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Gim DH, Choi IY, Ki YJ, Kim HK, Kim SS, Park KH, Song H, Choi DH. Short-term effects of PCSK-9 inhibitors on percutaneous coronary intervention in patients with acute coronary syndrome. Korean J Intern Med 2025; 40:438-448. [PMID: 40360221 PMCID: PMC12081118 DOI: 10.3904/kjim.2024.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 12/20/2024] [Accepted: 12/28/2024] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND/AIMS Proprotein-converting enzyme subtilisin-kexin type 9 (PCSK9) inhibitors act more promptly and efficiently than statins and reduce the risk of cardiovascular events in patients with acute coronary syndrome (ACS). This study aimed to assess the short-term effects of perioperative administration of a single-dose PCSK9 inhibitor in patients with ACS. METHODS This study included 789 consecutive patients undergoing percutaneous coronary intervention (PCI) for ACS. The primary clinical endpoint was the occurrence of major adverse cardiovascular events (MACEs) within one month, including cardiac death, non-fatal myocardial infarction, unanticipated revascularization, stroke, stent thrombosis, and rehospitalization for ischemic causes or heart failure. RESULTS PCSK9 inhibitors were administered to 201 of 789 patients. MACEs occurred in eight patients (4.0%) in the treated group and 60 patients (10.2%) in the non-treated group for one month (hazard ratio 0.38, 95% confidence interval 0.18 to 0.80, p = 0.010). The benefit of PCSK9 inhibitors in terms of MACEs was greater in the subgroup of patients treated more than 1 hour before PCI than in the subgroup treated less than 1 hour before PCI or treated after PCI and in the non-treated group. CONCLUSION In patients undergoing PCI for ACS, the risk of MACEs was lower in those treated with perioperative single-dose PCSK9 inhibitors than in those in the untreated group. This benefit was especially noticeable in the subgroups treated > 1 hour before PCI than in those treated less than 1 hour before PCI or after PCI, regardless of the clinical presentation of ACS.
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Affiliation(s)
- Dong Hyun Gim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
| | - In Young Choi
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
| | - Young-Jae Ki
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
| | - Sung Soo Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
| | - Keun-Ho Park
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
| | - Heesang Song
- Biochemistry and Molecular Biology, Chosun University School of Medicine, Gwangju,
Korea
| | - Dong-Hyun Choi
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju,
Korea
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Xia L, Yang Q, Jiang L, Zheng Y, Chen L, Lin S, Reinhardt JD, Lu X. Effect of perioperative remote ischemic conditioning on myocardial injury in patients with unstable angina undergoing percutaneous coronary intervention: protocol of a multicenter, randomized, double-blind clinical trial. Trials 2025; 26:63. [PMID: 39984971 PMCID: PMC11844111 DOI: 10.1186/s13063-025-08744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 01/27/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND Cardiovascular disease is a leading cause of death, with ischemic heart disease being a significant contributor. While percutaneous coronary intervention (PCI) effectively reduces mortality in myocardial infarction patients, its efficacy for unstable angina (UA) patients is controversial. Complications associated with PCI further limit application in UA. RIC is hypothesized to be an effective co-intervention that reduces PCI-related complications and may potentially enhance the efficacy of the PCI procedure itself. METHODS This is a pragmatic, prospective, dual-center, double-blind, randomized controlled clinical trial assessing the effect of remote ischemic conditioning (RIC) during percutaneous coronary intervention (PCI) on injury in unstable angina patients aged ≥ 18 years undergoing coronary angiography. Participants will be randomized to receive either RIC or Sham RIC, in addition to standard pharmacotherapy. Primary outcome includes periprocedural myocardial injury measured by hs-cTnT levels, while secondary outcomes encompass major adverse cardiovascular events, coronary artery lesions Gensini Score, arrhythmia, angina incidence, SAQ scores, ECG changes, and cardiac function assessed by two-dimensional echocardiography. The trial aims to recruit 574 participants and is scheduled to be initiated on 15 January 2024. We will conduct the primary statistical analysis using the intention-to-treat principle. Results from the trial will be presented as comparative summary statistics following the Consolidated Standards of Reporting Trials (CONSORT) guidelines. TRIAL REGISTRATION ChiCTR2400079855, 15 January 2024.
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Affiliation(s)
- Lingfeng Xia
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Qingyan Yang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Lingjun Jiang
- Department of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Yu Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Leilei Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China.
| | - Song Lin
- Department of Cardiology, the Affiliated Nanjing First Hospital of Nanjing Medical University, No. 68 Changle Road, Nanjing, 210008, China.
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction of Sichuan University and Hongkong Polytechnic University, No. 122 Huanghezhong Road First Section, Chengdu, 610207, China.
- Swiss Paraplegic Research, Nottwil, 6207, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6000, Switzerland.
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China.
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Zhu Y, Wang Z, Su T, Fang Z, Pang X, Tang X. Kinesophobia and its related factors in patients after percutaneous coronary intervention: A cross-sectional study. J Clin Nurs 2024; 33:4692-4707. [PMID: 38509582 DOI: 10.1111/jocn.17126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To explore the postoperative kinesophobia of patients after percutaneous coronary intervention (PCI) and its related factors. BACKGROUND Percutaneous coronary intervention is an effective method to treat coronary heart disease (CHD), and cardiac rehabilitation is an important auxiliary method after PCI. However, the compliance of patients with cardiac rehabilitation after PCI is not good, among which kinesophobia is an important influencing factor. DESIGN A descriptive cross-sectional design was implemented, and the high-quality reporting of the study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. METHODS In total, 351 inpatients who underwent PCI in three tertiary grade-A hospitals in China were selected by convenient sampling method. We use one-way ANOVA and multiple linear regression analysis to determine the relevant related factors. RESULTS The kinesophobia of patients after PCI was negatively correlated with chronic illness resource utilization and sense of personal mastery, and positively correlated with illness perception. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery entered the regression equation, which could explain 78.1% of the total variation. CONCLUSION The level of kinesiophobia of patients after PCI is high. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery are the related factors of kinesiophobia of patients after PCI. RELEVANCE TO CLINICAL PRACTICE By reducing the level of exercise fear of patients after PCI, patients are more likely to accept and adhere to the cardiac rehabilitation plan, thus improving their prognosis and improving their quality of life. PATIENT OR PUBLIC CONTRIBUTION The patient underwent PCI in the research hospital. Researchers screen them according to the inclusion criteria and invite them to participate in this study. If they meet the requirements, participants will answer the research questionnaire face to face after signing the informed consent form.
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Affiliation(s)
- Yue Zhu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin City, China
| | - Zhangyi Wang
- Nursing Department, Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hengyang City, Hunan Province, China
| | - Tao Su
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin City, China
| | - Zhiping Fang
- Emergency Department, Tianjin First Central Hospital, Tianjin City, China
| | - Xiaoli Pang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin City, China
| | - Xiaochun Tang
- Nursing Department, Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital, Hengyang City, Hunan Province, China
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Liu W, Qian S, Hu Y, Zhang R. The Serial Mediation Effects of Social Support and Self-Efficacy on Health Literacy and Self-Management Behaviors Among Young and Middle-Aged Cardiac Patients After Percutaneous Coronary Intervention: A Cross-Sectional Study in China. Risk Manag Healthc Policy 2024; 17:2893-2906. [PMID: 39600348 PMCID: PMC11590655 DOI: 10.2147/rmhp.s486800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024] Open
Abstract
Background Coronary heart disease (CHD) is a significant public health concern affecting an increasing number of young and middle-aged adults. Effective self-management is essential to promote the recovery and quality of life of patients with CHD after percutaneous coronary intervention (PCI), and is closely related to health literacy. However, little is known about the underlying mechanisms of this association. Objective This study aimed to investigate the mediating effects of social support and self-efficacy in the relationship between health literacy and self-management behaviors among young and middle-aged patients with CHD after PCI. Methods A cross-sectional study was conducted among 360 CHD patients aged 18-59 who after PCI within 1 to 3 months. The data were collected from September 2022 to July 2023 in a tertiary hospital in China. The questionnaires were utilized to gather data on demographic characteristics, social support, self-efficacy, health literacy, and self-management behaviors. The serial mediation model was examined via bootstrapping techniques using SPSS PROCESS v.4.3 macros (Model 6). Results Participants health literacy was associated with self-management behaviors both directly (β=0.334, P<0.001) and indirectly through social support (β=0.149, P<0.001) and self-efficacy (β=0.095, P<0.001). Social support and self-efficacy serially mediated the association between health literacy and self-management behaviors (β=0.226, P<0.001), with the total indirect effects accounting for 44.3%, these three mediating paths account for 24.8%, 15.8%, and 3.7% of the overall effect, respectively. Conclusion Health literacy influences self-management behaviors that the study's findings suggest were significant. Social support and self-efficacy act as mediators in the relationship between health literacy and self-management behaviors. Our findings provide helpful guidance for the future development of targeted and effective psychosocial interventions to enhance CHD patients' self-management, ultimately improving prognosis and quality of life.
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Affiliation(s)
- Wenqin Liu
- DSA Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China
| | - Shuyan Qian
- DSA Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China
| | - Yihan Hu
- Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China
| | - Ruo Zhang
- Nurse Practitioner, Nursing Department, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China
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Sallam M, Hassan H, Connolly D, Rahman MS. Commencement of Atorvastatin and Ezetimibe Immediately in Patients Presenting with Acute Coronary Syndrome. Eur Cardiol 2024; 19:e22. [PMID: 39588251 PMCID: PMC11588103 DOI: 10.15420/ecr.2024.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/12/2024] [Indexed: 11/27/2024] Open
Abstract
Lipids are implicated in the development of coronary atherosclerosis. Achieving a significant reduction in lipid levels remains a crucial aspect of secondary prevention following an acute coronary syndrome event. Novel lipid-lowering therapies now provide clinicians with a variety of therapeutic strategies to choose from and tailor to individual patient needs. This review focuses on evidence supporting the importance of early and intensive lipid-lowering therapy use in patients presenting with acute coronary syndrome, specifically addressing data relating to atorvastatin and ezetimibe use in this high-risk cohort of patients.
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Affiliation(s)
- Mohammed Sallam
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, West Midlands, UK
| | - Hossameldin Hassan
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, West Midlands, UK
| | - Derek Connolly
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, West Midlands, UK
| | - Mohammed Shamim Rahman
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, West Midlands, UK
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Yuksel Y, Yildiz C, Kose S. Assessment of Predictive Value of SYNTAX-II Score for Adverse Cardiac Events and Clinical Outcomes in Patients With Acute Coronary Syndrome. Angiology 2024; 75:754-763. [PMID: 37295413 DOI: 10.1177/00033197231181958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Prognostic information is important for the management of acute coronary syndrome (ACS). Our aim was to evaluate Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score-II (SSII) for predicting contrast induced nephropathy (CIN) and one-year major adverse cardiac events (MACE) in ACS patients. Coronary angiographic recordings of 1304 ACS patients were retrospectively examined. Predictive values of SYNTAX score (SS), SSII-percutaneous coronary intervention (SSII-PCI), SSII-coronary artery bypass graft (SSII-CABG) scores for CIN and MACE were assessed. Combination of CIN and MACE ratios constituted primary composite end-point. Patients with SSII-PCI scores >32.55 were compared with patients with lower scores. All of the three scoring systems predicted the composite primary end-point [SS: Area under the curve (AUC): .718, P < .001 (95% CI: .689-.747), SSII-PCI: AUC: .824, P < .001 (95% CI: .800-.849), SSII-CABG: AUC: .778, P < .001 (95% CI: .751-.805)]. Comparison of AUC of receiver operating characteristic curves showed that SSII-PCI score had better predictive value than that of SS and SSII-CABG scores. In multivariate analysis, the only predictor of the primary composite end-point was SSII-PCI score (odds ratio: 1.126, 95% CI: 1.107-1.146, P < .001). SSII-PCI score was a valuable tool for prediction of shock, CABG, myocardial infarction, stent thrombosis, development of CIN and one-year mortality.
