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Saura E, Anttila V, Gunn J, Kytö V. Short- and long-term outcomes of ST-segment elevation myocardial infarction treated with CABG: a population-based cohort study. BMJ Open 2025; 15:e089451. [PMID: 40374230 PMCID: PMC12083355 DOI: 10.1136/bmjopen-2024-089451] [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: 05/30/2024] [Accepted: 03/28/2025] [Indexed: 05/17/2025] Open
Abstract
OBJECTIVES To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery. DESIGN Retrospective nationwide cohort study. SETTING Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018. PARTICIPANTS 1069 patients (mean age: 66.4, 21.4% women). PRIMARY OUTCOME MEASURE All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG. RESULTS In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p<0.0001) during the study period. Cumulative 10-year mortality was 38.3%. Age, diabetes, renal disease, early surgery, usage of only venous grafts and concomitant procedures were associated with in-hospital mortality in multivariable modelling. Age, cerebrovascular disease, diabetes, heart failure, peripheral vascular disease, rheumatic disease and venous-only grafts were associated with 10-year mortality. Statins and beta blockers were used by >90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004-2008 to 63.1% in 2014-2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study. CONCLUSIONS Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.
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Affiliation(s)
- Emmi Saura
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Department of Surgery, University of Turku, Turku, Varsinais-Suomi, Finland
| | - Vesa Anttila
- Department of Surgery, University of Turku, Turku, Varsinais-Suomi, Finland
- Heart Centre, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Jarmo Gunn
- Department of Surgery, University of Turku, Turku, Varsinais-Suomi, Finland
- TYKS Acute, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Ville Kytö
- Heart Centre, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
- Cardiology, University of Turku, Turku, Varsinais-Suomi, Finland
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Lippi G, Lavie CJ, Sanchis-Gomar F. Detecting cardiac injury: the next generation of high-sensitivity cardiac troponins improving diagnostic outcomes. Clin Chem Lab Med 2025:cclm-2025-0418. [PMID: 40319385 DOI: 10.1515/cclm-2025-0418] [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: 04/03/2025] [Accepted: 04/28/2025] [Indexed: 05/07/2025]
Abstract
Cardiac injury, encompassing a spectrum of heart muscle damage, requires prompt and accurate diagnosis to improve patient outcomes. Early detection using cardiac biomarkers is vital for timely intervention and reducing mortality. This review highlights the role of high-sensitivity cardiac troponins (hs-cTns) in diagnosing cardiac injury. This article offers an overview of cardiac injury, including its causes, diagnostic challenges, and the evolution of biomarkers, up to the development and commercialization of "high-sensitivity" (hs-) cTns. The molecular structure of cardiac isoforms cTnI and cTnT, release kinetics, guidelines incorporation, diagnostic performance, and clinical application will be analyzed. It is concluded that the advent of hs-cTn assays has further expanded diagnostic capabilities by enabling the detection of low-level cTn elevations, which were previously undetectable using conventional methods. This enhanced sensitivity allows earlier identification of even minor cardiac injuries, facilitating prompt intervention and improving patient outcomes. However, this increased sensitivity also introduces interpretive challenges in understanding the nature of cardiac involvement, especially in distinguishing mild cTn elevations that may signify non-ischemic cardiac injury or be associated with other non-cardiac conditions.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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3
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Abdelaziz A, Elsayed H, Atta K, Desouky M, Gomaa M, Kadhim H, Mechi A, Abdelaziz M, Ezzat M, Mabrouk MA, Ellabban MH, Zawaneh EA, Hafez A, Elnaggar MY, Sena AO, Bahnasy A, Singer E. Drug-coated balloons versus drug-eluting stents in patients with small coronary artery disease: an updated meta-analysis. BMC Cardiovasc Disord 2025; 25:339. [PMID: 40301731 PMCID: PMC12042378 DOI: 10.1186/s12872-024-04426-5] [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: 09/19/2024] [Accepted: 12/16/2024] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND Drug-coated balloons (DCB) have promising results in the management of large coronary artery lesions (CAD), still their role in treating small CAD is not well established. We aimed to provide a comprehensive appraisal of the efficacy and safety of DCBs in patients with small CAD. METHODS We searched PubMed, Scopus, web of science, Ovid, and Cochrane Central from inception until 30 March, 2023. We included all relevant studies that compared DCB versus drug-eluting stents (DES) in small CAD patients undergoing PCI. We reported clinical outcomes as MACE, all-cause death, cardiac death, MI, TLR, TVR, and stent thrombosis, while angiographic outcomes were late lumen loss (LLL), mean lumen diameter (MLD), net luminal gain (NLG), and in-segment binary restenosis. RESULTS Twenty studies comprising 18,469 patients were included in this meta-analysis. The incidence rate of MACE was 9.4% in the DCB group compared to 9.9% in the DES group, without a significant difference in the risk of MACE (OR = 0.97, 95% CI: 0.77 to 1.22, p = 0.78). Moreover, DCB significantly decreased MLD and NLG compared to DES, with the following values, respectively (MD= -0.19, 95% CI: -0.32 to -0.06, p < 0.001, and MD -0.21, 95% CI: -0.40 to -0.01, p = 0.04). On the other hand, DCB was associated with higher odds in the risk of in-segment binary restenosis (OR 1.66, 95% CI: 1.03 to 2.68, p = 0.04). CONCLUSION DCB is an alternative approach to DES in the management of small CAD and should be validated in daily clinical practice. PROSPERO REGISTRATION CRD42023413068.
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Affiliation(s)
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Karim Atta
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | | | - Mahmoud Gomaa
- Faculty of Medicine Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Hallas Kadhim
- Al Muthanna University College of Medicine, Samawah, Iraq
| | - Ahmed Mechi
- Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq
| | - Mohamed Abdelaziz
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Mahmoud Ezzat
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Manar Alaa Mabrouk
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed Hatem Ellabban
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Emad Addin Zawaneh
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Jordan University of Science and Technology, Ar-Ramtha, Jordan
| | - Abdelrahman Hafez
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | | | - Ahmed O Sena
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Bahnasy
- Hematology and Oncology Department, Mayo Clinic, Scottsdale, AZ, USA
| | - Emad Singer
- University of Texas MD Anderson, Houston, TX, USA
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QIAO Z, LIN ZY, LIU QQ, ZHANG R, GUAN CD, YUAN S, ZOU TQ, BIAN XH, XIE LH, ZHU CG, WANG HY, GAO GF, DOU KF. Prognostic value of quantitative flow ratio measured immediately after percutaneous coronary intervention for chronic total occlusion. J Geriatr Cardiol 2025; 22:433-442. [PMID: 40352156 PMCID: PMC12060140 DOI: 10.26599/1671-5411.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined. METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA III trial were retrospectively measured for post-PCI QFR. The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs, composite of target vessel-related cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization). Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs, and all vessels were stratified by this optimal cutoff value. Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI. RESULTS Among 428 CTO vessels treated with PCI, 353 vessels (82.5%) were analyzable for post-PCI QFR. 31 VOCEs (8.7%) occurred at 2 years. Mean value of post-PCI QFR was 0.92 ± 0.13. Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91. The incidence of 2-year VOCEs in the vessel with post-PCI QFR < 0.91 (n = 91) was significantly higher compared with the vessels with post-PCI QFR ≥ 0.91 (n = 262) (22.0% vs. 4.2%, HR = 4.98, 95% CI: 2.32-10.70). CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO. Achieving functionally optimal PCI results (post-PCI QFR value ≥ 0.91) tends to get better prognosis for patients with CTO lesions.
