1
|
Rola P, Włodarczak S, Barycki M, Furtan Ł, Jastrzębski A, Kędzierska M, Doroszko A, Lesiak M, Włodarczak A. Safety and Efficacy of Orbital Atherectomy in the All-Comer Population: Mid-Term Results of the Lower Silesian Orbital Atherectomy Registry (LOAR). J Clin Med 2023; 12:5842. [PMID: 37762782 PMCID: PMC10532293 DOI: 10.3390/jcm12185842] [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: 08/11/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Coronary calcifications represent a challenging subset for the interventional cardiologist performing percutaneous coronary intervention (PCI) and are well-established risk factors for adverse outcomes. Adequate plaque modification prior to stent implantation is critical to achieve an optimal outcome following PCI. Recently, a novel orbital atherectomy device has been introduced into clinical practice to modify calcified plaques. We evaluated the mid-term safety and efficacy of OA in a high-risk "all-comers" population. METHODS We evaluated 96 consecutive patients with severely calcified coronary lesions who underwent PCI facilitated by the orbital atherectomy device. RESULTS In-hospital MACCE was 5.2% without target lesion revascularization. At 6-month follow-up, the MACCE rate was 10.4% with a concomitant TLR rate of 1%. CONCLUSIONS Our mid-term data showed good safety and efficacy of orbital atherectomy as a plaque-modifying tool in an all-comers cohort with severely calcified coronary lesions.
Collapse
Affiliation(s)
- Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland;
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (S.W.); (A.J.)
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Artur Jastrzębski
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (S.W.); (A.J.)
| | | | - Adrian Doroszko
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Faculty of Medicine, Wroclaw University of Science and Technology, 50-981 Wroclaw, Poland;
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, 61-848 Poznan, Poland;
| | - Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland;
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (S.W.); (A.J.)
| |
Collapse
|
2
|
Mascalchi M, Picozzi G, Puliti D, Diciotti S, Deliperi A, Romei C, Falaschi F, Pistelli F, Grazzini M, Vannucchi L, Bisanzi S, Zappa M, Gorini G, Carozzi FM, Carrozzi L, Paci E. Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed. Diagnostics (Basel) 2023; 13:2197. [PMID: 37443590 DOI: 10.3390/diagnostics13132197] [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: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55-69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.
Collapse
Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, 50121 Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 47521 Cesena, Italy
| | - Annalisa Deliperi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Chiara Romei
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Fabio Falaschi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Michela Grazzini
- Division of Pneumonology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Letizia Vannucchi
- Division of Radiology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Simonetta Bisanzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Francesca Maria Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| |
Collapse
|
3
|
Marjanovic Petkovic M, Vuksanovic M, Sagic D, Radovic I, Soldatovic I, Beljic Zivkovic T. Risk Factors for Coronary Artery Calcifications in Overweight or Obese Persons with Prediabetes: Can They Predict T2 Diabetes and Coronary Vascular Events? J Clin Med 2023; 12:3915. [PMID: 37373609 DOI: 10.3390/jcm12123915] [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: 04/22/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND It is difficult to predict the risk of developing atherosclerotic cardiovascular disease in subjects with prediabetes and obesity. The aim of this study was to assess risk factors for coronary artery calcifications (CACs) and the development of type 2 diabetes (T2D) and coronary vascular events (CVEs) after 7 years in 100 overweight or obese persons with prediabetes, according to the baseline coronary artery calcium score (CACS). METHODS Lipids, HbA1c, uric acid, and creatinine were assessed. Glucose, insulin, and c-peptide were determined during an oral glucose tolerance test. Multi-sliced computerized tomography with evaluation of CACS was performed. After 7 years, the subjects were assessed for T2D/CVE. RESULTS CACs were present in 59 subjects. No single biochemical marker could predict presence of a CAC. After 7 years, T2D developed in 55 subjects (61.8% initially had both IFG and IGT). A gain in weight was the only contributing factor for T2D. Nineteen subjects developed a CVE; increased initial clustering of HOMA-IR > 1.9, LDL > 2.6, and mmol/Land TGL > 1.7 mmol/L and higher CACS were present in that group. CONCLUSIONS No risk factors for CACs could be identified. A gain in weight is associated with T2D development, as are higher CACS and clustering of high LDL+TGL+HOMA-IR with CVEs.