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Affiliation(s)
- Yasin Yuksel
- Department of Cardiology, University of Health Sciences, Istanbul Training and Education Hospital, Istanbul, Turkey
| | - Cennet Yildiz
- Department of Cardiology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sennur Kose
- Department of Nephrology, University of Health Sciences, Istanbul Training and Education Hospital, Istanbul, Turkey
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Xiao Z, Riletu A, Yan X, Meng Q, Zhang W, Zhang N, Ma C, Guo X, Han J, Nie H, Deng H, Liu J, Chen J, Dong Y, Liu T. Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention. Cardiovasc Diagn Ther 2024; 14:621-629. [PMID: 39263480 PMCID: PMC11384458 DOI: 10.21037/cdt-23-482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/07/2024] [Indexed: 09/13/2024]
Abstract
Background Recurrent acute myocardial infarction requiring unplanned percutaneous coronary intervention (PCI) is one of the major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) after PCI. There is a continuing controversy about the association between serum cystatin C, a biomarker for the evaluation of renal function, and the prognosis of ACS patients following PCI. The retrospective study evaluated the association between serum cystatin C level and MACE in ACS patients after PCI. Methods Data were retrieved for 330 patients with ACS for primary PCI in a single center. Serum cystatin C levels were measured before PCI. All patients underwent regular follow-ups after PCI, and the studied endpoint was MACE, defined as the need for a repeat revascularization in the heart. The predictive value of serum cystatin C for MACE was analyzed using univariate and multivariate analysis. Restricted cubic spline (RCS) analysis was applied to evaluate the dose-response relationship between serum cystatin C level and MACE in ACS patients following PCI. Results After a median follow-up of 63 months (range, 1-148 months), 121 of the 330 patients experienced MACE. Compared to patients who did not have MACE, patients who had MACE showed a significant decrease in serum cystatin C levels (0.99±0.32 vs. 1.15±0.78 mg/L, P=0.03). In multivariate regression analysis, serum cystatin C level was an independent risk factor for MACE. According to the serum cystatin C level, patients were divided into 4 categories, Cox regression analysis illustrated that the second quartile of serum cystatin C level indicated an increased risk of MACE in patients with PCI for primary ACS compared to the highest quartile [Q2: adjusted hazard ratio (HR) =2.109; 95% confidence interval (CI): 1.193-3.727; P=0.01]. RCS analysis showed a significant U-shaped dose-response relationship between cystatin C level and MACE in patients with PCI for ACS (P for non-linearity =0.004). Conclusions These results indicated an association between serum cystatin C level and post-PCI MACE in ACS patients.
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Affiliation(s)
- Zhibin Xiao
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Aoge Riletu
- Department of Pharmacy, Inner Mongolian International Mongolian Hospital, Hohhot, China
| | - Xiaoyu Yan
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Qi Meng
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Weiru Zhang
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Na Zhang
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Chi Ma
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Xin Guo
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Jiatong Han
- Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Huijuan Nie
- Department of Cardiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Hui Deng
- Department of Neurology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jing Liu
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jianping Chen
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Yu Dong
- Department of Natural Medicinal Chemistry, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
- Engineering Technology Research Center of Pharmacodynamic Substance and Quality Control of Mongolian Medicine in Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Tianlong Liu
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory of Clinical and Basic Research on Cardiovascular Diseases, Basic Research Team of Cardiovascular Diseases, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Ren L, Liu W, Chen S, Zeng H. Longitudinal change of serum exosomal miR-186-5p estimates major adverse cardiac events in acute myocardial infarction patients receiving percutaneous coronary intervention. Front Cardiovasc Med 2024; 11:1341918. [PMID: 38694565 PMCID: PMC11061486 DOI: 10.3389/fcvm.2024.1341918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
Objective Our recently published study discovers that exosomal microRNA (miR)-186-5p promotes vascular smooth muscle cell viability and invasion to facilitate atherosclerosis. This research aimed to explore the prognostic implication of serum exosomal miR-186-5p in acute myocardial infarction (AMI) patients receiving percutaneous coronary intervention (PCI). Methods One hundred and fifty AMI patients receiving PCI and 50 healthy controls (HCs) were screened. Serum exosomal miR-186-5p was detected by reverse transcriptase-quantitative polymerase chain reaction assay in AMI patients at admission and after PCI, as well as in HCs after enrollment. Major adverse cardiac events (MACE) were recorded during follow-up in AMI patients receiving PCI. Results Serum exosomal miR-186-5p was raised in AMI patients vs. HCs (P < 0.001). Besides, serum exosomal miR-186-5p was positively linked to body mass index (P = 0.048), serum creatinine (P = 0.021), total cholesterol (P = 0.029), and C-reactive protein (P = 0.018); while it was reversely linked with estimated glomerular filtration rate (P = 0.023) in AMI patients. Interestingly, serum exosomal miR-186-5p was correlated with the diagnosis of ST-segment elevation myocardial infarction (P = 0.034). Notably, serum exosomal miR-186-5p was decreased after PCI vs. at admission (P < 0.001). The 6-, 12-, 18-, and 24-month accumulating MACE rates were 4.5%, 8.9%, 14.8%, and 14.8% in AMI patients. Furthermore, serum exosomal miR-186-5p ≥3.39 (maximum value in HCs) after PCI (P = 0.021) and its decrement percentage Conclusion Serum exosomal miR-186-5p is reduced after PCI, and its post-PCI high level or minor decrease estimates increased MACE risk in AMI patients.
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Affiliation(s)
- Lingyun Ren
- Anesthesiology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liu
- Anesthesiology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Chen
- Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haibo Zeng
- Anesthesiology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ray S. Role of statins in the management of dyslipidaemia. Indian Heart J 2024; 76 Suppl 1:S33-S37. [PMID: 38599727 PMCID: PMC11019333 DOI: 10.1016/j.ihj.2023.11.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 04/12/2024] Open
Abstract
Blood cholesterol has firmly been established as a crucial risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) by elegant epidemiological studies. Naturally, means to reduce blood cholesterol level took the centerstage of research in this field. After initial lukewarm results with nicotinic acid, fibrates and some other agents, statins emerged as the most effective class of medicine to reduce blood cholesterol; in particular, the most atherogenic low density lipoprotein cholesterol (LDL-C). Also, they are very safe and well tolerated. As ASCVD comes in various stages, statins have also been tried in different settings, e.g., primary prevention, secondary prevention, as part of coronary intervention strategy, familial hypercholesterolemia, etc. Almost in all clinical scenarios, statins proved themselves to impart clinical benefit. Though side effects of statins are outweighed by their benefits, nonetheless clinicians should detect the side effects early to avoid major problems.
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Affiliation(s)
- Saumitra Ray
- Intervention Cardiology, Advanced Medical Research Institute (Dhakuria), 99/5/C, Ballygunge Place, Kolkata, West Bengal, India.
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Yadav S, Sawhney JPS. Treatment of dyslipidemia in acute coronary syndrome. Indian Heart J 2024; 76 Suppl 1:S51-S57. [PMID: 38307382 PMCID: PMC11019335 DOI: 10.1016/j.ihj.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/25/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
Despite numerous improvements in the management of acute coronary syndrome(ACS), it is a major cause of mortality in India. Lipids play a critical role in pathogenesis of ACS and reduction of lipid parameters plays a pivotal role in secondary prevention. High total cholesterol and high low-density lipoprotein(LDL) are the major lipid abnormalities globally as well as in Indians. Among all the lipid parameters, LDL is the primary target of lipid-lowering therapies across the globe. High-dose statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and bempedoic acid are recommended therapies for LDL reduction in ACS patients. Statins have pleiotropic effects on the modulation of thrombogenesis, endothelial dysfunction, and myocardial protection. Multiple randomised controlled trials and meta-analyses have shown that the use of high-dose statin has significant benefits in ACS. LDL reduction goal is < 55 mg/dl or at least 50 % reduction from the baseline regardless of age or gender. Non-fasting LDL should be measured soon after the ACS as it varies minimally with food intake. The first line of therapy after ACS is to advise lifestyle modifications, combination therapy including high-dose statin with ezetimibe, and evaluation after 4-6 weeks of the index event. If the goal is not achieved then PCSK 9 inhibitors or Bempedoic acid should be used in combination with statins and ezetimibe to reduce recurrent ischaemic events. Despite the proven effect of these lipid-lowering therapies, undertreatment is still a big hurdle across the globe. Prohibitive costs, adverse effects, medication non-adherence, variation in health practice in different countries, and clinical inertia to prescribe this medication by physicians are the main reasons for the undertreatment.
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García-Campa M, Flores-Ramírez R, Rojo-Garza S, Carrizales-Sepúlveda EF, Regalado-Ceballos D, Reyes-Araiza R, Álvarez-Villalobos N, Rodríguez-Gutiérrez R, Azpiri-López JR. Atorvastatin before percutaneous coronary intervention: A systematic review and meta-analysis. PLoS One 2024; 19:e0293404. [PMID: 38165842 PMCID: PMC10760670 DOI: 10.1371/journal.pone.0293404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/11/2023] [Indexed: 01/04/2024] Open
Abstract
Atorvastatin is widely recommended for long-term secondary prevention in STEMI patients with no contraindication. Although high-dose atorvastatin has been shown to reduce important patient outcomes such as MACE, there is still doubt that high-dose atorvastatin could have the same protective effect in patients undergoing PCI in the short and long term. We searched the following electronic databases: Scopus, Web of Science, MEDLINE, EMBASE, and Cochrane Central considering studies that enrolled adult patients with a confirmed diagnosis of STEMI or NSTEMI undergoing PCI. The intervention must have been atorvastatin alone compared to a placebo, standard care, or a different atorvastatin dose. A total of (n = 11) studies were included in the quantitative analysis. Information on (N = 5,399) patients was available; 2,654 were assigned to receive high-dose atorvastatin therapy, and 2,745 comprised the control group. High-dose atorvastatin pre-loading significantly reduced MACE at one month of follow-up (RR: 0.78; 95% CI: 0.67-0.91; p = 0.014) in both STEMI and NSTEMI. All-cause mortality was reduced in patients with STEMI (RR: 0.28; 95% CI: 0.10-0.81; p = 0.029). The quality of the body of evidence was rated overall as moderate. Patients presenting with STEMI or NSTEMI benefit from high-dose atorvastatin pre-loading before PCI by reducing MACE at 30 days. The use of high-dose atorvastatin in STEMI patients reduced all-cause mortality. The beneficial effects of atorvastatin pre-loading are limited to 30 days post-PCI.
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Affiliation(s)
- Mariano García-Campa
- Cardiology Service, "Dr. José Eleuterio González" University Hospital of the Autonomous University of Nuevo Leon, Monterrey, Mexico
- Plataforma INVEST UANL-KER Unit Mayo Clinic, School of Medicine and University Hospital "Dr. José E González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Ramiro Flores-Ramírez
- Cardiology Service, "Dr. José Eleuterio González" University Hospital of the Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Sabrina Rojo-Garza
- Plataforma INVEST UANL-KER Unit Mayo Clinic, School of Medicine and University Hospital "Dr. José E González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | | | - Diego Regalado-Ceballos
- Plataforma INVEST UANL-KER Unit Mayo Clinic, School of Medicine and University Hospital "Dr. José E González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Raúl Reyes-Araiza
- Cardiology Service, "Dr. José Eleuterio González" University Hospital of the Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Neri Álvarez-Villalobos
- Plataforma INVEST UANL-KER Unit Mayo Clinic, School of Medicine and University Hospital "Dr. José E González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Rene Rodríguez-Gutiérrez
- Plataforma INVEST UANL-KER Unit Mayo Clinic, School of Medicine and University Hospital "Dr. José E González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - José Ramón Azpiri-López
- Cardiology Service, "Dr. José Eleuterio González" University Hospital of the Autonomous University of Nuevo Leon, Monterrey, Mexico
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Jin ZL, He T, Peng L, Wu XY, Fan D, Chen M, Fan YZ, Guo YL, Lu ZB, Wang HR. Lipoprotein(a) and Benefit of PCSK9 Inhibition in Emergency Complex Higher-risk and Indicated Patients. Curr Med Sci 2023; 43:1206-1212. [PMID: 37755635 DOI: 10.1007/s11596-023-2791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/13/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE There is a large population of patients classified as complex higher-risk and indicated patients (CHIPs) in China with a poor prognosis. The treatment of these patients is complex and challenging, especially when acute cardiac events occur, such as acute coronary syndrome (ACS) or heart failure. Pharmacotherapy and some mechanical circulatory support (MCS) therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention (PCI). LDL-C is an important pathogenic factor in atherosclerosis, and the target of blood lipid control. Recent studies have revealed that lipoprotein(a) [Lp(a)], which is formed when a covalent bond between apolipoprotein(a) and apolipoprotein B-100 is made, produces an LDL-like particle. This particle is an independent risk factor for the development of atherosclerosis, and is closely correlated to stent thrombosis and restenosis. Furthermore, this requires active intervention. PCSK9 inhibitors have been used in lipid-lowering treatment, and preventing atherosclerosis. The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS, and the association between the change in Lp(a) and survival after 2 years of follow-up. METHODS The present real-world, prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020, and these patients were followed up for 2 years. These patients were divided into two groups: PCSK9 group (n=161) given the combined PCSK9 inhibitor (140 mg of evolocumab every 2 weeks) and statins-based therapy, and SOC group (n=160) treated with statin-based lipid-lowering therapy alone. Then, the change in lipid index was measured, and the cardiovascular (CV) event recurrence rate was evaluated after one month and 2 years. Afterwards, the contribution of serum lipid parameters, especially the Lp(a) alteration, in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed. RESULTS The LDL-C level was significantly reduced in both groups: 52.3% in the PCSK9 group and 32.3% (P<0.001) in the SOC group. It is noteworthy that the Lp(a) level decreased by 13.2% in the PCSK9 group, but increased by 30.3% in the SOC group (P<0.001). Furthermore, the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period. In the PCSK9 group, the Lp(a) reduction was associated with the baseline Lp(a) levels of the patients (r2 =-0.315, P<0.001). Moreover, the decrease in Lp(a) contributed to the decline in CV events in patients who received ACS CHIPs-PCI, and the decrease in Lp(a) level was independent of the LDL-C level reduction. CONCLUSION The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a) levels in ACS CHIPs-PCI. However, further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.