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Affiliation(s)
- Zheng QIAO
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhang-Yu LIN
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian-Qian LIU
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui ZHANG
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang-Dong GUAN
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng YUAN
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong-Qiang ZOU
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Hui BIAN
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Hua XIE
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Gang ZHU
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao-Yu WANG
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guo-Feng GAO
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke-Fei DOU
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
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Li C, Liu X, Lv X, Zhou W, Fan G, Zhu F. The application of the triglyceride-glucose-body mass index (TyG-BMI) in predicting acute kidney injury in diabetic patients following coronary artery bypass grafting surgery. J Cardiothorac Surg 2025; 20:221. [PMID: 40281638 PMCID: PMC12023640 DOI: 10.1186/s13019-025-03455-1] [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] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND The triglyceride-glucose-body mass index (TyG-BMI), a marker for insulin resistance, is recognized for its predictive role in cardiovascular and metabolic diseases, including kidney disease. we explored the TyG-BMI index's association with postoperative kidney injury in coronary artery bypass grafting (CABG) patients, who are at an elevated risk for such complications, underscoring its potential as a predictor for acute kidney injury (AKI). METHODS This single-center, retrospective study included 126 patients. Patients were divided into AKI and non-AKI groups postoperatively according to the KDIGO classification criteria. Univariate logistic regression was used to screen for variables with significant differences (P < 0.01), and multiple multivariate regression models were constructed to analyze independent risk factors in the multivariate regression model and to analyze the value of TyG-BMI in predicting AKI in diabetic patients after CABG. RESULTS Compared to the non-AKI group, the AKI group had statistically significant differences in preoperative fasting triglycerides, preoperative fasting glucose, preoperative and postoperative creatinine levels, ICU stay duration, and TyG-BMI levels (P < 0.05). Based on the results of univariate regression analysis, a multivariate logistic regression model A was constructed using all significant variables, and a multivariate logistic regression model 2 was constructed using significant variables other than TyG-BMI. ROC analysis showed that model 2 had better predictive performance than model 1 (AUC = 0.836 vs. 0.766). A positive correlation was observed between TyG-BMI and AKI occurrence (Spearman's correlation coefficient: R = 0.33, P = 0.00019). CONCLUSION Elevated TyG-BMI levels are closely associated with AKI in diabetic patients after CABG. TyG-BMI has potentially predictive value for AKI in diabetic patients after CABG and may play a crucial role in risk stratification in clinical practice.
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Affiliation(s)
- Chen Li
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Xiaobin Liu
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Xingping Lv
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Wei Zhou
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Guoliang Fan
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Feng Zhu
- Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
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Tantawy M, Saad M, Hussien S, Selim G, Tamara A. Predilation in Primary Percutaneous Coronary Intervention. Interv Cardiol 2025; 20:e15. [PMID: 40342566 PMCID: PMC12060174 DOI: 10.15420/icr.2024.12] [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: 04/02/2024] [Accepted: 09/22/2024] [Indexed: 05/11/2025] Open
Abstract
Background In primary percutaneous coronary intervention (pPCI), balloon predilation is frequently carried out before stenting but there is a lack of data regarding optimal balloon size and the effect of balloon size on procedural and clinical outcomes. Aims This study compares small balloon predilation (≤50% of proximal vessel diameter) with large balloon predilation (>50% of proximal vessel diameter) in pPCI. Methods This multicentre prospective observational study included consecutive ST elevation MI (STEMI) patients undergoing pPCI at three tertiary centres in Egypt. Demographic, clinical and angiographic data were collected for all the patients. The primary outcome was the presence of no reflow at the conclusion of the procedure and secondary outcomes included procedural complications - no reflow, dissection, abrupt vessel closure, fluoroscopy time and procedural time - and clinical outcomes - in-hospital left ventricular ejection fraction (LVEF), cardiogenic shock, stent thrombosis, ventricular fibrillation, stroke, death, ST-segment resolution >50% 1 hour after PCI and LVEF at discharge. Results A total of 384 pPCI procedures were included. The small balloon group (n=222) and the large balloon group (n=162) were comparable in terms of baseline characteristics. The large balloon group had a significantly higher incidence of no reflow (n=23 [14.2%] versus n=6 [2.7%], p<0.001), procedural complications: n=31 [19.4%] versus n=10 [4.5%], p<0.001) and contrast volume (190.4 ± 40.2 ml versus 177.4 ± 29.4 ml, p=0.0003) compared to the small balloon group. ST-segment resolution >50% after PCI was more frequent in the small balloon group (n=182 [81.98%] versus n=109 [67.28%], p<0.001). Conclusion This study suggests that using a smaller balloon size for predilation in pPCI is associated with improved coronary flow, reduced procedural complications and better ST-segment resolution.