Collapse
Affiliation(s)
- Milica Marjanovic Petkovic
- Division of Endocrinology Diabetes and Metabolic Disorders, Zvezdara University Medical Center, Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Miljanka Vuksanovic
- Division of Endocrinology Diabetes and Metabolic Disorders, Zvezdara University Medical Center, Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragan Sagic
- Cardiovascular Institute Dedinje, Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Radovic
- Blood and Transfusion Institute of Serbia, 11000 Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatics, Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Teodora Beljic Zivkovic
- Division of Endocrinology Diabetes and Metabolic Disorders, Zvezdara University Medical Center, Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
4
|
Zaki-Metias KM, MacLean JJ, Mergo PA, Ogunde B, Al-Hameed M, Trivax CZ. Breast Arterial Calcifications: Reporting Preferences and Impact on Screening for Coronary Artery Disease. J Breast Imaging 2021; 3:687-693. [PMID: 38424930 DOI: 10.1093/jbi/wbab076] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Breast arterial calcifications (BAC) have been shown to correlate with measures of coronary artery disease risk stratification, although reporting of BAC is optional by BI-RADS guidelines. The purpose of this study is to determine referring provider preferences in BAC reporting on mammography reports and if such reporting has any impact on patient management. METHODS This study was approved by the local institutional review board. A voluntary eight-question survey regarding the preferences and outcomes of BAC reporting on mammography was distributed to 1085 primary care physicians, obstetrics and gynecologists, medical oncologists, and breast and general surgeons in our health system via a secure online platform. Data analysis including Pearson chi-square was performed with a P-value of <0.05 for significance. RESULTS A response rate of 19.1% (207/1085) was attained, with 21/207 (10.1%) of respondents indicating they do not routinely order mammograms excluded from further analysis. A total of 62.4% (116/186) of ordering physicians indicated a preference for reporting of BAC in both the body and impression of the radiology report, with 82.3% (153/186) of respondents placing importance on the quantity of atherosclerotic calcifications. Most participants (148/186, 79.6%) reported that the presence of BAC would prompt further investigation for coronary artery disease and associated risk factors. CONCLUSION The majority of responding physicians indicated a preference for detailed reporting of BAC and that such reporting would impact patient care. Understanding referring provider preferences regarding ancillary findings of BAC will allow for improved communication and value in mammography.
Collapse
Affiliation(s)
| | - Jeffrey J MacLean
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Paul A Mergo
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Barakat Ogunde
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Mohammed Al-Hameed
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Cory Z Trivax
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
- Huron Valley Radiology, Ypsilanti, MI, USA
| |
Collapse
|
5
|
Emaus MJ, Išgum I, van Velzen SGM, van den Bongard HJGD, Gernaat SAM, Lessmann N, Sattler MGA, Teske AJ, Penninkhof J, Meijer H, Pignol JP, Verkooijen HM. Bragatston study protocol: a multicentre cohort study on automated quantification of cardiovascular calcifications on radiotherapy planning CT scans for cardiovascular risk prediction in patients with breast cancer. BMJ Open 2019; 9:e028752. [PMID: 31352417 PMCID: PMC6661654 DOI: 10.1136/bmjopen-2018-028752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is an important cause of death in breast cancer survivors. Some breast cancer treatments including anthracyclines, trastuzumab and radiotherapy can increase the risk of CVD, especially for patients with pre-existing CVD risk factors. Early identification of patients at increased CVD risk may allow switching to less cardiotoxic treatments, active surveillance or treatment of CVD risk factors. One of the strongest independent CVD risk factors is the presence and extent of coronary artery calcifications (CAC). In clinical practice, CAC are generally quantified on ECG-triggered cardiac CT scans. Patients with breast cancer treated with radiotherapy routinely undergo radiotherapy planning CT scans of the chest, and those scans could provide the opportunity to routinely assess CAC before a potentially cardiotoxic treatment. The Bragatston study aims to investigate the association between calcifications in the coronary arteries, aorta and heart valves (hereinafter called 'cardiovascular calcifications') measured automatically on planning CT scans of patients with breast cancer and CVD risk. METHODS AND ANALYSIS In a first step, we will optimise and validate a deep learning algorithm for automated quantification of cardiovascular calcifications on planning CT scans of patients with breast cancer. Then, in a multicentre cohort study (University Medical Center Utrecht, Utrecht, Erasmus MC Cancer Institute, Rotterdam and Radboudumc, Nijmegen, The Netherlands), the association between cardiovascular calcifications measured on planning CT scans of patients with breast cancer (n≈16 000) and incident (non-)fatal CVD events will be evaluated. To assess the added predictive value of these calcifications over traditional CVD risk factors and treatment characteristics, a case-cohort analysis will be performed among all cohort members diagnosed with a CVD event during follow-up (n≈200) and a random sample of the baseline cohort (n≈600). ETHICS AND DISSEMINATION The Institutional Review Boards of the participating hospitals decided that the Medical Research Involving Human Subjects Act does not apply. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT03206333.