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Affiliation(s)
- Zhi-Li Jin
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Tao He
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Li Peng
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Xiao-Yan Wu
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Di Fan
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Ming Chen
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Yong-Zhen Fan
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China
| | - Yuan-Lin Guo
- Cardio-Metabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China
| | - Zhi-Bing Lu
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China.
| | - Hai-Rong Wang
- Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China.
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Chen W, Ni M, Huang H, Cong H, Fu X, Gao W, Yang Y, Yu M, Song X, Liu M, Yuan Z, Zhang B, Wang Z, Wang Y, Chen Y, Zhang C, Zhang Y. Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition). MedComm (Beijing) 2023; 4:e438. [PMID: 38116064 PMCID: PMC10729292 DOI: 10.1002/mco2.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/11/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Since the four working groups of the Chinese Society of Cardiology issued first expert consensus on coronary microvascular diseases (CMVD) in 2017, international consensus documents on CMVD have increased rapidly. Although some of these documents made preliminary recommendations for the diagnosis and treatment of CMVD, they did not provide classification of recommendations and levels of evidence. In order to summarize recent progress in the field of CMVD, standardize the methods and procedures of diagnosis and treatment, and identify the scientific questions for future research, the four working groups of the Chinese Society of Cardiology updated the 2017 version of the Chinese expert consensus on CMVD and adopted a series of measures to ensure the quality of this document. The current consensus has raised a new classification of CMVD, summarized new epidemiological findings for different types of CMVD, analyzed key pathological and molecular mechanisms, evaluated classical and novel diagnostic technologies, recommended diagnostic pathways and criteria, and therapeutic strategies and medications, for patients with CMVD. In view of the current progress and knowledge gaps of CMVD, future directions were proposed. It is hoped that this expert consensus will further expedite the research progress of CMVD in both basic and clinical scenarios.
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Affiliation(s)
- Wenqiang Chen
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Mei Ni
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - He Huang
- Department of CardiologySir Run Run Shaw Hospital affiliated with Zhejiang University School of MedicineHangzhouChina
| | - Hongliang Cong
- Department of CardiologyTianjin Chest Hospital, Tianjin UniversityTianjinChina
| | - Xianghua Fu
- Department of CardiologyThe Second Hospital of Hebei Medical UniversityShijiazhuangHebeiChina
| | - Wei Gao
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Yuejin Yang
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiantao Song
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Meilin Liu
- Department of GeriatricsPeking University First HospitalBeijingChina
| | - Zuyi Yuan
- Department of CardiologyThe First Affiliated Hospital of Xian Jiaotong UniversityXianChina
| | - Bo Zhang
- Department of CardiologyFirst Affiliated Hospital, Dalian Medical UniversityDalianLiaoningChina
| | - Zhaohui Wang
- Department of CardiologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yan Wang
- Department of CardiologyXiamen Cardiovascular Hospital, Xiamen UniversityXiamenChina
| | - Yundai Chen
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China; for the Basic Research Group, Atherosclerosis and Coronary Heart Disease Group, Interventional Cardiology Group, and Women's Heart Health Group of the Chinese Society of Cardiology
| | - Cheng Zhang
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yun Zhang
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
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Yang C, Wu YJ, Qian J, Li JJ. Landscape of Statin as a Cornerstone in Atherosclerotic Cardiovascular Disease. Rev Cardiovasc Med 2023; 24:373. [PMID: 39077097 PMCID: PMC11272851 DOI: 10.31083/j.rcm2412373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/24/2023] [Accepted: 11/10/2023] [Indexed: 07/31/2024] Open
Abstract
Atherosclerosis, the key pathogenesis of cardiovascular disease, is a leading cause of death and disability worldwide. Statins are first-line lipid-lowering drugs, which have been demonstrated to be powerful agents for anti-atherosclerosis. Numerous studies have confirmed the cardiovascular benefits and long-term safety of statins in a wide range of patients. Statins play an indispensable and irreplaceable part in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). In this article, we summarize the evolution of statins and their role in the treatment of cholesterol. The anti-atherosclerotic mechanism of statins, its efficacy, safety and clinical outcomes in secondary and primary prevention of ACSVD in different patient populations, the combination treatment effects, and guideline recommendations are also detailed. This paper highlights the profound significance of statins as the most successful anti-atherogenic drug in the cardiovascular field.
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Affiliation(s)
- Cheng Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Yong-Jian Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Jie Qian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
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Sun J, Jin X, Zhang L, Shen H, Yu H. Rosuvastatin plus ticagrelor decreases the risk of major adverse cardiovascular events and elevates cardiac function compared with ticagrelor alone in patients undergoing percutaneous coronary intervention: A meta‑analysis. Exp Ther Med 2023; 26:525. [PMID: 37869634 PMCID: PMC10587883 DOI: 10.3892/etm.2023.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
Several previous studies have reported that rosuvastatin plus ticagrelor is superior to ticagrelor monotherapy in patients receiving percutaneous coronary intervention (PCI); several others, however, dispute this. The present meta-analysis summarized relevant studies, aiming to comprehensively explore the efficacy of rosuvastatin plus ticagrelor vs. ticagrelor monotherapy in patients receiving PCI. Published studies comparing the efficacy between rosuvastatin plus ticagrelor and ticagrelor alone among patients receiving PCI were searched in the CNKI, Wanfang, CQVIP, EMBASE, Cochrane and PubMed databases until January 2023. The present meta-analysis included 3 cohort studies and 4 randomized controlled trials with 426 patients receiving rosuvastatin plus ticagrelor and 424 patients receiving ticagrelor monotherapy. Rosuvastatin plus ticagrelor decreased the occurrence of major adverse cardiovascular events (MACE) compared with ticagrelor [relative risk (RR), 0.29; 95% confidence interval (CI), 0.18-0.47]. Subgroup analysis revealed similar findings in studies with a follow-up of <6 months (RR, 0.24; 95% CI, 0.13-0.47) and ≥6 months (RR, 0.36; 95% CI, 0.18-0.70), as well as in studies using 10 mg rosuvastatin (RR, 0.27; 95% CI, 0.15-0.50) and 20 mg rosuvastatin (RR, 0.33; 95% CI, 0.16-0.69). In addition, rosuvastatin plus ticagrelor decreased the left ventricular (LV) end-systolic diameter [mean difference (MD), -0.71; 95% CI, -(1.36-0.07)], LV end-diastolic diameter [MD, -1.17; 95% CI, -(1.91-0.43)] and N-terminal pro-B-type natriuretic peptide [MD, -2.97; 95% CI, -(4.55-1.38)], and increased the LV ejection fraction (MD, 0.99; 95% CI, 0.74-1.25). In conclusion, rosuvastatin plus ticagrelor was shown to decrease the risk of MACE and elevate cardiac function compared with ticagrelor monotherapy in patients receiving PCI.
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Affiliation(s)
- Jinling Sun
- Department of Geriatrics, Zibo Central Hospital, Zibo, Shandong 255036, P.R. China
| | - Xiaodong Jin
- Department of Geriatrics, Zibo Central Hospital, Zibo, Shandong 255036, P.R. China
| | - Limei Zhang
- Department of Endocrinology, Zibo Central Hospital, Zibo, Shandong 255036, P.R. China
| | - Hongshuai Shen
- Department of Geriatrics, Zibo Central Hospital, Zibo, Shandong 255036, P.R. China
| | - Hui Yu
- Department of Endocrinology, Zibo Central Hospital, Zibo, Shandong 255036, P.R. China
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Ndrepepa G, Kastrati A. Coronary No-Reflow after Primary Percutaneous Coronary Intervention-Current Knowledge on Pathophysiology, Diagnosis, Clinical Impact and Therapy. J Clin Med 2023; 12:5592. [PMID: 37685660 PMCID: PMC10488607 DOI: 10.3390/jcm12175592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Coronary no-reflow (CNR) is a frequent phenomenon that develops in patients with ST-segment elevation myocardial infarction (STEMI) following reperfusion therapy. CNR is highly dynamic, develops gradually (over hours) and persists for days to weeks after reperfusion. Microvascular obstruction (MVO) developing as a consequence of myocardial ischemia, distal embolization and reperfusion-related injury is the main pathophysiological mechanism of CNR. The frequency of CNR or MVO after primary PCI differs widely depending on the sensitivity of the tools used for diagnosis and timing of examination. Coronary angiography is readily available and most convenient to diagnose CNR but it is highly conservative and underestimates the true frequency of CNR. Cardiac magnetic resonance (CMR) imaging is the most sensitive method to diagnose MVO and CNR that provides information on the presence, localization and extent of MVO. CMR imaging detects intramyocardial hemorrhage and accurately estimates the infarct size. MVO and CNR markedly negate the benefits of reperfusion therapy and contribute to poor clinical outcomes including adverse remodeling of left ventricle, worsening or new congestive heart failure and reduced survival. Despite extensive research and the use of therapies that target almost all known pathophysiological mechanisms of CNR, no therapy has been found that prevents or reverses CNR and provides consistent clinical benefit in patients with STEMI undergoing reperfusion. Currently, the prevention or alleviation of MVO and CNR remain unmet goals in the therapy of STEMI that continue to be under intense research.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany;
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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17
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Badimon L, Mendieta G, Vilahur G. Statins revisited: therapeutic applications beyond lipid lowering? Eur Heart J 2023:ehad324. [PMID: 37316965 DOI: 10.1093/eurheartj/ehad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Lina Badimon
- Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Av. S. Antoni M. Claret, 167, ES-08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226), Spain
- Cardiovascular Research Chair, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Gemma Vilahur
- Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Av. S. Antoni M. Claret, 167, ES-08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226), Spain
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Nedkoff L, Briffa T, Murray K, Gaw J, Yates A, Sanfilippo FM, Nicholls SJ. Risk of early recurrence and mortality in high-risk myocardial infarction patients: A population-based linked data study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200185. [PMID: 37122877 PMCID: PMC10139974 DOI: 10.1016/j.ijcrp.2023.200185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/18/2022] [Accepted: 03/30/2023] [Indexed: 05/02/2023]
Abstract
Background Survival during the early period following myocardial infarction (MI) has significantly improved although there are limited data on cardiovascular recurrence during this period. Methods We identified all emergency hospitalisations for MI from November 1, 2011 to October 31, 2016 in Western Australia from a linked hospitalisation/mortality dataset. Patients were included if they survived >3 days, had no acute kidney injury, and had ≥1 of: ≥65 years, prior MI, diabetes or peripheral arterial disease. Outcomes were major adverse cardiovascular events (MACE, a composite of CVD death, recurrent MI or stroke), cardiovascular disease (CVD) death, all-cause mortality, recurrent MI and stroke. Cumulative risks at 90-days and 1-year were estimated from Kaplan-Meier analyses and predictors of each outcome from multivariable Cox regression models. Results There were 8024 high-risk MI patients identified (males 61.8%). Median age was 73.7 years (IQR 66.3-82.2). Half of the risk of MACE occurred in the first 90-days post-MI (6.6% vs 12.6% at 1-year) and was underpinned by risk of recurrent MI. Risk was generally higher in women than men (MACE: 6.0% males, 7.7% females, p = 0.0025; CVD mortality: 1.7% males, 3.7% females; all-cause mortality: 2.8% males, 5.6% females, p < 0.0001). Independent predictors of 90-day MACE were increasing age, heart failure history, hypertension and prior stroke. Female sex was not associated with a higher rate of any of the outcomes after multivariable adjustment. Conclusion Half of cardiovascular events in the year following an MI occur within 90-days, demonstrating that reductions in MI burden could be achieved by further targeted intervention in the early period following an MI.