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Affiliation(s)
- Mahmoud Tantawy
- College of Medicine, Department of Cardiology, Misr University for Science and Technology Cairo, Egypt
| | - Marwan Saad
- Brown University Health Cardiovascular Institute, Division of Cardiology, Alpert Medical School Department of Medicine, Brown University Providence, RI, US
| | - Sherif Hussien
- College of Medicine, Department of Cardiology, Misr University for Science and Technology Cairo, Egypt
| | - Ghada Selim
- Department of Internal Medicine, Division of Cardiology, Ain Shams University Cairo, Egypt
| | - Ahmed Tamara
- Department of Internal Medicine, Division of Cardiology, Ain Shams University Cairo, Egypt
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ZHU YH, HONG XL, HU TL, BIAN QQ, CHEN YF, ZHOU TP, LI J, FU GS, ZHANG WB. Clinical implication of post-angioplasty quantitative flow ratio in the patients with coronary artery de novo lesions underwent drug-coated balloons treatment. J Geriatr Cardiol 2025; 22:332-343. [PMID: 40351397 PMCID: PMC12059561 DOI: 10.26599/1671-5411.2025.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Abstract
Background Quantitative flow ratio (QFR) holds significant value in guiding drug-coated balloon (DCB) treatment and enhancing outcomes. However, the predictive capability of post-angioplasty QFR for long-term clinical events in patients with de novo lesions who receive DCB treatment remains uncertain. The aim of this study was to explore the potential significance of post-angioplasty QFR measurements in predicting clinical outcomes in patients underwent DCB treatment for de novo lesions. Methods Patients who underwent DCB-only intervention for de novo lesions were enrolled. QFR was conducted after DCB treatment. The patients were then categorized based on post-angioplasty QFR. The primary endpoint was major adverse cardiac events (MACE), encompassing all-cause death, cardiovascular death, nonfatal myocardial infarction, stroke, and target vessel revascularization. Results A total of 553 patients with 561 lesions were included. The median follow-up period was 505 days, during which 66 (11.8%) MACEs occurred. Based on post-procedural QFR grouping, there were 259 cases in the high QFR group (QFR > 0.93) and 302 cases in the low QFR group (QFR ≤ 0.93). Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MACE in the low QFR group (log-rank P = 0.004). The multivariate Cox proportional hazards model demonstrated a significant inverse correlation between QFR and the occurrence of MACEs (HR = 0.522, 95%CI: 0.289-0.942, P = 0.031). Landmark analysis indicated that high QFR had a significant reducing effect on the cumulative incidence of MACEs within 1 year (log-rank P = 0.016) and 1-5 years (log-rank P = 0.026). Conclusions In patients who underwent DCB-only treatment for de novo lesions, higher post-procedural QFR values (> 0.93) were identified as an independent protective factor against adverse prognosis.
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Affiliation(s)
- Yun-Hui ZHU
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xu-Lin HONG
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tian-Li HU
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qian-Qian BIAN
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu-Fei CHEN
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tian-Ping ZHOU
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing LI
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guo-Sheng FU
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Bin ZHANG
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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ZHANG SY. Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2024. J Geriatr Cardiol 2025; 22:277-331. [PMID: 40351394 PMCID: PMC12059564 DOI: 10.26599/1671-5411.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Abstract
In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure (HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.
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Affiliation(s)
- Shu-Yang ZHANG
- Chinese Society of Cardiology, Chinese Medical Association; Chinese College of Cardiovascular Physician; Chinese Heart Failure Association of Chinese Medical Doctor Association; Editorial Board of Chinese Journal of Cardiology;This guideline was first published in the Zhonghua Xin Xue Guan Bing Za Zhi 2024; 52(3): 235–275.
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Khairy AM, Hafez AH, Elshahat A, Emara A, Aboueisha H, Fahmy MI, Abdelaziz A, Yasseen I. Comparing cross-over stenting and focal ostial stenting for ostial left anterior descending coronary artery lesions: a systematic review and meta-analysis. BMC Cardiovasc Disord 2025; 25:131. [PMID: 40000947 PMCID: PMC11852548 DOI: 10.1186/s12872-024-04393-x] [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: 04/23/2024] [Accepted: 12/02/2024] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND The ideal revascularization approach for ostial left anterior descending coronary artery (L.A.D.) lesions continues to be a matter of debate. Two primary stenting strategies are often contemplated for managing these lesions: focal ostial stenting (F.O.S.) and the provisional strategy, alternatively termed cross-over stenting (C.O.S.) from the LM to the L.A.D. artery. AIM Our objective is to assess the efficacy of C.O.S. vs. F.O.S. techniques in patients with ostial L.A.D. lesions who underwent percutaneous coronary intervention (P.C.I.). METHODS We systematically searched five electronic databases to identify relevant studies. The data was pooled as odds ratio (O.R.) with its 95% confidence interval (C.I.) using the DerSimonian-Laird random effect model in STATA 17 MP. Significance was determined by a p-value > 0.05 between intervention subgroups. RESULTS Nine articles with a total of 1492 patients were included in the meta-analysis. The pooled O.R. for Major Adverse Cardiovascular Events (MACE) was 0.88 (95% C.I. [0.39, 1.99], P = 0.76), indicating comparable rates between F.O.S. and C.O.S. For all-cause death, the O.R. was 1.46 (95% C.I. [0.53, 4.02], P = 0.46), with no significant differences between the compared techniques. Cardiovascular death showed no preference between treatments (O.R.=0.99, 95% C.I. [0.30, 3.31], P = 0.99), and similarly for myocardial infarction (O.R.=0.74, 95% C.I. [0.38, 1.44], P = 0.37). CONCLUSION Our meta-analysis comparing C.O.S. and F.O.S. for L.A.D. lesions revealed similar efficacy in clinical and angiographic outcomes.
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Affiliation(s)
- Ahmed M Khairy
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Abdelrahman H Hafez
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
- Medical Research Group of Egypt (MRGE), Cairo, Egypt.
| | - Ahmed Elshahat
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Emara
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hadeel Aboueisha
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed Ismael Fahmy
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Yasseen
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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10
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Omori H, Kawase Y, Mizukami T, Tanigaki T, Hirata T, Okubo M, Kamiya H, Kawasaki M, Kondo T, Suzuki T, Matsuo H. Diagnostic Performance of Artificial Intelligence-Based Angiography-Derived Non-Hyperemic Pressure Ratio Using Pressure Wire as Reference. Circ J 2025; 89:323-330. [PMID: 39631935 DOI: 10.1253/circj.cj-24-0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
BACKGROUND The angiography-derived non-hyperemic pressure ratio (angioNHPR) is a novel index of NHPR based on artificial intelligence (AI) that does not require pressure wires. We investigated the diagnostic accuracy of angioNHPR for detecting hemodynamically relevant coronary artery disease. METHODS AND RESULTS In this retrospective single-center study, angioNHPR was assessed using the invasive NHPR as the reference standard. An angioNHPR ≤0.89 was defined as indicative of physiologically significant stenosis. Two angiographic projections ≥30° difference in angulation were selected. The lumen and centerline were automatically segmented by the prototype software, allowing for the calculation of the angioNHPR. We assessed 222 vessels from 178 patients. The accuracy of angioNHPR was 76.6% (95% confidence interval [CI] 70.4-82.0), with sensitivity 66.2% (95% CI 54.0-77.0), specificity 81.5% (95% CI 74.3-87.3), positive predictive value 62.7% (95% CI 53.6-70.9), and negative predictive value 83.7% (95% CI 78.6-87.7). The angioNHPR showed good correlation with invasive NHPR (r=0.72; 95% CI 0.64-0.77; P<0.001), and the agreement between angioNHPR and invasive NHPR was -0.01 (limits of agreement: -0.13, 0.11). The area under the curve (AUC) of angioNHPR was 0.81 (95% CI 0.75-0.86), which was significantly higher than that of 2-dimensional quantitative coronary angiography (AUC 0.69; 95% CI 0.62-0.75; P=0.007). CONCLUSIONS AI-based angioNHPR demonstrates good diagnostic performance using invasive NHPR as the reference standard.