Collapse
Affiliation(s)
- Marleen J Emaus
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne G M van Velzen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Sofie A M Gernaat
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikolas Lessmann
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margriet G A Sattler
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joan Penninkhof
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hanneke Meijer
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
6
|
Xiong Y, Li J, Sun S, Han M, Liao R, Li Y, Wang L, Lin L, Liu Q, Su B. Association of mineral content outside of bone with coronary artery calcium and 1-year cardiovascular prognosis in maintenance hemodialysis patients. Artif Organs 2019; 43:988-1001. [PMID: 30932185 PMCID: PMC6850757 DOI: 10.1111/aor.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/18/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 02/05/2023]
Abstract
Coronary artery calcifications (CACs) are common among maintenance hemodialysis (MHD) patients and associated with increased morbidity and mortality due to cardiovascular events. The insight into chronic kidney disease‐mineral and bone disorder (CKD‐MBD) established a correlation between dysregulated mineral metabolism and CACs. This study aimed to identify the association of mineral content outside of bone (MCOB) with CACs and cardiovascular events in MHD patients. In the pilot prospective study with no intervention, patients underwent body composition assessment by body composition monitor after hemodialysis and computed tomography examination using the Agatston scoring method simultaneously within a week. The primary end point included cardiovascular events and cardiovascular death. Correlations and receiver operating characteristic analysis elucidated the associations of MCOB with CACs; multivariate analysis assessed the cardiovascular risk for groups with different MCOB. One hundred three eligible patients with an average age of 48 (35‐63) years old were enrolled and followed up to 12 (11‐12.5) months, among which 52.4% had detectable CACs at baseline. MCOB showed an inverse correlation with Agatston score and significantly discriminated the patients with Agatston score > 0 (AUC = 0.737; P < 0.001) and 400 (AUC = 0.733; P < 0.001). MCOB ≤ 9.2657 mg/kg was an independent risk factor for CACs (OR = 4.853; P = 0.044) and strong predictor for cardiovascular morbidity and mortality (HR = 10.108; P = 0.042), as well as rehospitalization (HR = 2.689; P = 0.004). MCOB inversely correlated with the presence and extent of CACs, and could discriminate Agatston score > 0 and 400, which also presented as an independent indicator for CKD‐MBD and 1‐year cardiovascular prognosis in adult MHD patients. Additional studies are required for identifying this issue.
Collapse
Affiliation(s)
- Yuqin Xiong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiameng Li
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Si Sun
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Han
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Yupei Li
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Liya Wang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Liping Lin
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Liu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Januszek RA, Dziewierz A, Siudak Z, Rakowski T, Legutko J, Rzeszutko Ł, Kleczyński P, Dudek D, Bartuś S. Diabetes and periprocedural outcomes in patients treated with rotablation during percutaneous coronary interventions. Cardiol J 2018; 27:VM/OJS/J/58158. [PMID: 30234901 PMCID: PMC8016042 DOI: 10.5603/cj.a2018.0102] [Citation(s) in RCA: 4] [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: 04/19/2018] [Revised: 09/07/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study is to assess differences in periprocedural outcomes among diabetic and non-diabetic patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA). METHODS Under assessment were 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) including all PCIs performed in Poland in 2015 and 2016. Data was extracted of 975 patients treated with RA - 336 (34.5%) diabetics and 639 (65.5%) non-diabetics. Periprocedural complications were defined as overall rate or particular complications such as deaths, no-reflows, perforations, dissections, cerebral strokes or bleedings.. Multivariate analysis was performed to assess predictors of periprocedural complications. RESULTS The mean age was similar in diabetics and non-diabetics (70.9 ± 9.0 vs. 72.1 ± 9.9; p = 0.06). Diabetics were more often females (p < 0.01), with arterial hypertension (p < 0.01), kidney failure (p < 0.01) and prior myocardial infarction (p = 0.01). No significant differences were observed in overall or individual periprocedural complications and angiographic success was expressed as thrombolysis in myocardial infarction grade 3 flow after PCI. At baseline, de-novo lesions accounted for 96.5% in diabetics and 99% in non-diabetics (p < 0.01), while overall rate of restenosis was 3.5% and 1%, respectively (p < 0.01). Diabetes was an independent predictor of periprocedural complications in the overall group of patients treated with PCI (OR 1.11, 95% CI 1.04-1.194; p < 0.001). CONCLUSIONS The negative impact of diabetes on the incidence of periprocedural complications and angiographic effectiveness in the group of patients treated with RA is mitigated in the comparison to the non-RA group.