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Affiliation(s)
- Lee Nedkoff
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
- Corresponding author. School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Hwy, Crawley, Western, 6009, Australia.
| | - Tom Briffa
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Kevin Murray
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - James Gaw
- CSL Behring, 189 – 209 Camp Road, Broadmeadows, Victoria, 3047, Australia
| | - Andrea Yates
- CSL Behring, 189 – 209 Camp Road, Broadmeadows, Victoria, 3047, Australia
| | - Frank M. Sanfilippo
- The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Stephen J. Nicholls
- Victorian Heart Institute, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
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AlRahimi J, AlSaif S, Alasnag M, Awan Z, Almutairi F, Al Mudaiheem H, Gencer B, Catapano AL, Mach F, Tash A. 2022 Saudi Guidelines for the Management of Dyslipidemia. Heart Views 2023; 24:67-92. [PMID: 37305331 PMCID: PMC10249637 DOI: 10.4103/heartviews.heartviews_102_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/16/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Jamilah AlRahimi
- Department of Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Shukri AlSaif
- Department of Cardiology, Saud AlBabtain Cardiac Center, Dammam, Saudi Arabia
| | - Mirvat Alasnag
- Department of Cardiology, Catheterization Laboratory, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Zuhier Awan
- Medicine, Biochemistry and Molecular Genetics, Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fawaz Almutairi
- Department of Cardiology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hajer Al Mudaiheem
- Therapeutic Affairs Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Baris Gencer
- Department of Cardiology, Geneva University Hospital, Geneva
- Institute of Primary Healthcare (BIHAM), Bern University, Bern, Switzerland
| | - Alberico L. Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - François Mach
- Department of Cardiology, Geneva University Hospital, Geneva
| | - Adel Tash
- Cardiac Services Development, Ministry of Health, Riyadh, Saudi Arabia
- National Heart Center, Saudi Health Council, Riyadh, Saudi Arabia
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20
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Nemani L. Practical Approach to Diagnosis, Prevention, and Management of Coronary No-Reflow. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/ijcdw_18_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Coronary no-reflow (NR) defined as inadequate myocardial perfusion despite restoration of coronary artery patency is a bane for an interventional cardiologist. It can complicate percutaneous coronary interventions especially in the setting of STEMI and dampens the potential benefits of PPCI. Broadly classified as Reperfusion NR and Interventional NR, mechanism is multifactorial. The basic underlying culprit is microvascular obstruction either secondary to distal embolization, intravascular plugging, or ischemic reperfusion injury. Coronary angiogram is an easy, readily available, and essential modality to diagnose no-reflow, but the gold standard is gadolinium-enhanced cardiovascular magnetic resonance imaging. Preventive strategies for NR should be integral part of prePCI planning especially in clinical scenario where NR is expected such as STEMI with delayed presentation and high thrombus burden, atherectomy, and SVG PCI. The cornerstone of treatment for NR is local vasodilators and antiplatelet therapy to ameliorate vasospasm and thromboembolism respectively, and different combinations of the two should be used in no specific order to achieve reversal of NR. NR phenomenon is associated with poor short-term and long-term prognosis and every attempt should be made to avoid or reverse it. Therapeutic hypothermia, hyperoxemic reperfusion therapy, targeted anti-inflammatory approach, and cellular approach appear proising but further research is mandatory.
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Affiliation(s)
- Lalita Nemani
- Department of Cardiac Sciences, Dr. Ismail Surgical Center, Dubai, United Arab Emirates,
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21
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Xiao J, Sun Q, Ran L, Wang Y, Qin X, Xu X, Tang C, Liu L, Zhang G. pH-Responsive Selenium Nanoplatform for Highly Efficient Cancer Starvation Therapy by Atorvastatin Delivery. ACS Biomater Sci Eng 2023; 9:809-820. [PMID: 36622161 DOI: 10.1021/acsbiomaterials.2c01500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Recently, starvation-inducing nutrient deprivation has been regarded as a promising strategy for tumor suppression. As a first-line lipid-lowering drug, atorvastatin (ATV) significantly reduces caloric intake, suggesting its potential in starvation therapy for suppressing tumors. Accordingly, we developed a novel starvation therapy agent (HA-Se-ATV) in this study to suppress tumor growth by using hyaluronic acid (HA)-conjugated chitosan polymer-coated nano-selenium (Se) for loading ATV. HA-Se-ATV targets cancer cells, following which it effectively accumulates in the tumor tissue. The HA-Se-ATV nanoplatform was then activated by inducing a weakly acidic tumor microenvironment and subsequently releasing ATV. ATV and Se synergistically downregulate the levels of cellular adenosine triphosphate while inhibiting the expression of thioredoxin reductase 1. Consequently, the starvation-stress reaction of cancer cells is significantly elevated, leading to cancer cell death. Furthermore, the in vivo results indicate that HA-Se-ATV effectively suppresses tumor growth with a low level of toxicity, demonstrating its great potential for clinical translation.
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Affiliation(s)
- Jianmin Xiao
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
| | - Qiong Sun
- Department of Stomatology, PLA Strategic Support Force Medical Center, Beijing100101, China
| | - Lang Ran
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
| | - Yinfeng Wang
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
| | - Xia Qin
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
| | - Xiaotong Xu
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
| | - Chuhua Tang
- Department of Stomatology, PLA Strategic Support Force Medical Center, Beijing100101, China
| | - Lu Liu
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
| | - Guilong Zhang
- School of Pharmacy, Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai264003, P. R. China
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22
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Sethi R, Mohan L, Vishwakarma P, Singh A, Sharma S, Bhandari M, Shukla A, Sharma A, Chaudhary G, Pradhan A, Chandra S, Narain VS, Dwivedi SK. Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction. World J Cardiol 2023; 15:23-32. [PMID: 36714366 PMCID: PMC9850672 DOI: 10.4330/wjc.v15.i1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity. In patients with STEMI who could not receive primary percutaneous coronary intervention (PCI) on time, pharmacoinvasive strategy (thrombolysis followed by timely PCI within 3-24 h of its initiation) is an effective option. AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis. METHODS This was a physician-initiated, single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries. Patients received routine pharmacoinvasive therapy (PCI within 3-24 h of thrombolysis) in one group and delayed pharmacoinvasive therapy (PCI within 24-72 h of thrombolysis) in another group. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure. The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification, angina, and dyspnea within 30 d. RESULTS The mean age in the two groups was comparable (55.1 ± 10.1 years vs 54.2 ± 10.5 years, P = 0.426). Diabetes was present among 20.2% and 22.1% of patients in the routine and delayed groups, respectively. Smoking rate was 54.6% and 55.8% in the routine and delayed groups, respectively. Thrombolysis was initiated within 6 h of onset of symptoms in both groups (P = 0.125). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively. No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d (8.7% vs 12.9%, P = 0.152). Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation. Secondary endpoints such as angina, dyspnea, and major bleeding were non-significantly different between the two groups. CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
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Affiliation(s)
- Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Lalit Mohan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Abhishek Singh
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Swati Sharma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Ayush Shukla
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
| | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Sudhanshu Kumar Dwivedi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
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23
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Zhang L, Zhang Y, Chu C, Deng F, Zhou J, Yuan Z. Associations of pre-hospital statin treatment with in-hospital outcomes and severity of coronary artery disease in patients with first acute coronary syndrome-findings from the CCC-ACS project. Front Cardiovasc Med 2023; 9:1030108. [PMID: 36741846 PMCID: PMC9889368 DOI: 10.3389/fcvm.2022.1030108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023] Open
Abstract
Background The current burden of dyslipidemia, the pre-hospital application of statins and the association of pre-hospital statins with the severity of coronary artery disease (CAD) and in-hospital outcomes in Chinese patients with first acute coronary syndrome (ACS) are very significant and remain unclear. Methods A total of 41,183 patients who underwent coronary angiography and were diagnosed with ACS for the first time from a nationwide registry study (CCC-ACS) were enrolled. The severity of CAD was assessed using the CAD prognostic index (CADPI). The patients were classified into statin and non-statin groups according to their pre-hospital statin treatment status. Clinical characteristics, CADPI and in-hospital outcomes were compared, and a logistic regression analysis was performed to determine whether pre-hospital statin therapy is associated with in-hospital outcomes and CADPI. A sensitivity analysis was used to further explore the issues above. Results The non-statin group had more in-hospital all-cause deaths (1.2 vs. 0.8%, P = 0.010). However, no association exists between statin pretreatment and in-hospital major adverse cardiovascular events (MACEs) or all-cause deaths in the entire population and subgroups (all P > 0.05). Surprisingly, statin pretreatment was associated with an 8.9% higher risk of severely obstructive CAD (CADPI ≥ 37) (OR, 1.089; 95% CI, 1.010-1.175, P = 0.028), and similar results were observed in subgroups of females, those aged 50 to 75 years, and patients with hypertension. Conclusion Statin pretreatment was not related to MACEs or all-cause death during hospital stay, but it was associated with a higher risk of increased angiographic severity in patients with first ACS.
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Affiliation(s)
- Lisha Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,*Correspondence: Lisha Zhang,
| | - Yan Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chao Chu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Fuxue Deng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,Zuyi Yuan,
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24
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Krychtiuk KA, Ahrens I, Drexel H, Halvorsen S, Hassager C, Huber K, Kurpas D, Niessner A, Schiele F, Semb AG, Sionis A, Claeys MJ, Barrabes J, Montero S, Sinnaeve P, Pedretti R, Catapano A. Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:939-949. [PMID: 36574353 DOI: 10.1093/ehjacc/zuac123] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 12/28/2022]
Abstract
After experiencing an acute coronary syndrome (ACS), patients are at a high risk of suffering from recurrent ischaemic cardiovascular events, especially in the very early phase. Low density lipoprotein-cholesterol (LDL-C) is causally involved in atherosclerosis and a clear, monotonic relationship between pharmacologic LDL-C lowering and a reduction in cardiovascular events post-ACS has been shown, a concept termed 'the lower, the better'. Current ESC guidelines suggest an LDL-C guided, step-wise initiation and escalation of lipid-lowering therapy (LLT). Observational studies consistently show low rates of guideline-recommended LLT adaptions and concomitant low rates of LDL-C target goal achievement, leaving patients at residual risk, especially in the vulnerable post-ACS phase. In addition to the well-established 'the lower, the better' approach, a 'strike early and strike strong' approach in the early post-ACS phase with upfront initiation of a combined lipid-lowering approach using high-intensity statins and ezetimibe seems reasonable. We discuss the rationale, clinical trial evidence and experience for such an approach and highlight existing knowledge gaps. In addition, the concept of acute initiation of PCSK9 inhibition in the early phase is reviewed. Ultimately, we focus on hurdles and solutions to provide high-quality, evidence-based follow-up care in post-ACS patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria.,Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, 50678 Cologne, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, 1160 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria.,Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alexander Niessner
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, France and EA3920, Besancon, France
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Division of Innovation and Research, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER-CV, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - José Barrabes
- Acute Cardiac Care Unit, Cardiology Service, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERC-V, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Roberto Pedretti
- Director of Cardiovascular Department, Head of Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Alberico Catapano
- Professor of Pharmacology, Director Center of Epidemiology and Preventive Pharmacology, Director Laboratory of Lipoproteins, Immunity and Atherosclerosis Department of Pharmacological and Biomolecular Sciences Director Center for the Study of Atherosclerosis at Bassini Hospital University of Milan, Milan, Italy
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Mensink FB, Los J, Ten Cate TJF, Oemrawsingh RM, Brouwer MA, El Messaoudi S, van Royen N, Cornel JH, Riksen NP, van Geuns RJM. Pharmaco-invasive therapy: Early implementation of statins and proprotein convertase subtilisin/kexin type 9 inhibitors after acute coronary syndrome. Front Cardiovasc Med 2022; 9:1061346. [PMID: 36568547 PMCID: PMC9772027 DOI: 10.3389/fcvm.2022.1061346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Elevated LDL-cholesterol (LDL-C) plays a major role in atheroma formation and inflammation. Medical therapy to lower elevated LDL-C is the cornerstone for reducing the progression of atherosclerotic cardiovascular disease. Statin therapy, and more recently, other drugs such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have proven efficacy in long-term lowering of LDL-C and therefore diminish cardiovascular risk. During an acute coronary syndrome (ACS), a systemic inflammatory response can destabilize other non-culprit atherosclerotic plaques. Patients with these vulnerable plaques are at high risk of experiencing recurrent cardiovascular events in the first few years post-ACS. Initiating intensive LDL-C lowering therapy in these patients with statins or PCSK9 inhibitors can be beneficial via several pathways. High-intensity statin therapy can reduce inflammation by directly lowering LDL-C, but also through its pleiotropic effects. PCSK9 inhibitors can directly lower LDL-C to recommended guideline thresholds, and could have additional effects on inflammation and plaque stability. We discuss the potential role of early implementation of statins combined with PCSK9 inhibitors to influence these cascades and to mediate the associated cardiovascular risk, over and above the well-known long-term beneficial effects of chronic LDL-C lowering.