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Affiliation(s)
- Hiroyuki Omori
- Department of Cardiovascular Medicine, Gifu Heart Center
- Department of Cardiovascular Medicine, Toyohashi Heart Center
| | | | - Takuya Mizukami
- Department of Cardiovascular Medicine, Gifu Heart Center
- Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Tetsuo Hirata
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Hiroki Kamiya
- Department of Cardiovascular Medicine, Gifu Heart Center
| | | | - Takeshi Kondo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine, Toyohashi Heart Center
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
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11
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Wen M, Li J, Jia S, Wang S, Zhao S, Su P, Xu D, Gong M. CAS-OPCABG vs OPCABG-alone in patients with asymptomatic carotid Stenosis: Multi-center experience. IJC HEART & VASCULATURE 2025; 56:101497. [PMID: 39790479 PMCID: PMC11714374 DOI: 10.1016/j.ijcha.2024.101497] [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: 02/22/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 01/12/2025]
Abstract
Objective The objective was to evaluate the relationship between carotid stenting and off-pump coronary artery grafting (CAS-OPCABG) and OPCABG only in patients with asymptomatic severe carotid stenosis. Methods This study retrospectively included 669 patients with asymptomatic severe carotid artery stenosis who underwent OPCABG at multiple centers. After propensity score matching for baseline characteristics, the study compared two groups of patients with clinical data, early and midterm death, stroke, and myocardial infarction (MI). Results After matching, there was no significant difference between two groups at baseline. The rates of early stroke, midterm stroke, and intensive care unit (ICU) stay were significantly lower in the CAS OPCABG group, yet the use of the internal mammary artery (IMA) was comparatively lower. Kaplan-Meier analysis revealed that there was no significant difference in midterm mortality between two groups. In the bilateral asymptomatic carotid stenosis subgroup, the early stroke rate was significantly lower after CAS-OPCABG, but there was no significant difference in the unilateral carotid stenosis subgroup. Multivariate logistic regression analysis identified previous atrial fibrillation, previous stroke, aortic atherosclerosis, bilateral carotid stenosis and the use of an intra-aortic balloon pump (IABP) as significant risk factors for early postoperative stroke, CAS emerged as a protective factor. Use of IMA was found to be a protective factor against postoperative mortality. Conclusions CAS-OPCABG is an efficacious and safe approach for the treatment of asymptomatic severe carotid artery stenosis, effectively decreasing the incidence of postoperative stroke.
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Affiliation(s)
- Mingxiu Wen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Jinzhang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Songhao Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Shipan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Shuanglei Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Pixiong Su
- Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dong Xu
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Gong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
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12
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Xiong Q, Chen S, Luo J, Xiong P, Nie Z, Huang L, Wang Y, Lei Z, Zhang L, Wang J. Prognostic Significance of Homocysteine Levels in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Propensity Score Matching and Weighting Analysis. Rev Cardiovasc Med 2025; 26:25518. [PMID: 40026518 PMCID: PMC11868880 DOI: 10.31083/rcm25518] [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: 07/02/2024] [Revised: 09/09/2024] [Accepted: 09/26/2024] [Indexed: 03/05/2025] Open
Abstract
Background Elevated homocysteine (Hcy) levels have been linked to poorer outcomes in acute coronary syndrome. This study aimed to assess the predictive value of elevated Hcy levels for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods This retrospective cohort study included 183 STEMI patients who underwent primary PCI at a tertiary university hospital in southern China from January 2020 to December 2021. Laboratory values, including Hcy levels, were obtained within 24 hours of admission. Patients were categorized into elevated and normal Hcy groups using a threshold of 12 μmol/L. The study outcome was the occurrence of 6-point MACE, defined as cardiac death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization (PCI or coronary artery bypass grafting), heart failure and all-cause death. Survival analyses were conducted using Kaplan-Meier and Cox proportional hazard methods. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) approaches were employed to minimize bias. Results The mean age of the patients was 64.8 years, with 76.0% being male. After adjusting with PSM or IPTW, covariate imbalances between the two groups were corrected. Over a median follow-up period of 25.8 months, 55 MACE events occurred, resulting in an event rate of 30.1%. Patients with elevated Hcy levels had a higher incidence of MACE in both unadjusted (hazard ratio [HR] = 2.778; 95% confidence interval [CI]: 1.591-4.850; p < 0.001) and adjusted analyses (PSM: HR = 2.995; 95% CI: 1.397-6.423, p = 0.005; IPTW: HR = 3.2; 95% CI: 1.631-6.280, p < 0.001). Multivariate Cox regression further confirmed that elevated Hcy levels were associated with a worse prognosis across the entire cohort (HR = 1.062, 95% CI: 1.029-1.097, p < 0.001), PSM cohort (HR = 1.089, 95% CI: 1.036-1.145, p < 0.001), and IPTW cohort (HR = 1.052, 95% CI: 1.020-1.086, p = 0.001). Conclusions Elevated plasma levels of Hcy (≥12 μmol/L) are associated with worse outcomes in STEMI patients undergoing primary PCI, highlighting the potential role of Hcy as a prognostic marker in this population.