Collapse
Affiliation(s)
- Rafał A Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Giustino G, Mastoris I, Baber U, Sartori S, Stone GW, Leon MB, Serruys PW, Kastrati A, Windecker S, Valgimigli M, Dangas GD, Von Birgelen C, Smits PC, Kandzari D, Galatius S, Wijns W, Steg PG, Stefanini GG, Aquino M, Morice MC, Camenzind E, Weisz G, Jeger RV, Kimura T, Mikhail GW, Itchhaporia D, Mehta L, Ortega R, Kim HS, Chieffo A, Mehran R. Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration. JACC Cardiovasc Interv 2016; 9:1890-901. [PMID: 27659564 DOI: 10.1016/j.jcin.2016.06.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 04/05/2016] [Revised: 05/17/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND The clinical correlates and the prognostic significance of CAC in women undergoing percutaneous coronary intervention with DES remain unclear. METHODS Patient-level data from female participants in 26 randomized trials of DES were pooled. Study population was categorized according to the presence of moderate or severe versus mild or no target lesion CAC, assessed through coronary angiography. Co-primary endpoints of interest were the composite of death, myocardial infarction (MI), or target lesion revascularization and death, MI, or stent thrombosis at 3-year follow-up. RESULTS Among 11,557 women included in the pooled dataset, CAC status was available in 6,371 women. Of these, 1,622 (25.5%) had moderate or severe CAC. In fully adjusted models, independent correlates of CAC were age, hypertension, hypercholesterolemia, smoking, previous coronary artery bypass graft surgery, and worse left ventricular and renal function. At 3 years, women with CAC were at higher risk for death, MI, or target lesion revascularization (18.2% vs. 13.1%; adjusted hazard ratio: 1.56; 95% confidence interval: 1.33 to 1.84; p < 0.0001) and death, MI, or stent thrombosis (12.7% vs. 8.6%; adjusted hazard ratio: 1.48; 95% confidence interval: 1.21 to 1.80; p = 0.0001). The adverse effect of CAC on ischemic outcomes appeared to be consistent across clinical and angiographic subsets of women, including new-generation DES. CONCLUSIONS Women undergoing PCI of calcified lesions tend to have worse clinical profile and remain at increased ischemic risk, irrespective of new-generation DES.
Collapse
|
9
|
Abazid RM, Kattea MO, Sayed S, Saqqah H, Qintar M, Smettei OA. Visceral adipose tissue influences on coronary artery calcification at young and middle-age groups using computed tomography angiography. Avicenna J Med 2015; 5:83-8. [PMID: 26229760 PMCID: PMC4510826 DOI: 10.4103/2231-0770.160242] [Citation(s) in RCA: 3] [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] [Indexed: 12/12/2022] Open
Abstract
Purpose: The purpose of the study was to evaluate the impact of excessive visceral adipose tissue (VAT) on subclinical coronary atherosclerosis and coronary artery calcifications (CAC) in young and middle-age groups using multislice computed tomography. Methods: This study is a single center, cross-sectional study. Eligible patients (n = 159), who under the age of 61 years, with chest pain and mild to moderate probability to have coronary artery disease (CAD) were enrolled. Coronary calcium score and epicardial adipose tissue (EAT) were measured at the level of the left main coronary artery while VAT was measured at the level of the iliac crest. Results: The average age was (48 ± 8 years). The mean VAT was (38 ± 21 cm2) with no significant difference between men and women (38 ± 22 vs. 37 ± 19 P = 0.8) respectively. Student's t-test analysis showed significantly higher VAT in patients with detectable CAC than patients with no CAC (48 ± 24 vs. 33 ± 18 P = 0.00002), respectively. Univariate regression analysis showed that VAT and EAT, are strong predictor for CAC (hazard ratio [HR] 1.034, 95% confidence interval [CI: 1.016–1.052]. P <0.001 and [HR] 1.344, 95% CI: [1.129–1.601] P = 0.001), respectively. Conclusion: Excessive VAT is significantly associated with positive CAC. VAT can strongly predict subclinical CAD in individuals at young and middle-age groups.
Collapse
Affiliation(s)
- Rami M Abazid
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia ; Department of Cardiac Imaging, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - M Obadah Kattea
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia ; Department of Cardiac Imaging, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - Sawsan Sayed
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - Hanaa Saqqah
- Department of Cardiac CT Technicians, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - Mohammed Qintar
- Department of Internal Medicine, Cleveland Clinic Foundation Cleveland, OH, USA
| | - Osama A Smettei
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia ; Department of Cardiac Imaging, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| |
Collapse
|