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Affiliation(s)
- F. B. Mensink
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: F. B. Mensink,
| | - J. Los
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - T. J. F. Ten Cate
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - R. M. Oemrawsingh
- Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
| | - M. A. Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - S. El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - N. van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - J. H. Cornel
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - N. P. Riksen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - R. J. M. van Geuns
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
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Liu T, Shu J, Liu Y, Xie J, Li T, Li H, Li L. Atorvastatin attenuates ferroptosis-dependent myocardial injury and inflammation following coronary microembolization via the Hif1a/Ptgs2 pathway. Front Pharmacol 2022; 13:1057583. [PMID: 36569299 PMCID: PMC9772535 DOI: 10.3389/fphar.2022.1057583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives: Coronary microembolization (CME) represents a serious periprocedural complication after percutaneous coronary intervention. Ferroptosis has been identified in multiple cardiovascular diseases. In this study, we aimed to investigate the effects of atorvastatin (ATV) on ferroptosis and inflammation following CME and elucidate the underlying mechanism. Methods: We established a rat model of CME by injecting microspheres into the left ventricle. Deferoxamine (DFO), a selective ferroptosis inhibitor, or ATV was pretreated before modeling. Cardiac function and cardiac troponin T (cTnT) levels were detected. Levels of ferroptosis-associated genes, malondialdehyde (MDA), glutathione (GSH), and ferrous iron (Fe2+) were measured to validate ferroptosis. Levels of tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) were assayed to determine the inflammation. Chromatin immunoprecipitation was performed to determine the binding of hypoxia-inducible factor 1 subunit alpha (Hif1a) to the promoter of prostaglandin-endoperoxide synthase-2 (Ptgs2). Results: Ferroptosis and inflammation were induced following CME with increased levels of MDA (∼2.5 fold, p < 0.01), Fe2+ (∼1.5 fold, p < 0.01), TNF-α, and IL-1β and decreased GSH levels (∼42%, p < 0.01). Meanwhile, the level of Ptgs2 was significantly increased, while those of glutathione peroxidase 4 (Gpx4) and solute carrier family 7 member 11 (Slc7a11) were decreased. The level of cTnT was increased by 7-fold (p < 0.01). Left ventricular ejection fraction (LVEF) was significantly reduced (∼85% in the sham group versus ∼45% in the CME group, p < 0.01). DFO or Ptgs2 silencing inhibited the increase of MDA, Ptgs2, TNF-α, and IL-1β, and induced the levels of GSH and Gpx4, followed by reduction in cTnT levels by approximately 50% (p < 0.01). LVEF was improved by approximately 2 fold (p < 0.01). Mechanistically, the transcription factor Hif1a bound to the promoter of Ptgs2 and upregulated its expression. In addition, ATV inhibited the activation of the Hif1a/Ptgs2 axis and attenuated cardiac ferroptosis and inflammation, thus ameliorating CME-induced myocardial injury (LVEF, ∼34% elevation; cTnT, ∼1.8 fold decrease, p < 0.01). Conclusion: Atorvastatin ameliorates ferroptosis-mediated myocardial injury and inflammation following CME via the Hif1a/Ptgs2 pathway.
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Affiliation(s)
- Tao Liu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin Shu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yangchun Liu
- Cardiothoracic Surgery Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Xie
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tao Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Haoliang Li
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China,Guangxi Key Laboratory of Precision Medicine for Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Nanning, China,*Correspondence: Lang Li,
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Impact of Prior Statin Therapy on In-Hospital Outcome of STEMI Patients Treated with Primary Percutaneous Coronary Intervention. J Clin Med 2022; 11:jcm11185298. [PMID: 36142948 PMCID: PMC9502753 DOI: 10.3390/jcm11185298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Prior statin therapy has a cardioprotective effect in patients undergoing elective or urgent percutaneous coronary intervention (PCI). However, data on patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI are still controversial. We retrospectively evaluated the effect of prior statin therapy on in-hospital clinical outcomes in consecutive STEMI patients undergoing primary PCI. Methods: A total of 1790 patients (mean age 67 ± 11 years, 1354 men) were included. At admission, all patients were interrogated about prior (>6 months) statin therapy. The primary endpoint of the study was the composite of in-hospital mortality, acute pulmonary edema, and cardiogenic shock in patients with or without prior statin therapy. Results: A total of 427 patients (24%) were on prior statin therapy. The incidence of the primary endpoint was similar in patients with or without prior statin therapy (15% vs. 16%; p = 0.38). However, at multivariate analysis, prior statin therapy was associated with a lower risk of the primary endpoint, after adjustment for major prognostic predictors (odds ratio 0.61 [95% CI 0.39−0.96]; p = 0.03). Conclusions: This study demonstrated that prior statin therapy is associated with a better in-hospital clinical outcome in patients with STEMI undergoing primary PCI compared to those without prior statin therapy.
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Statins in High Cardiovascular Risk Patients: Do Comorbidities and Characteristics Matter? Int J Mol Sci 2022; 23:ijms23169326. [PMID: 36012589 PMCID: PMC9409457 DOI: 10.3390/ijms23169326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality are decreasing in high-income countries, but ASCVD remains the leading cause of morbidity and mortality in high-income countries. Over the past few decades, major risk factors for ASCVD, including LDL cholesterol (LDL-C), have been identified. Statins are the drug of choice for patients at increased risk of ASCVD and remain one of the most commonly used and effective drugs for reducing LDL cholesterol and the risk of mortality and coronary artery disease in high-risk groups. Unfortunately, doctors tend to under-prescribe or under-dose these drugs, mostly out of fear of side effects. The latest guidelines emphasize that treatment intensity should increase with increasing cardiovascular risk and that the decision to initiate intervention remains a matter of individual consideration and shared decision-making. The purpose of this review was to analyze the indications for initiation or continuation of statin therapy in different categories of patient with high cardiovascular risk, considering their complexity and comorbidities in order to personalize treatment.
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Enhanced-Dose Statins for ST-Segment Elevation Myocardial Infarction Patients after Emergency Percutaneous Coronary Intervention. DISEASE MARKERS 2022; 2022:2751750. [PMID: 35801005 PMCID: PMC9256331 DOI: 10.1155/2022/2751750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/04/2022] [Indexed: 11/21/2022]
Abstract
Background Acute ST-segment elevation myocardial infarction (STEMI) is a serious multiple acute cardiovascular disease. This study investigated the effect of statins on the efficacy and prognosis of STEMI patients after emergency PCI. Methods From October 2019 to January 2021, 98 patients with STEMI in our hospital were selected and divided into study group and control group. The study group took atorvastatin 40 mg 2 hours before surgery, 40 mg/day after surgery, and 20 mg/day 1 week later. The control group received 20 mg of atorvastatin every night after admission. The cardiac output, left ventricular ejection fraction, blood flow classification, vagus nerve function, heart rate deceleration force and chemoreflex sensitivity were compared between the two groups, and recorded the incidence of adverse reactions before and after treatment and 3 months after treatment. The number of major adverse cardiac events (MACEs) was also recorded. Results Before treatment, there were no differences in CO, CI, and LVEF between the study and control groups. After treatment, CO, CI, and LVEF in the study group were significantly higher than those in the control group. Before treatment, there was no significant difference in TIMI blood flow classification among the groups, and after treatment, the study group was better than the control group. DC and ChRS were significantly higher in the study group than in the control group. There was no difference in the incidence of adverse reactions between the study group and the control group. However, the incidence of MACE in the study group was lower than that in the control group. Conclusion Enhanced-dose atorvastatin for STEMI patients improved PCI treatment effect, cardiac function, and vagus nerve function and reduced the incidence of adverse cardiac events. Thus, statins are safe and worth considering.
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Puri R, Mehta V, Duell PB, Iyengar SS, Yusuf J, Dalal J, Narasingan SN, Kalra D, Kapoor A, Pradhan A, Mukhopadhyay S, Vijayaraghavan K, Aggarwal R, Muruganathan A, Prabhakar D, Misra S, Shetty S, Kasliwal RR, Bansal M, Khanna N, Khan A, Melinkeri RP, Kumar S, Chakraborty RN, Bardoloi N, Sahoo P, Vinayagam P, Modi R, Nanda R, Wong ND. Evidence for intensive LDL-C lowering for acute coronary syndrome: Recommendations from the Lipid Association of India. J Clin Lipidol 2022; 16:261-271. [PMID: 35508456 DOI: 10.1016/j.jacl.2022.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 02/08/2023]
Abstract
Patients with acute coronary syndrome (ACS) have a high risk of subsequent adverse cardiovascular outcomes, particularly within the first 30 days. Although it is well documented that initiation of statin therapy in the setting of ACS improves short- and long-term cardiovascular outcomes, and achievement of lower levels of low density lipoprotein cholesterol (LDL-C) incrementally improves outcomes, many patients with ACS have persistent hypercholesterolemia after discharge from the hospital. This is a missed opportunity that prompted the Lipid Association of India to develop recommendations for earlier initiation of more aggressive LDL-C lowering treatment, particularly for patients of South Asian descent who are well-documented to have earlier onset of more aggressive atherosclerotic cardiovascular disease. The Lipid Association of India recommends individualized aggressive LDL-C goals after ACS, which can be rapidly achieved with high intensity statin therapy and subsequent goal-directed adjunctive treatment with ezetimibe and PCSK9 inhibitors. Improved treatment of hypercholesterolemia achieved within weeks after ACS has the potential to reduce the high rate of morbidity and mortality in these high risk patients.
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Affiliation(s)
- Raman Puri
- Indraprastha Apollo Hospitals, New Delhi, India.
| | - Vimal Mehta
- Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - P Barton Duell
- Knight Cardiovascular Institute & Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA
| | - S S Iyengar
- Department of Cardiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Jamal Yusuf
- Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Jamshad Dalal
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - S N Narasingan
- The Tamil Nadu Dr MGR Medical University and Managing Director, SNN Specialties Clinic, Chennai, Tamil Nadu, India
| | | | | | - Akshaya Pradhan
- Department of Cardiology King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | | | - Rajeev Aggarwal
- Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | | | - D Prabhakar
- Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Sadanand Shetty
- Head Department of Cardiology, K. J. Somaiya Super Speciality Institute, Sion (East), Mumbai, India
| | - Ravi R Kasliwal
- Division of Clinical and Preventive Cardiology, Medanta Hospital, Haryana, India
| | - Manish Bansal
- Department of Cardiology, Medanta Hospital Gurugram, Haryana, India
| | - N Khanna
- Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aziz Khan
- Crescent Hospital & Heart Centre, Nagpur, Maharashtra, India
| | | | - Soumitra Kumar
- Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | - Neil Bardoloi
- Cardiology, Excel Care Hospital, Guwahati, Assam, India
| | | | - Palaniappen Vinayagam
- Dr V. Palaniyappen Diabetes Specialties Centre and Sri Sakthi Vinayakar hospital, Tamil Nadu, India
| | - Ranjan Modi
- Indraprastha Apollo Hospitals, New Delhi, India
| | - Rashmi Nanda
- Cardiac Care Centre, South Extension, New Delhi, India
| | - Nathan D Wong
- Heart Disease Prevention Program Division of Cardiology, University of California Irvine, USA
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Burger AL, Pogran E, Muthspiel M, Kaufmann CC, Jäger B, Huber K. New Treatment Targets and Innovative Lipid-Lowering Therapies in Very-High-Risk Patients with Cardiovascular Disease. Biomedicines 2022; 10:biomedicines10050970. [PMID: 35625707 PMCID: PMC9138506 DOI: 10.3390/biomedicines10050970] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
The effective and fast reduction of circulating low-density lipoprotein cholesterol (LDL-C) is a cornerstone for secondary prevention of atherosclerotic disease progression. Despite the substantial lipid-lowering effects of the established treatment option with statins and ezetimibe, a significant proportion of very-high-risk patients with cardiovascular disease do not reach the recommended treatment goal of <55 mg/dL (<1.4 mmol/L). Novel lipid-lowering agents, including the proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies alirocumab and evolocumab, the small interfering ribonucleotide acid (si-RNA) inclisiran, as well as the recently approved bempedoic acid, now complete the current arsenal of LDL-C lowering agents. These innovative therapies have demonstrated promising results in clinical studies. Besides a strong reduction of LDL-C by use of highly effective agents, there is still discussion as to whether a very rapid achievement of the treatment goal should be a new strategic approach in lipid-lowering therapy. In this review, we summarize evidence for the lipid-modifying properties of these novel agents and their safety profiles, and discuss their potential pleiotropic effects beyond LDL-C reduction (if any) as well as their effects on clinical endpoints as cardiovascular mortality. In addition to a treatment strategy of “the lower, the better”, we also discuss the concept of “the earlier, the better”, which may also add to the early clinical benefit of large LDL-C reduction after an acute ischemic event.