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Affiliation(s)
- Qianfeng Xiong
- Department of Cardiology, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Shaoyong Chen
- Department of Cardiology, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Junke Luo
- Department of Cardiac Intensive Care Unit, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Pengfeng Xiong
- Department of Cardiology, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Zhenyun Nie
- Department of Cardiology, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Lei Huang
- Department of Cardiology, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Yao Wang
- Department of Cardiology, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Zhen Lei
- Department of Thoracic Surgery, Fengcheng People’s Hospital, The Affiliated Fengcheng Hospital of Yichun University, 331100 Fengcheng, Jiangxi, China
| | - Lihui Zhang
- Health Care Bureau, Health Commission of Shanxi Province, 030032 Taiyuan, Shanxi, China
- Department of Cardiology, The Third Clinical Medical College of Shanxi Medical University, 030032 Taiyuan, Shanxi, China
| | - Jing Wang
- Prevention & Healthcare Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032 Taiyuan, Shanxi, China
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13
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Ren Q, Mu X, Li Y, Zhang J, Liang Y, Zhang Q, Han Y. Predictive Value of Cardiopulmonary Exercise Testing Parameters in Patients under Percutaneous Coronary Intervention with High Pulse Pressure. Rev Cardiovasc Med 2025; 26:25847. [PMID: 40026507 PMCID: PMC11868889 DOI: 10.31083/rcm25847] [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: 07/25/2024] [Revised: 10/22/2024] [Accepted: 11/01/2024] [Indexed: 03/05/2025] Open
Abstract
Background The correlation between cardiopulmonary exercise testing (CPET) parameters and the prognosis of patients undergoing percutaneous coronary intervention (PCI) with high pulse pressure (PP) is unclear. The purpose of present study is to investigate the correlation of CPET parameters in patients under PCI with high PP and assess their reference value for prognosis. Methods Individuals aged 18 years and older who were diagnosed with coronary artery disease (CAD) and underwent PCI along with CPET from November 1, 2015 to September 30, 2021 were enrolled. The patients were categorized into two groups based on PP: high PP group (PP of males ≥50 mmHg; PP of females ≥60 mmHg) and normal PP group (PP of males <50 mmHg; PP of females <60 mmHg). The primary endpoint was major adverse cardiovascular events (MACE). The optimal predictors of MACE were identified through Cox regression analysis. The time-dependent receiver operating characteristic (ROC) curves were generated and the area under the ROC curve (AUC) was measured to evaluate the discriminatory ability in patients with high PP. Results A total of 2785 patients were included in present study, with a median follow-up period of 1215 (687-1586) days. Through multifactorial analysis, it was determined that peak oxygen uptake (peak VO2, hazard ratio (HR): 0.94, 95% confidence interval (95% CI): 0.88 to 1.00, p = 0.038) and ventilatory equivalent for carbon dioxide (VE/VCO2, HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.007) are important predictive factors in the parameters of CPET. The ROC based on diabetes mellitus (DM), smoking, peak VO2, and VE/VCO2 could effectively evaluate the prognosis of patients [1-year AUC: 0.636 (0.515~0.758), 3-year AUC: 0.675 (0.599~0.752), 5-year AUC: 0.718 (0.607~0.830)]. Conclusions The prognosis of CAD patients with high PP was worse compared to the patients with normal PP. The peak VO2 and VE/VCO2 were predictors of MACE in CAD patients with high PP.
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Affiliation(s)
- Qiang Ren
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
- Department of Cardiology, Beifang Hospital of China Medical University, 110016 Shenyang, Liaoning, China
| | - Xingbo Mu
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
- Department of Cardiology, Beifang Hospital of China Medical University, 110016 Shenyang, Liaoning, China
| | - Yushan Li
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
| | - Jian Zhang
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
| | - Yanchun Liang
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
| | - Quanyu Zhang
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
| | - Yaling Han
- State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China
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14
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Juan-Salvadores P, De La Torre Fonseca LM, Calderon-Cruz B, Veiga C, Pintos-Rodríguez S, Fernandez Barbeira S, Jimenez Diaz VA, Iñiguez Romo A. Ischaemia-reperfusion time differences in ST-elevation myocardial infarction in very young patients: a cohort study. Open Heart 2025; 12:e002957. [PMID: 39875170 PMCID: PMC11784106 DOI: 10.1136/openhrt-2024-002957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 01/06/2025] [Indexed: 01/30/2025] Open
Abstract
INTRODUCTION ST-elevation myocardial infarction (STEMI) is one of the most prevalent presentations in young patients. It is essential to emphasise that each minute of delay in providing medical care is negatively correlated to the patient's prognosis. The present study was carried out to evaluate the ischaemia-reperfusion times in patients ≤40 years of age versus individuals >40 years of age and their association with mortality and major adverse cardiac event (MACE) over the long term. METHODS A retrospective, multicentre cohort study was carried out in 6799 patients diagnosed with STEMI. Two groups were established: patients diagnosed with STEMI and aged >40 years, and patients diagnosed with STEMI and aged ≤40 years. RESULTS The patients in the young group had a significantly sooner electrocardiographic diagnosis than the patients >40 years of age. A delay was observed in females, with a relative risk (RR) of 1.21 (95% CI 1.13 to 1.30) (p<0.001). Presenting dyspnoea (RR 1.76, 95% CI 1.5 to 2.06) (p<0.001) or going to a hospital without haemodynamics (RR 1.55, 95% CI 1.45 to 1.67) (p<0.001) was related to increased delay. The occurrence of MACE in the first year of follow-up was related to different risk factors, along with a delay in healthcare (HR 1.25, 95% CI 1.10 to 1.54) (p<0.042). CONCLUSION This study shows that young patients with STEMI tend to receive a sooner diagnosis than older individuals. Delays in healthcare represent one of the main factors related to the occurrence of MACE and non-event-free survival.
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Affiliation(s)
- Pablo Juan-Salvadores
- Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | | | - Beatriz Calderon-Cruz
- Methodolgy Unit, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Cesar Veiga
- Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Samuel Pintos-Rodríguez
- Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Saleta Fernandez Barbeira
- Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Victor Alfonso Jimenez Diaz
- Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Andres Iñiguez Romo
- Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
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15
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Kageyama S, Revaiah PC, Tsung-Ying T, Miyashita K, Tobe A, O'Leary N, Reiber JHC, Tu S, Zaman A, Sabaté M, Möllmann H, Sharif F, Lemoine J, Wlodarczak A, Garg S, Onuma Y, Serruys PW. Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes. Sci Rep 2025; 15:2228. [PMID: 39825017 PMCID: PMC11742033 DOI: 10.1038/s41598-025-85872-9] [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: 04/24/2024] [Accepted: 01/07/2025] [Indexed: 01/20/2025] Open
Abstract
Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-PCI and the medium term predicted vessel-oriented composite endpoint (VOCE). Paired pre-procedure QFRs were assessed in 503 patients and 1022 vessels in the Multivessel TALENT (MVT) trial. The pathophysiological pattern of CAD was defined as "predominantly diffuse" or "focal" according to a virtual QFR pullback pressure gradient (PPG) index < 0.78 and ≥ 0.78, respectively. Physiological "focal severity" was assessed using the QFR gradient per mm (dQFR/ds), with a value ≥ 0.025/mm the threshold for a "major gradient". A post-PCI QFR ≥ 0.91 was considered optimal. Median pre-PCI PPG index was 0.70 (IQR 0.59-0.80). The prevalence of "predominantly diffuse" CAD and "major gradient" were 68.6% and 85.8%, respectively. A "Predominantly diffuse" pattern with a major gradient had a higher risk of a post-PCI QFR < 0.91 (OR 1.52,95%CI 1.47-1.58). In multivariable analysis, low QFR PPG index (diffuse disease) was an independent determinant of a post-PCI QFR < 0.91 (per 0.1 decrease of QFR PPG index, OR:9.8, 95% CI 3.0-32.2, p < 0.001). Based on post-PCI QFR the predicted 2-year VOCE, a powered endpoint in the MVT trial, was 6.1% and 4.2% in diffuse and focal lesions, respectively. A pre-procedure physiological pattern of diffuse CAD is an independent determinant of an unfavourable immediate hemodynamic outcome post-PCI, and detrimentally affects the predicted 2-year VOCE.Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672 Unique Identifier: NCT04390672 (registration date 15/05/2020).
