State Medical University, Russia
| | | | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care & Research, Italy.,EURObservational Research Programme, ESC, France
| | | | - Philippe G Steg
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, and Université de Paris, France
| | - Hanna Szwed
- 2nd Department of Coronary Artery Disease Institute of Cardiology, Poland
| | | | | | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
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Abstract
Direct-acting oral anticoagulants (DOACs) are easier to use, safer than and as effective as vitamin K antagonists (VKA) in the treatment of non-valvular AF (NVAF). Because of their favourable safety profile and easier use than VKAs, DOACs as anti-thrombotic therapy may have a role in the management of chronic coronary syndromes (CCS). To date, few studies have evaluated DOACs in this setting. Initial studies have focused on patients receiving DOACs for NVAF undergoing acute or elective percutaneous coronary intervention who additionally require dual antiplatelet therapy (DAPT). Rivaroxaban 15 mg once daily plus a P2Y12 inhibitor compared with a VKA regimen was associated with a reduction of bleedings (HR 0.59; 95% CI [0.47–0.76]; p<0.001). Rivaroxaban 2.5 mg twice daily plus DAPT up to 12 months followed by rivaroxaban 15 mg once daily plus P2Y12 inhibitor showed similar results. Dabigatran 110 mg twice daily plus a P2Y12 inhibitor versus a VKA regimen was associated with a reduction of bleedings (HR 0.52; 95% CI [0.42–0.63]; p<0.001), after a mean follow-up of 14 months. A dabigatran 150 mg regimen showed similar results. Apixaban 5 mg twice daily plus a P2Y12 inhibitor versus a VKA regimen confirmed at 6 months the safety of DOACs with a reduction of bleedings (HR 0.69; 95% CI [0.58–0.81]; p<0.001 for non-inferiority and superiority). Edoxaban 60 mg once daily plus a P2Y12 inhibitor was non-inferior to a VKA regimen on bleeding outcomes (major bleeding or non-major clinically relevant non-major bleeding) after a 12-month follow-up (HR 0.83; 95% CI [0.65–1.05]; p=0.001 for non-inferiority; p=0.1154 for superiority). Meta-analysis of these four trials confirmed the safety of DOACs regarding bleeding outcomes, but showed a trend toward stent thrombosis for dual antithrombotic therapy using DOACs versus triple antithrombotic therapy using VKAs. DOACs may show promise in the management of high-risk patients with chronic coronary syndromes. In these patients, rivaroxaban 2.5 mg twice daily in addition to aspirin was shown to reduce the composite outcome of cardiovascular death, stroke or MI compared to aspirin alone (HR 0.76; 95% CI [0.66–0.86]; p<0.001). All-cause death, cardiovascular death and stroke were also significantly lower. This benefit was at the cost of an increase in non-fatal bleeding.
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Affiliation(s)
- Emmanuel Sorbets
- Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France.,Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Philippe Gabriel Steg
- Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.,Département Hospitalo-Universitaire FIRE, Paris, France.,Laboratory for Vascular Translational Science, INSERM U-1148, Paris, France.,French Alliance for Cardiovascular Clinical Trials, F-CRIN Network, France.,Université de Paris, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Paris, France
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Barone-Rochette G, Bruère D, Mansencal N. How to explore coronary artery disease? Arch Cardiovasc Dis 2019; 112:546-549. [PMID: 31331760 DOI: 10.1016/j.acvd.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Gilles Barone-Rochette
- Department of Cardiology, CHU Grenoble-Alpes, 38043 Grenoble, France; Inserm, U1039, Radiopharmaceutiques Biocliniques, Grenoble Alpes University, 38700 La Tronche, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, 31059 Toulouse, France.
| | - Didier Bruère
- Centre de Cardiologie Clinique Du Pont De Chaume, 82000 Montauban, France
| | - Nicolas Mansencal
- Service de Cardiologie, CHU Ambroise-Paré, AP-HP, 92104 Boulogne Billancourt, France; Inserm U1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94805 Villejuif, France
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