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Affiliation(s)
- Achim Leo Burger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160 Vienna, Austria; (A.L.B.); (E.P.); (M.M.); (C.C.K.); (B.J.)
| | - Edita Pogran
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160 Vienna, Austria; (A.L.B.); (E.P.); (M.M.); (C.C.K.); (B.J.)
| | - Marie Muthspiel
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160 Vienna, Austria; (A.L.B.); (E.P.); (M.M.); (C.C.K.); (B.J.)
| | - Christoph Clemens Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160 Vienna, Austria; (A.L.B.); (E.P.); (M.M.); (C.C.K.); (B.J.)
| | - Bernhard Jäger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160 Vienna, Austria; (A.L.B.); (E.P.); (M.M.); (C.C.K.); (B.J.)
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160 Vienna, Austria; (A.L.B.); (E.P.); (M.M.); (C.C.K.); (B.J.)
- Medical School, Sigmund Freud University, 1020 Vienna, Austria
- Correspondence: ; Tel.: +43-1-49150-2301
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Annibali G, Scrocca I, Aranzulla TC, Meliga E, Maiellaro F, Musumeci G. "No-Reflow" Phenomenon: A Contemporary Review. J Clin Med 2022; 11:2233. [PMID: 35456326 PMCID: PMC9028464 DOI: 10.3390/jcm11082233] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/04/2022] Open
Abstract
Primary percutaneous angioplasty (pPCI), represents the reperfusion strategy of choice for patients with STEMI according to current international guidelines of the European Society of Cardiology. Coronary no-reflow is characterized by angiographic evidence of slow or no anterograde epicardial flow, resulting in inadequate myocardial perfusion in the absence of evidence of mechanical vessel obstruction. No reflow (NR) is related to a functional and structural alteration of the coronary microcirculation and we can list four main pathophysiological mechanisms: distal atherothrombotic embolization, ischemic damage, reperfusion injury, and individual susceptibility to microvascular damage. This review will provide a contemporary overview of the pathogenesis, diagnosis, and treatment of NR.
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Affiliation(s)
| | | | | | | | | | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano Umberto I, 10128 Turin, Italy; (G.A.); (I.S.); (T.C.A.); (E.M.); (F.M.)
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33
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Wykrzykowska JJ, Renkens MPL. Risk factor management and OCT characteristics of plaque vulnerability: the Holy Grail of plaque and patient vulnerability. Int J Cardiovasc Imaging 2022; 38:715-717. [PMID: 34258663 PMCID: PMC11130014 DOI: 10.1007/s10554-021-02320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
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Zheng Y, Reinhardt JD, Li J, Hu D, Lin S, Wang L, Dai R, Fan Z, Ding R, Chen L, Yuan L, Xu Z, Cheng Y, Yan C, Zhang X, Wang L, Zhang X, Teng M, Yu Q, Yin A, Lu X. Can Clinical and Functional Outcomes Be Improved with an Intelligent "Internet Plus"-Based Full Disease Cycle Remote Ischemic Conditioning Program in Acute ST-elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention? Rationale and Design of the i-RIC Trial. Cardiovasc Drugs Ther 2022; 36:45-57. [PMID: 32607820 DOI: 10.1007/s10557-020-07022-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute ST-elevation myocardial infarction (STEMI) is associated with a high incidence of complications as well as a considerable hospitalization rate and economic burden. Preliminary evidence suggests that remote ischemic conditioning (RIC) is a promising non-invasive intervention that may effectively and safely reduce myocardial infarct size, subsequent cardiac events and complications, and mortality. However, RIC's cardio-protective effect remains under debate, especially for single timepoint RIC programs. Adequately powered large-scale randomized controlled trials investigating clinical outcomes are thus needed to clarify the role of full disease cycle RIC programs. METHODS The intelligent "Internet Plus"-based full disease cycle remote ischemic conditioning (i-RIC) trial is a pragmatic, multicenter, randomized controlled, parallel group, clinical trial. The term, intelligent "Internet Plus"-based full disease cycle, refers to smart devices aided automatic and real-time monitoring of remote ischemic pre-, per- or post-conditioning intervention for patients with STEMI undergoing percutaneous coronary intervention (PCI). Based on this perspective, 4700 STEMI patients from five hospitals in China will be randomized to a control and an intervention group. The control group will receive PCI and usual care, including pharmacotherapy, before and after PCI. The intervention group will receive pre-, per-, and post-operative RIC combined with long-term i-RIC over a one-month period in addition. A smartphone application, an automated cuff inflation/deflation device and "Internet Plus"-based administration will be used in the long-term phase. The primary outcome is the combined cardiac death or hospitalization for heart failure rate. Secondary outcomes include clinical and functional outcomes: major adverse cardiac and cerebrovascular events rate, all-cause mortality, myocardial reinfarction rate, readmission rate for heart failure and ischemic stroke rate, unplanned revascularization rate, plasma concentration of myocardial infarction-related key biomarkers, infarct size, cardiac function, cardiopulmonary endurance, health-related quality of life, total hospital length of stay, total medical cost, and compliance with treatment regime. DISCUSSION The i-RIC trial is designed to test the hypothesis that clinical and functional outcomes can be improved with the i-RIC program in STEMI patients undergoing PCI. The concept of RIC is expected to be enhanced with this intelligent "Internet Plus"-based program focusing on the full disease cycle. If the i-RIC program results in superior improvement in primary and secondary outcomes, it will offer an innovative treatment option for STEMI patients and form the basis of future recommendations. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR2000031550, 04 April 2020.
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Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction of Sichuan University and Hongkong Polytechnic University, Chengdu, 610207, China
- Swiss Paraplegic Research, 6207, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6000, Lucerne, Switzerland
| | - Jianan Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Dayi Hu
- Heart Centre, Peking University People's Hospital, Beijing, 100000, China
| | - Song Lin
- Department of Cardiology, the Affiliated Nanjing First Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Liansheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ruozhu Dai
- Department of Cardiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Zhiqing Fan
- Department of Cardiology, Daqing Oilfield General Hospital, Daqing, 163001, China
| | - Rongjing Ding
- Heart Centre, Peking University People's Hospital, Beijing, 100000, China
| | - Leilei Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Liang Yuan
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zhihui Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yihui Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Chengjie Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
- Department of Neurorehabilitation, Kunshan Rehabilitation Hospital, Kunshan, 215300, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Lu Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meiling Teng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Qiuyu Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Aimei Yin
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China.
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Safitri N, Alaina MF, Pitaloka DAE, Abdulah R. A Narrative Review of Statin-Induced Rhabdomyolysis: Molecular Mechanism, Risk Factors, and Management. Drug Healthc Patient Saf 2021; 13:211-219. [PMID: 34795533 PMCID: PMC8593596 DOI: 10.2147/dhps.s333738] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022] Open
Abstract
Although statins are effective for treating hypercholesterolemia, they can have various side effects, including rhabdomyolysis, a potentially fatal condition. This review evaluated the incidence and underlying molecular mechanism of statin-induced rhabdomyolysis and analyzed its risk factors, prevention, and management. We focused on the clinical and randomized clinical trials of statin monotherapies and combinations with other drugs. The primary mechanism of statin therapy-induced rhabdomyolysis is believed to be a decrease in ubiquinone (coenzyme Q) produced by the HMG-CoA pathway. Additionally, different types of lipophilic and hydrophilic statins play a role in causing rhabdomyolysis. Although statin-induced rhabdomyolysis has a low incidence, there is no guarantee that patients will be free of this side effect. Rhabdomyolysis can be prevented by reducing the risk factors, such as using CYP3A4 inhibitors, using high-dose statins, and strenuous physical activities.
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Affiliation(s)
- Nisa Safitri
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia
| | - Maya Fadila Alaina
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia
| | - Dian Ayu Eka Pitaloka
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, 45363, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, 45363, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, 45363, Indonesia
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Sun C, Zheng W, Liang L, Liu Z, Sun W, Tang R. Ezetimibe Improves Rosuvastatin Effects on Inflammation and Vascular Endothelial Function in Acute Coronary Syndrome Patients Undergoing PCI. J Interv Cardiol 2021; 2021:2995602. [PMID: 34566523 PMCID: PMC8443370 DOI: 10.1155/2021/2995602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Little is known of the acute effects of ezetimibe in patients with acute coronary syndrome (ACS) undergoing PCI. We investigated whether ezetimibe improves inflammation and vascular endothelial function in patients with ACS undergoing PCI. METHODS We randomized 171 patients with ACS undergoing PCI to receive ezetimibe 10 mg/day plus rosuvastatin 20 mg/day (combination group, n = 81) versus rosuvastatin 20 mg/day (rosuvastatin group, n = 90). Lipid profile, type II secretory phospholipase A2 (sPLA2-IIa), interleukin-1β (IL-1β), vascular cell adhesion molecule-1 (VCAM-1), and intercellular cell adhesion molecule-1 (ICAM-1) were measured at baseline and after 7 days. Three months after PCI, clinical outcomes were examined. RESULT The levels of sPLA2-IIa and IL-1β reduced significantly in both groups, but more when ezetimibe and rosuvastatin were coadministered (sPLA2-IIa: 6.16 ± 2.67 vs. 7.42 ± 3.53 ng/ml, p=0.01; IL-1β: 37.39 ± 26.25 vs. 48.98 ± 32.26 pg/ml, p=0.01). A significant rise of VCAM-1 and ICAM-1 was observed on day 7 after PCI in the both groups, but was less in the combination group (VCAM-1: 918.28 ± 235.31 vs. 988.54 ± 194.41 ng/ml, p=0.03; ICAM-1: 213.01 ± 100.15 vs. 246.88 ± 105.71 ng/ml, p=0.03). Patients in the combination versus rosuvastatin group appeared to suffer from less major adverse events. Periprocedural therapy of ezetimibe improves rosuvastatin effects on proinflammatory responses and endothelial function associated with ACS patients undergoing PCI. This trial is registered with https://clinicaltrials.gov/ct2/show/ChiCTR-IPR-17012219 (Chinese Clinical Trial Registry, http://www.chictr.org.cn on 02/08/2017).
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Affiliation(s)
- Changqing Sun
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Wuyang Zheng
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Ling Liang
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Zuheng Liu
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Wenchao Sun
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Rong Tang
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
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Borovac JA, Leth-Olsen M, Kumric M, D'Amario D, Schwarz K, Glavas D, Bozic J. Efficacy of high-dose atorvastatin or rosuvastatin loading in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials with GRADE qualification of available evidence. Eur J Clin Pharmacol 2021; 78:111-126. [PMID: 34423376 DOI: 10.1007/s00228-021-03196-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE We aimed to summarize current evidence regarding the impact of a high-dose statin loading before percutaneous coronary intervention (PCI) on short-term outcomes in patients presenting with the acute coronary syndrome (ACS). METHODS This meta-analysis was based on a search of the MEDLINE, Cochrane Central Register of Controlled Trials, Ovid Journals, and SCOPUS for randomized controlled trials that compared high-dose atorvastatin or rosuvastatin with no or low-dose statin administered before planned PCI in statin-naive patients with ACS. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), and all-cause mortality at 30 days. Prespecified subanalyses were performed with respect to statin and ACS type. RESULTS A total of eleven trials enrolling 6291 patients were included, of which 75.4% received PCI. High-dose statin loading was associated with an overall 43% relative risk (RR) reduction in MACCE at 30 days (RR 0.57, 95% CI 0.41-0.77) in whole ACS population. This effect was primarily driven by the 39% reduction in the occurrence of MI (RR 0.61, 95% CI 0.46-0.80). No significant effect on all-cause mortality reduction was observed (RR 0.92, 95% CI 0.67-1.26). In the setting of ST-elevation myocardial infarction (STEMI), atorvastatin loading was associated with a 33% reduction in MACCE (RR 0.67, 95% CI 0.48-0.94), while in non-ST-elevation myocardial infarction ACS (NSTE-ACS), rosuvastatin loading was associated with 52% reduction in MACCE at 30 days (RR 0.48, 95% CI 0.34-0.66). The level of evidence as qualified with GRADE was low to high, depending on the outcome. CONCLUSION A high-dose loading of statins before PCI in patients with ACS reduces MACCE and reduces the risk of MI with no impact on mortality at 30 days. Atorvastatin reduces MACCE in STEMI while rosuvastatin reduces MACCE in NSTE-ACS at 30 days.