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Affiliation(s)
- Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
- Corrib Core Lab, University of Galway, Galway, Ireland
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Pruthvi Chenniganahosahalli Revaiah
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
- Corrib Core Lab, University of Galway, Galway, Ireland
| | - Tsai Tsung-Ying
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
- Corrib Core Lab, University of Galway, Galway, Ireland
| | - Kotaro Miyashita
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
- Corrib Core Lab, University of Galway, Galway, Ireland
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
- Corrib Core Lab, University of Galway, Galway, Ireland
| | - Neil O'Leary
- School of Mathematical and Statistical Sciences, Galway, Ireland
| | | | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Manel Sabaté
- Department of Cardiology, Clinic Hospital, Barcelona, Spain
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Faisal Sharif
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Julien Lemoine
- Department of Cardiology, Clinique Louis Pasteur, Nancy, France
| | - Adrian Wlodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
- Corrib Core Lab, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland.
- Corrib Core Lab, University of Galway, Galway, Ireland.
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland.
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16
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Casanova-Sandoval J, Miñana-Escrivà G, Bosch-Peligero E, Muñoz-Camacho JF, Fernández-Rodríguez D, Rivera K, Fernández-Cisnal A, Valcárcel-Paz D, García-Guimarães M. [[The ultrathin-strut everolimus-eluting stent in a real-world population: the Everythin multicenter registry]]. REC: INTERVENTIONAL CARDIOLOGY 2025; 7:23-28. [PMID: 40417152 PMCID: PMC12097315 DOI: 10.24875/recic.m24000484] [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: 07/07/2024] [Accepted: 09/02/2024] [Indexed: 05/27/2025] Open
Abstract
Introduction and objectives Ultrathin-strut stents (UTS) represent a significant advancement in percutaneous coronary intervention. This study aimed to evaluate the safety and short- to mid-term outcomes of stenting with the thinnest struts on the market (50 µm) using a biodegradable everolimus-eluting polymer (Evermine 50) in real-world patients with coronary artery disease. Methods A single-arm, multicenter, prospective study was conducted in real-world patients. A total of 161 patients with de novo lesions who received at least 1 UTS stent were enrolled. The primary safety endpoint was the occurrence of major adverse cardiovascular events, defined as cardiac death, target-vessel myocardial infarction, or the need for revascularization of the target lesion at 12 months. The incidence of stent thrombosis at 12 months was also analyzed. Results The study included 161 patients with a mean age of 64 ± 14 years; 79% were male, 34% had diabetes, and 66% had hypertension. The most common indication for intervention was non-ST-segment elevation myocardial infarction (42%), followed by ST-segment elevation myocardial infarction (22%). The procedural success rate was 100%. At 12 months of follow-up, the incidence of MACE was 2.5%, and the definite stent thrombosis rate was 1.3%. Conclusions The use of the 50 µm UTS stent with a biodegradable everolimus-eluting polymer demonstrated a favorable safety profile and good clinical outcomes in unselected patients at 1 year of follow-up.
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Affiliation(s)
- Juan Casanova-Sandoval
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Grup de Fisiologia i Patologia Cardiaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, EspañaServicio de Cardiología, Hospital Universitario Arnau de VilanovaGrup de Fisiologia i Patologia CardiacaInstitut de Recerca Biomèdica de Lleida (IRBLleidaLleidaEspaña
| | - Gema Miñana-Escrivà
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Universidad de Valencia, Valencia, EspañaServicio de Cardiología, Hospital Clínico Universitario de ValenciaInstituto de Investigación Sanitaria (INCLIVA)Universidad de ValenciaValenciaEspaña
| | - Eduard Bosch-Peligero
- Servicio de Cardiología, Hospital Universitari Parc Taulí de Sabadell, Universidad Autónoma de Barcelona, Barcelona, EspañaServicio de CardiologíaHospital Universitari Parc Taulí de SabadellUniversidad Autónoma de BarcelonaBarcelonaEspaña
| | - Juan Francisco Muñoz-Camacho
- Servicio de Cardiología, Hospital Universitario Mutua de Terrassa, Terrassa, Barcelona, EspañaServicio de CardiologíaHospital Universitario Mutua de TerrassaTerrassaEspaña
| | - Diego Fernández-Rodríguez
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Grup de Fisiologia i Patologia Cardiaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, EspañaServicio de Cardiología, Hospital Universitario Arnau de VilanovaGrup de Fisiologia i Patologia CardiacaInstitut de Recerca Biomèdica de Lleida (IRBLleidaLleidaEspaña
| | - Kristian Rivera
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Grup de Fisiologia i Patologia Cardiaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, EspañaServicio de Cardiología, Hospital Universitario Arnau de VilanovaGrup de Fisiologia i Patologia CardiacaInstitut de Recerca Biomèdica de Lleida (IRBLleidaLleidaEspaña
| | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Universidad de Valencia, Valencia, EspañaServicio de Cardiología, Hospital Clínico Universitario de ValenciaInstituto de Investigación Sanitaria (INCLIVA)Universidad de ValenciaValenciaEspaña
| | - Daniel Valcárcel-Paz
- Servicio de Cardiología, Hospital Universitari Parc Taulí de Sabadell, Universidad Autónoma de Barcelona, Barcelona, EspañaServicio de CardiologíaHospital Universitari Parc Taulí de SabadellUniversidad Autónoma de BarcelonaBarcelonaEspaña
| | - Marcos García-Guimarães
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Grup de Fisiologia i Patologia Cardiaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, EspañaServicio de Cardiología, Hospital Universitario Arnau de VilanovaGrup de Fisiologia i Patologia CardiacaInstitut de Recerca Biomèdica de Lleida (IRBLleidaLleidaEspaña
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17
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Ikeda H, Hasegawa K, Uzui H, Mukai M, Tama N, Ishida K, Tada H. Characteristics of Incident Coronary Artery Disease in Patients Undergoing Atrial Fibrillation Ablation. Int Heart J 2025; 66:220-225. [PMID: 40159359 DOI: 10.1536/ihj.24-676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Few reports have provided detailed characteristics of incident coronary artery disease (CAD) and its risk factors in patients undergoing ablation (ABL) for atrial fibrillation (AF).Patients undergoing ablation for AF with no documented CAD were retrospectively studied at our institution. Patients were divided into 2 groups: those in whom significant stenosis was detected incidentally on coronary angiography (CAG) performed at the same time as ablation, and those without. The detection rate and its predictors were examined.Of the 550 patients, 20 had incidental CAD (detection rate: 3.6%). We compared the clinical data between these 20 patients (ABL-CAD group) and the 530 patients who displayed no significant stenosis on CAG. In multivariate analysis, age, hemoglobin A1c (HbA1c), and high-density lipoprotein cholesterol (HDL-chol) were predictive factors (odds ratio: 1.08, 2.43, 1.58, 95% CIs: 1.01-1.14, 1.53-3.86, 0.92-0.99; P = 0.014, 0.004, 0.024, respectively) for identification of CAD. Multivariate analysis based on cut-off values from receiver operating characteristic analysis identified age, HbA1c ≥ 6.1%, and HDL-chol ≤ 49 mg/dL as predictors (odds ratios: 1.06, 4.04, 3.07; 95% CIs: 1.00-1.12, 1.58-10.3, 1.1-8.01; P = 0.04, 0.01, 0.021, respectively). The area under the curve was significantly greater for age and HbA1c ≥ 6.1% and HDL-chol ≤ 49 mg/dL than for age alone (0.810 versus 0.672; P = 0.005).Patients undergoing ablation for AF appear likely to have CAD if HbA1c is ≥ 6.1% and HDL-chol is ≤ 49 mg/dL.
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Affiliation(s)
- Hiroyuki Ikeda
- Department of Cardiovascular Medicine, University of Fukui
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, University of Fukui
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, University of Fukui
- Department of Clinical Nursing, University of Fukui
| | - Moe Mukai
- Department of Cardiovascular Medicine, University of Fukui
| | - Naoto Tama
- Department of Cardiovascular Medicine, University of Fukui
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, University of Fukui
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
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18
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Gallo I, Hidalgo F, González-Manzanares R, Alvarado M, Perea J, de Lezo JS, Romero M, Ojeda S, Pan M. [[Percutaneous treatment of the left main coronary artery in older adults. Impact of frailty on mid-term results]]. REC: INTERVENTIONAL CARDIOLOGY 2025; 7:6-14. [PMID: 40417160 PMCID: PMC12097336 DOI: 10.24875/recic.m24000471] [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: 01/14/2024] [Accepted: 03/20/2024] [Indexed: 05/27/2025] Open
Abstract
Introduction and objectives In elderly and frail patients, there is limited evidence on the therapeutic management of left main coronary artery (LM) disease. The objective of this study was to evaluate mid-term clinical outcomes in older adults undergoing percutaneous coronary intervention (PCI) of LM. Methods We conducted a retrospective study including all older patients (≥ 75 years) undergoing LM-PCI at a high-volume center between 2017 and 2021. The primary endpoint was a composite of major adverse cardiovascular events (MACE). Patients were grouped according to the presence of frailty based on the FRAIL scale. Inverse probability of treatment weighting was used to account for clinical differences between the 2 groups. Results A total of 140 patients were included in the study (median age 80 [78-84]; 36% women). Of them, 49% met the criteria for frailty. After a median follow-up of 19 [5-35] months, 40 MACE (29%) were recorded. The all-cause death rate was 32%. There were no differences in the risk of MACE between frailty groups, but patients with frailty had an increased risk of all-cause mortality (HRadj, 1.95 [1.02-3.75]; P = .046). Conclusions LM-PCI in older adults with multiple associated comorbidities could be considered a feasible option in this special population. The rate of MACE at follow-up was acceptable. Frailty was associated with a worse prognosis in terms of all-cause mortality at follow-up.
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Affiliation(s)
- Ignacio Gallo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
| | - Francisco Hidalgo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)CórdobaEspaña
| | - Rafael González-Manzanares
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)CórdobaEspaña
| | - Marcos Alvarado
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
| | - Jorge Perea
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
| | - Javier Suárez de Lezo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)CórdobaEspaña
| | - Miguel Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)CórdobaEspaña
- Departamento de Medicina, Universidad de Córdoba, Córdoba, EspañaDepartamento de MedicinaUniversidad de CórdobaCórdobaEspaña
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)CórdobaEspaña
- Departamento de Medicina, Universidad de Córdoba, Córdoba, EspañaDepartamento de MedicinaUniversidad de CórdobaCórdobaEspaña
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, EspañaServicio de CardiologíaHospital Universitario Reina SofíaCórdobaEspaña
- Instituto Maimónides de Investigación Biomédica de (IMIBIC), Córdoba, EspañaInstituto Maimónides de Investigación Biomédica de (IMIBIC)CórdobaEspaña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), EspañaCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)CórdobaEspaña
- Departamento de Medicina, Universidad de Córdoba, Córdoba, EspañaDepartamento de MedicinaUniversidad de CórdobaCórdobaEspaña
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Lounes MS, Meftah A, Bedjaoui A, Belhadi C, Allal K, Boulaam H, Sayah A, Hafidi I, Tebache E, Allali A, Benkhedda S. [[Incidence and predictors of radial artery occlusion following transradial coronary procedures]]. REC: INTERVENTIONAL CARDIOLOGY 2025; 7:15-22. [PMID: 40417153 PMCID: PMC12097311 DOI: 10.24875/recic.m24000479] [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: 04/30/2024] [Accepted: 07/12/2024] [Indexed: 05/27/2025] Open
Abstract
Introduction and objectives The use of transradial access for percutaneous coronary procedures has increased due to its advantages over the femoral approach. However, this benefit comes at the expense of a higher rate of radial artery occlusion (RAO). Our objective was to assess the incidence and predictors of RAO following transradial catheterization. Additionally, we studied anatomic variations of the radial artery (RA). Methods This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. The forearm arteries were evaluated by ultrasound. If RAO was present, follow-up ultrasound examinations were performed at 1 and 3 months postprocedure. Results Our study population included 288 men (67.4%) and 139 women (32.6%). The mean age was 61.9 ± 11.1 years. RAO occurred in 48 patients (11.24%), and spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, independent predictors of RAO were younger age (OR, 0.642; 95%CI, 0.480-0.858; P = .031), low periprocedural systolic blood pressure (OR, 0.598; 95%CI, 0.415-0.862; P = .007), a small radial diameter (OR, 0.371; 95%CI, 0.323-0.618; P = .031), insufficient anticoagulation (OR, 0.287; 95%CI, 0.163-0.505; P < .001), occlusive hemostasis (OR, 0.128; 95%CI, 0.047-0.353; P < .001), and long duration of hemostasis. The overall incidence of RA anatomic variations was 14.8% (n = 63). Among these, 40 patients (63.5%) had a high radial origin, 18 (28.6%) had extreme RA tortuosity, and 5 (7.9%) had a complete radioulnar loop. Conclusions The main modifiable predictors of RAO are insufficient heparinization and occlusive hemostasis. Preventive strategies should focus primarily on these 2 predictive factors to reduce the risk of RAO.