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Affiliation(s)
- Josip A Borovac
- Department of Pathophysiology, School of Medicine, University of Split, Split, Croatia. .,Clinic for Heart and Cardiovascular Diseases, University Hospital of Split (KBC Split), Split, Croatia.
| | - Mette Leth-Olsen
- Department of Pathophysiology, School of Medicine, University of Split, Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, School of Medicine, University of Split, Split, Croatia
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome, Italy
| | - Konstantin Schwarz
- Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St, Pölten, Krems, Austria
| | - Duska Glavas
- Clinic for Heart and Cardiovascular Diseases, University Hospital of Split (KBC Split), Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, School of Medicine, University of Split, Split, Croatia
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Song JW, Nam HS, Ahn JW, Park HS, Kang DO, Kim HJ, Kim YH, Han J, Choi JY, Lee SY, Kim S, Oh WY, Yoo H, Park K, Kim JW. Macrophage targeted theranostic strategy for accurate detection and rapid stabilization of the inflamed high-risk plaque. Theranostics 2021; 11:8874-8893. [PMID: 34522216 PMCID: PMC8419038 DOI: 10.7150/thno.59759] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
Rationale: Inflammation plays a pivotal role in the pathogenesis of the acute coronary syndrome. Detecting plaques with high inflammatory activity and specifically treating those lesions can be crucial to prevent life-threatening cardiovascular events. Methods: Here, we developed a macrophage mannose receptor (MMR)-targeted theranostic nanodrug (mannose-polyethylene glycol-glycol chitosan-deoxycholic acid-cyanine 7-lobeglitazone; MMR-Lobe-Cy) designed to identify inflammatory activity as well as to deliver peroxisome proliferator-activated gamma (PPARγ) agonist, lobeglitazone, specifically to high-risk plaques based on the high mannose receptor specificity. The MMR-Lobe-Cy was intravenously injected into balloon-injured atheromatous rabbits and serial in vivo optical coherence tomography (OCT)-near-infrared fluorescence (NIRF) structural-molecular imaging was performed. Results: One week after MMR-Lobe-Cy administration, the inflammatory NIRF signals in the plaques notably decreased compared to the baseline whereas the signals in saline controls even increased over time. In accordance with in vivo imaging findings, ex vivo NIRF signals on fluorescence reflectance imaging (FRI) and plaque inflammation by immunostainings significantly decreased compared to oral lobeglitazone group or saline controls. The anti-inflammatory effect of MMR-Lobe-Cy was mediated by inhibition of TLR4/NF-κB pathway. Furthermore, acute resolution of inflammation altered the inflamed plaque into a stable phenotype with less macrophages and collagen-rich matrix. Conclusion: Macrophage targeted PPARγ activator labeled with NIRF rapidly stabilized the inflamed plaques in coronary sized artery, which could be quantitatively assessed using intravascular OCT-NIRF imaging. This novel theranostic approach provides a promising theranostic strategy for high-risk coronary plaques.
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Affiliation(s)
- Joon Woo Song
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Hyeong Soo Nam
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jae Won Ahn
- Department of Systems Biotechnology, Chung-Ang University, Anseong, South Korea
| | - Hyun-Sang Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Dong Oh Kang
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Hyun Jung Kim
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Yeon Hoon Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jeongmoo Han
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jah Yeon Choi
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Yul Lee
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Sunwon Kim
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Wang-Yuhl Oh
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hongki Yoo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Kyeongsoon Park
- Department of Systems Biotechnology, Chung-Ang University, Anseong, South Korea
| | - Jin Won Kim
- Multimodal Imaging and Theranostic Lab., Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
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Gencer B, Mach F. PCSK9 inhibition could be effective for acute myocardial infarction. Curr Med Chem 2021; 29:1016-1026. [PMID: 34348606 DOI: 10.2174/0929867328666210804091003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
In this review, we will explore the role of PCSK9 and inhibition of PCSK9 in patients after acute myocardial infarction (MI). Despite the implementation of evidence-based therapies to improve outcomes, mortality at one-year remains at 12-15% and the need to further reduce complications related to MI persists. Mechanistic and epidemiologic studies suggest that the naturally occurring PCSK9 protein increases coronary plaque vulnerability through several pathways, including pro-inflammatory LDL-C oxidation and direct modification of plaque composition. PCSK9 inhibitors are a class of drugs with proven efficacy in patients with recent MI. The latest guidelines recommend the use of PCSK9 in patients with recent MI early in the process of care to reduce LDL-C values and associated morbidity. The use of PCSK9 inhibition could be beneficial for mortality reduction after an acute MI and should be tested in an appropriately powered randomized controlled trial.
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Affiliation(s)
- Baris Gencer
- Cardiology Division, Geneva University Hospitals. Switzerland
| | - François Mach
- Cardiology Division, Geneva University Hospitals. Switzerland
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Effects of atorvastatin doses on serum level of procalcitonin and predictors for major adverse cardiovascular events in patients with acute myocardial infarction: a pilot study and post hoc analysis. Coron Artery Dis 2021; 31:e87-e93. [PMID: 34292180 DOI: 10.1097/mca.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammation plays an important role in acute myocardial infarction (AMI). Procalcitonin levels rise in response to proinflammatory stimuli. This study aimed to investigate the effects of different doses of atorvastatin on the serum inflammatory profiles, especially procalcitonin and major adverse cardiovascular events (MACEs) in patients with AMI during hospitalization. METHODS The patients who were admitted to the Coronary Care Unit of The Third Medical Center of PLA General Hospital (Beijing, China) between January 2015 and December 2015 with a diagnosis of AMI were enrolled, and randomized to atorvastatin 20 mg/day postoperatively (20-mg group), 40 mg/day postoperatively (40-mg group) and 80 mg preoperatively+40 mg/day postoperatively (80/40-mg group). Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) were evaluated before and at 1 and 3 days after percutaneous coronary intervention (PCI). RESULTS A total of 112 patients with AMI (23 women and 89 men) were prospectively eligible for the study. There were no significant differences in most clinical data among the three groups. The 80/40-mg group showed significantly reduced serum procalcitonin levels at 1 and 3 days after PCI (P < 0.001) and reduced hs-CRP levels at 3 days P = 0.001) compared with 20-mg and 40-mg groups. Serum procalcitonin (OR, 4.593; 95% CI, 1.476-8.387; P = 0.005), hs-CRP (OR, 1.149; 95% CI, 1.012-1.338; P = 0.018), highly sensitive cardiac troponin T (OR, 1.255; 95% CI, 1.004-1.569, P = 0.009) and Gensini score (OR, 1.022; 95% CI, 1.045-1.062; P = 0.013) were independently associated with MACEs during hospitalization. CONCLUSION The use of atorvastatin 80 mg before and 40 mg/day after PCI in patients with AMI can effectively reduce serum inflammatory factors. procalcitonin and hs-CRP were independently associated with in-hospital MACEs.
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Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy. J Clin Med 2021; 10:jcm10132968. [PMID: 34279451 PMCID: PMC8268641 DOI: 10.3390/jcm10132968] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 02/06/2023] Open
Abstract
The significant reduction in ‘ischemic time’ through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis.
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHDM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFDO, Santos ECL, Piegas LS, Soeiro ADM, Negri AJDA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLDAA, Sena JP, Peixoto JM, Souza JAD, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LADO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MTD, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RDSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VDMG, Chalela WA, Mathias Júnior W. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021. Arq Bras Cardiol 2021; 117:181-264. [PMID: 34320090 PMCID: PMC8294740 DOI: 10.36660/abc.20210180] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Gilson Soares Feitosa Filho
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Centro Universitário de Tecnologia e Ciência (UniFTC), Salvador, BA - Brasil
| | - João Luiz Petriz
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
| | | | | | - Walmor Lemke
- Clínica Cardiocare, Curitiba, PR - Brasil
- Hospital das Nações, Curitiba, PR - Brasil
| | | | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - José A Marin Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | | | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCor), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Felipe Gallego Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brasil
| | - Juliana Ascenção de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Lilia Nigro Maia
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
| | | | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luís Alberto de Oliveira Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luis Augusto Palma Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Bueno da Silva Rivas
- Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Múcio Tavares de Oliveira Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, BA - Brasil
- Universidade Salvador (UNIFACS), Salvador, BA - Brasil
- Hospital EMEC, Salvador, BA - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Otávio Rizzi Coelho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | - Paulo Rogério Soares
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Talia Falcão Dalçóquio
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - William Azem Chalela
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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Beyerle A, Greene B, Dietrich B, Kingwell BA, Panjwani P, Wright SD, Herzog E. Co-administration of CSL112 (apolipoprotein A-I [human]) with atorvastatin and alirocumab is not associated with increased hepatotoxic or toxicokinetic effects in rats. Toxicol Appl Pharmacol 2021; 422:115557. [PMID: 33932462 DOI: 10.1016/j.taap.2021.115557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
CSL112 (apolipoprotein A-I, apo AI [human]) is an investigational drug in Phase 3 development for risk reduction of early recurrent cardiovascular events following an acute myocardial infarction (AMI). Although CSL112 is known to be well tolerated with a regimen of four weekly 6 g intravenous infusions after AMI, high doses of reconstituted apo AI preparations can transiently elevate liver enzymes in rats, raising the possibility of additive liver toxicity and toxicokinetic (TK) effects upon co-administration with cholesterol-lowering drugs, i.e., HMG-CoA reductase and proprotein convertase subtilisin/kexin type 9 inhibitors. We performed a toxicity and TK study in CD rats assigned to eleven treatment groups, including two dose levels of intravenous (IV) CSL112 (140 mg/kg, low-dose; 600 mg/kg, high-dose) administered as a single dose, alone or with intravenous alirocumab 50 mg/kg/week and/or oral atorvastatin 10 mg/kg/day. In addition, control groups of atorvastatin and alirocumab alone and in combination were investigated. Results showed some liver enzyme elevations (remaining <2-fold of baseline) related to administration of CSL112 alone. There was limited evidence of an additive effect of CSL112 on liver enzymes when combined, at either dose level, with alirocumab and/or atorvastatin, and histology revealed no evidence of an increased incidence or severity of hepatocyte vacuolation compared to the control treatments. Co-administration of the study drugs had minimal effect on their respective exposure levels, and on levels of total cholesterol and high-density lipoprotein cholesterol. These data support concomitant use of CSL112 with alirocumab and/or atorvastatin with no anticipated negative impact on liver safety and TK.
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Affiliation(s)
- Andrea Beyerle
- CSL Behring GmbH, Marburg, Emil-von-Behring-Str. 76, 35041 Marburg, Germany.
| | - Brandon Greene
- CSL Behring GmbH, Marburg, Emil-von-Behring-Str. 76, 35041 Marburg, Germany.
| | - Barbara Dietrich
- CSL Behring GmbH, Walcherstraße 1A/Stiege 1, 1020 Vienna, Austria.
| | | | - Priya Panjwani
- CSL Behring GmbH, Marburg, Emil-von-Behring-Str. 76, 35041 Marburg, Germany.
| | - Samuel D Wright
- CSL Behring LLC, 1020 1st Ave, King of Prussia, PA 19406, USA
| | - Eva Herzog
- CSL Behring LLC, 1020 1st Ave, King of Prussia, PA 19406, USA.
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Liu J, Zhang B, Chen M, Zheng B. High-dose statin pretreatment decreases periprocedural myocardial infarction and cardiovascular events in East Asian patients undergoing percutaneous coronary intervention: A meta-analysis of fifteen randomized controlled trials. Medicine (Baltimore) 2021; 100:e26278. [PMID: 34160392 PMCID: PMC8238325 DOI: 10.1097/md.0000000000026278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/18/2020] [Accepted: 05/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Numerous studies have shown that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and short-term major adverse cardiac events (MACE) in western people undergoing percutaneous coronary intervention (PCI). However, the effects in East Asian patients are still controversial. The objective was to evaluate the effects of short-term high-dose statin (all types) pretreatment compared with the control (low-dose or no statin) on the reduction of the rate of MACE and PMI in East Asian patients. METHODS PubMed/Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) in East Asian patients up to December 2019, in which short-term high-dose statin pretreatment was compared with control for patients undergoing PCI. The primary outcome measure was the incidence of MACE at 30 days. The secondary outcome measure was the incidence of PMI. The meta-analysis was performed with the fixed-effect model or random-effects model according to the heterogeneity. The meta-analysis was performed using RevMan 5.3 software (Cochrane Collaboration). RESULTS Fifteen RCTs that enrolled 4313 East Asian patients were identified. High-dose statin pretreatment was associated with a 54% relative reduction in 30-day MACE (OR, 0.46; 95% CI, 0.31-0.67; P < .001) and a 50% relative reduction in PMI (OR, 0.50; 95% CI, 0.34-0.76; P = .001). CONCLUSIONS High-dose statin pretreatment can significantly reduce 30-day MACE and PMI for East Asian patients undergoing PCI.
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Jin S, Nie X, Li Y, Yuan J, Cui Y, Zhao L. Effect of More Intensive LDL-C-Lowering Therapy on Long-term Cardiovascular Outcomes in Early-Phase Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Clin Ther 2021; 43:e217-e229. [PMID: 34092409 DOI: 10.1016/j.clinthera.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The effect of more intensive LDL-C-lowering therapy (ILLT) on long-term cardiovascular outcomes during the early phase of acute coronary syndromes (ACSs) remains uncertain. We aimed to explore the influence of more intensive LDL-C-lowering therapyduring the early disease phase on long-term cardiovascular events among patients with ACSs. METHODS Randomized controlled trials that focused on the effect of more ILLT during early-phase ACSs on long-term major adverse cardiac events (MACEs) were searched in electronic databases (MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases) from database inception until November 23, 2019. The end points included the incidence of MACEs, myocardial infarction, stroke, revascularization, heart failure, and death events. Study risk of bias was assessed using the Cochrane Collaboration tools. Fixed- or random-effects models and meta-regression were performed to evaluate the association between baseline/proportional reduction of LDL-C levels during early-phase disease and the risk of end points using risk ratios with 95% CIs. FINDINGS A total of 53,199 participants were involved from 19 studies. The risk of MACEs decreased by 17% (95% CI, 0.76-0.90; P = 0.0012) for more intensive versus control therapy but varied by baseline and proportional reduction of LDL-C levels during early disease phase. The risk reduction of MACEs for more intensive versus control therapy among different subgroups was 26% (95% CI, 0.57-0.95; P = 0.06) with a baseline level >130 mg/dL, 23% (95% CI, 0.63-0.94; P = 0.02) with a baseline level of 100 to 130 mg/dL, and 10% (95% CI, 0.83-0.99; P = 0.07) with a baseline level <100 mg/dL. A significant difference of risk reduction for MACEs existed between patients treated with statin plus ezetimibe versus statin alone in the subgroup with a baseline level >130 mg/dL and proportional reduction >50%. Patients treated with more intensive therapy benefited from reduced risk of myocardial infarction, stroke, revascularization, and heart failure compared with control therapy. IMPLICATIONS More ILLT during early disease phase could significantly reduce the risk of long-term cardiovascular outcome in patients with ACSs. This benefit was most pronounced in patients with higher baseline and larger reduction of LDL-C levels in MACEs.
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Affiliation(s)
- Siyao Jin
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Department of Clinical Pharmacy, College of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Xiaolu Nie
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yuxi Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jinjie Yuan
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yimin Cui
- Department of Cardiology, Peking University First Hospital, Beijing, China.
| | - Libo Zhao
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Xue Y, Shen J, Hong W, Zhou W, Xiang Z, Zhu Y, Huang C, Luo S. Risk stratification of ST-segment elevation myocardial infarction (STEMI) patients using machine learning based on lipid profiles. Lipids Health Dis 2021; 20:48. [PMID: 33957898 PMCID: PMC8101132 DOI: 10.1186/s12944-021-01475-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Numerous studies have revealed the relationship between lipid expression and increased cardiovascular risk in ST-segment elevation myocardial infarction (STEMI) patients. Nevertheless, few investigations have focused on the risk stratification of STEMI patients using machine learning algorithms. METHODS A total of 1355 STEMI patients who underwent percutaneous coronary intervention were enrolled in this study during 2015-2018. Unsupervised machine learning (consensus clustering) was applied to the present cohort to classify patients into different lipid expression phenogroups, without the guidance of clinical outcomes. Kaplan-Meier curves were implemented to show prognosis during a 904-day median follow-up (interquartile range: 587-1316). In the adjusted Cox model, the association of cluster membership with all adverse events including all-cause mortality, all-cause rehospitalization, and cardiac rehospitalization was evaluated. RESULTS All patients were classified into three phenogroups, 1, 2, and 3. Patients in phenogroup 1 with the highest Lp(a) and the lowest HDL-C and apoA1 were recognized as the statin-modified cardiovascular risk group. Patients in phenogroup 2 had the highest HDL-C and apoA1 and the lowest TG, TC, LDL-C and apoB. Conversely, patients in phenogroup 3 had the highest TG, TC, LDL-C and apoB and the lowest Lp(a). Additionally, phenogroup 1 had the worst prognosis. Furthermore, a multivariate Cox analysis revealed that patients in phenogroup 1 were at significantly higher risk for all adverse outcomes. CONCLUSION Machine learning-based cluster analysis indicated that STEMI patients with increased concentrations of Lp(a) and decreased concentrations of HDL-C and apoA1 are likely to have adverse clinical outcomes due to statin-modified cardiovascular risks. TRIAL REGISTRATION ChiCTR1900028516 ( http://www.chictr.org.cn/index.aspx ).
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Affiliation(s)
- Yuzhou Xue
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jian Shen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Weifeng Hong
- Department of Medical Imaging, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Wei Zhou
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhenxian Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuansong Zhu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Chuiguo Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Abstract
Although technological and procedural advances have resulted in substantial improvements in clinical outcomes following percutaneous coronary interventions (PCI), recurrent coronary events may occur despite achieving optimal procedural results. Beyond myocardial revascularisation failure related to anatomical or stent-related factors, adverse cardiovascular events post PCI often arise from non-culprit lesions not treated during index interventions. While stenting treats a focal manifestation of a systemic, progressive disease, the residual risk following an acute coronary syndrome (ACS) or elective PCI is largely related to the systemic pro-atherogenic effects of suboptimally controlled cardiovascular risk factors. Lowering atherogenic lipid levels, in particular low-density lipoprotein cholesterol (LDL-C), can halt the progression of coronary atherosclerosis and improve cardiovascular outcomes to an extent that is proportional to the magnitude of LDL-C reduction. Early (in-hospital) initiation of intensive statin therapy leads to a very early clinical benefit following ACS, and prolonged adherence to optimised lipid-lowering treatment effectively reduces longer-term cardiovascular events following PCI. Therefore, achieving guideline-recommended treatment goals for LDL-C with statins and, if indicated, with the addition of non-statin lipid-lowering drugs should become a priority for all physicians involved in the treatment of patients with coronary heart disease, including comprehensive strategies initiated during the in-hospital care of patients undergoing coronary interventions. This review article summarises current evidence on the role of LDL-C in the development and progression of coronary atherosclerosis, discusses the clinical benefits of intensive lipid-lowering treatments, and presents current guideline recommendations, with emphasis on patients undergoing PCI.
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Liu J, Zhong Z, Ou S, Peng K. Application effect of evidence-based nursing in perioperative period of acute coronary syndrome. Am J Transl Res 2021; 13:2653-2661. [PMID: 34017425 PMCID: PMC8129314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of evidence-based nursing on anxiety and depression, sleep quality and life quality of patients with acute coronary syndrome during perioperative period of percutaneous coronary intervention. METHOD 113 patients with acute coronary syndrome treated with percutaneous coronary intervention in our hospital from November 2016 to June 2019 were collected and randomly divided into group A and group B. Among them, 58 cases in group A were given routine nursing care, another 55 cases in group B were given evidence-based nursing on the basis of group A. The left ventricular ejection fraction (EF) and left ventricular end diastolic diameter (LVEDD), VAS pain score index, anxiety and depression after nursing intervention were observed in groups A and B. The improvement of sleep quality (Pittsburgh Sleep Quality Index (PSQI)), the incidence of adverse reactions, nursing satisfaction (with the total score of 10 points for each item, the higher score indicates the higher satisfaction), coronary self-management scale (CSMS) were recorded so as to evaluate self-management ability and quality of life after nursing. RESULTS After nursing, the indicators of heart function, VAS score, anxiety, depression, sleep quality, incidence of adverse reactions, nursing satisfaction, self-management score and quality of life in Group B showed better results compared with Group A (P < 0.05). CONCLUSION Evidence-based nursing can alleviate anxiety and depression of patients with acute coronary syndrome during perioperative period of percutaneous coronary intervention and improve the quality of life.
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Affiliation(s)
- Juan Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of University of South China Hengyang 421001, Hunan Province, China
| | - Zhen Zhong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of University of South China Hengyang 421001, Hunan Province, China
| | - Shuyan Ou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of University of South China Hengyang 421001, Hunan Province, China
| | - Kuang Peng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of University of South China Hengyang 421001, Hunan Province, China
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Chu X, Wang R, Song G, Jiang X. Predictive value of inflammatory factors on coronary restenosis after percutaneous coronary intervention in patients with coronary heart disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25356. [PMID: 33787637 PMCID: PMC8021324 DOI: 10.1097/md.0000000000025356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence reveals that inflammatory factors can predict coronary restenosis in patients suffering from coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Perhaps, inflammatory factors are promising biomarkers for the diagnosis of coronary restenosis after PCI. However, the accuracy of inflammatory factors has not been systematically evaluated. Therefore, it is necessary to perform a meta-analysis to certify the diagnostic values of inflammatory factors on coronary restenosis after PCI. METHODS China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine disc (CBM), PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies to explore the potential diagnostic values of inflammatory factors on coronary restenosis after PCI from inception to January 2021. All data were extracted by 2 experienced researchers independently. The risk of bias about the meta-analysis was confirmed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The data extracted were synthesized and heterogeneity was investigated as well. All of the above statistical analyses were carried out with Stata 16.0. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study clarified confusions about the specificity and sensitivity of inflammatory factors on coronary restenosis after PCI, thus further guiding their promotion and application. ETHICS AND DISSEMINATION Ethical approval will not be necessary since this systematic review and meta-analysis will not contain any private information of participants or violate their human rights. TRIAL REGISTRATION NUMBER DOI 10.17605/OSF.IO/N28JX.
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Affiliation(s)
| | | | | | - Xiaohan Jiang
- Department of Medical Genetics and Prenatal Diagnosis, Hospital Affiliated 5 to Nantong University, Taizhou People's Hospital, Taizhou 225300, Jiangsu province, China
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Safety and Efficacy of Perioperative Use of Evolocumab in Myocardial Infarction Patients: Study Protocol for a Multicentre Randomized Controlled Trial. Adv Ther 2021; 38:1801-1810. [PMID: 33638801 DOI: 10.1007/s12325-021-01662-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/10/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The SECURE-PCI study supports a perioperative loading dose of statins, although whether an intensive lipid-lowering strategy prior to percutaneous coronary intervention further benefits acute coronary syndrome patients remains controversial. Evolocumab, a proprotein-converting enzyme subtilisin/kexin type 9 (PCSK9) inhibitor, acts more quickly and effectively than statins and reduces the risk of cardiovascular events in post-myocardial infarction (MI) patients. Nonetheless, whether it can be safely used in perioperative MI patients and whether perioperative application can benefit patients are still unknown. This study aims to evaluate the safety and efficacy of this treatment regimen. METHODS A multicentre, prospective, randomized, controlled superiority trial will be conducted in 530 statin-naïve MI patients. All eligible patients will be randomized to the evolocumab group (140 mg subcutaneously injected once before revascularization + 14 days after the first dose) or the control group (no evolocumab injection). Evolocumab will then be administered depending on the patient's lipid profile. Both groups will be treated simultaneously with standardized secondary preventive medications. The primary end points are major adverse cardiovascular events (a composite of death, recurrent MI, unanticipated revascularization, stroke and any rehospitalization for ischaemic causes) within 12 months. The secondary end point is post-infarction angina after pain relief. The safety end points include myopathy, impaired liver or renal function, and other adverse events during the follow-up period. OUTCOMES This is the first trial to evaluate the safety and efficacy of evolocumab pre-treatment on prognosis in MI patients. Perioperative evolocumab injection may be a new, safe way to improve prognosis. TRIAL REGISTRATION Chinese Clinical Trial Registry ( http://www.chictr.org.cn ; ChiCTR1900024526). Registered on 13 July 2019 and updated on 31 May 2020. The study is currently recruiting patients.
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