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Affiliation(s)
- Mohamed Sofiane Lounes
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
- Cardiology Oncology Collaborative Research Group “COCRG Laboratory”, Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, ArgeliaCardiology Oncology Collaborative Research Group “COCRG Laboratory”Faculty of MedicineUniversity1 Benyoucef BENKHEDDAArgelArgelia
| | - Abdelouahed Meftah
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
- Cardiology Oncology Collaborative Research Group “COCRG Laboratory”, Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, ArgeliaCardiology Oncology Collaborative Research Group “COCRG Laboratory”Faculty of MedicineUniversity1 Benyoucef BENKHEDDAArgelArgelia
| | - Ali Bedjaoui
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
- Cardiology Oncology Collaborative Research Group “COCRG Laboratory”, Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, ArgeliaCardiology Oncology Collaborative Research Group “COCRG Laboratory”Faculty of MedicineUniversity1 Benyoucef BENKHEDDAArgelArgelia
| | - Chamseddine Belhadi
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
- Cardiology Oncology Collaborative Research Group “COCRG Laboratory”, Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, ArgeliaCardiology Oncology Collaborative Research Group “COCRG Laboratory”Faculty of MedicineUniversity1 Benyoucef BENKHEDDAArgelArgelia
| | - Karima Allal
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
| | - Hacene Boulaam
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
- Cardiology Oncology Collaborative Research Group “COCRG Laboratory”, Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, ArgeliaCardiology Oncology Collaborative Research Group “COCRG Laboratory”Faculty of MedicineUniversity1 Benyoucef BENKHEDDAArgelArgelia
| | - Adel Sayah
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
| | - Ilies Hafidi
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
| | - Elhadi Tebache
- Cardiology Department, Military Central Hospital, Argel, ArgeliaCardiology DepartmentMilitary Central HospitalArgelArgelia
| | - Abdelhakim Allali
- University Heart Center Lübeck, Medical Clinic II, Lübeck, AlemaniaUniversity Heart Center LübeckMedical Clinic IILübeckAlemania
| | - Salim Benkhedda
- Cardiology Oncology Collaborative Research Group “COCRG Laboratory”, Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, ArgeliaCardiology Oncology Collaborative Research Group “COCRG Laboratory”Faculty of MedicineUniversity1 Benyoucef BENKHEDDAArgelArgelia
- Cardiology Department A2, Mustapha Pacha Hospital, Argel, ArgeliaCardiology Department A2Mustapha Pacha HospitalArgelArgelia
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20
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Neumann FJ. [[Percutaneous coronary intervention of the left main in the elderly: a reasonable option]]. REC: INTERVENTIONAL CARDIOLOGY 2025; 7:1-2. [PMID: 40417157 PMCID: PMC12097380 DOI: 10.24875/recic.m24000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 05/27/2025] Open
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology and Angiology, University Heart Center Freiburg · Bad Krozingen, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, AlemaniaUniversity Heart Center Freiburg · Bad KrozingenUniversity Heart Center Freiburg · Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgAlemania
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21
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Habib M. Combination of atorvastatin plus N-acetylcysteine versus atorvastatin alone to prevent contrast-induced nephropathy. Arch Med Sci Atheroscler Dis 2024; 9:e207-e211. [PMID: 40007988 PMCID: PMC11851341 DOI: 10.5114/amsad/195767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/10/2024] [Indexed: 02/27/2025] Open
Abstract
Introduction Contrast-induced acute renal injury is the third leading cause of hospital-acquired acute kidney injury. Our trial aimed to compare high-dose statin versus statin plus N-acetylcysteine (NAC) to prevent contrast-induced nephropathy. Material and methods Randomized control trial included patients who undergoing elective percutaneous coronary intervention (PCI) at Alshifa Hospital in Gaza, the first group (statin: 50 patients) received 80 mg of atorvastatin orally once daily for 3 days. The second group (statin + NAC: 50 patients) received 80 mg of atorvastatin orally once daily for 3 days, plus NAC 1200 mg orally twice daily every 12 h for 2 days. All patients underwent measurement of serum creatinine and urea level before PCI and 2-3 days after the procedure. The primary endpoint was to compare development of contrast-induced nephropathy between the two groups. Results The total group comprised 100 patients: 71 male patients and 29 female patients. Mean age was 59 ±9.8 years. After intervention serum creatinine decreased from 1.02 ±0.27 mg/dl to1.01 ±0.29 mg/dl in the statin group, while it decreased from 1.08 ±0.36 mg/dl to 0.92 ±0.13 mg/dl in the statin + NAC group. The difference between the two groups was significant (p = 0.048). Also, the urea plasma level in the statin group decreased from 34.5 ±9.7 mmol/l to 30.6 ±8.7 mmol/l after PCI, while in the statin + NAC group it decreased from 36.4 ±9.9 mmol/l to 26.2 ±10.6 mmol/l; the difference between the two groups was significant (p = 0.017). Contrast-induced nephropathy was seen in 9 (18%) patients in the statin group and in 2 (4%) patients in the statin + NAC group (p = 0.025). Conclusions The combination of high-dose atorvastatin plus NAC compared to atorvastatin alone was associated with a significant reduction of contrast-induced nephropathy in patients undergoing PCI.
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Bershtein LL, Lunina MD, Evdokimov DS, Nayden TV, Gumerova VE, Kochanov IN, Ivanov AA, Boldueva SA, Resnyanskaya ED, Zbyshevskaya EV, Evtushenko AE, Piltakyan VK, Sayganov SA. Association of Severity of Coronary Artery Disease With Traditional Risk Factors, Clinical Characteristics and Carotid Plaque Burden in Patients With Acute Coronary Syndrome. KARDIOLOGIIA 2024; 64:44-50. [PMID: 39784132 DOI: 10.18087/cardio.2024.12.n2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/29/2024] [Accepted: 09/10/2024] [Indexed: 01/12/2025]
Abstract
AIM To study the associations between risk factors, clinical characteristics, severity of brachiocephalic artery (BCA) atherosclerosis and severity of coronary artery (CA) disease in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS The study included patients with any type of ACS and obstructive coronary artery disease confirmed by coronary angiography. A quantitative analysis of coronary angiography data was performed with an assessment of the number of CAs with significant stenosis and calculation of the SYNTAX score. The major clinical and laboratory parameters that are risk factors for atherosclerosis and/or affect the cardiovascular prognosis were assessed; for patients with ACS without ST segment elevation (NSTE-ACS), the risk score was calculated by the GRACE scale. The BCA ultrasound examination was performed with a quantitative analysis of atherosclerotic burden. RESULTS The study included 312 patients aged 64 [56, 72] years; the proportion of men was 69.2%. The frequency of lesions of 1, 2 and 3 coronary arteries was 34.6, 35.3, and 30.1%, respectively; the SYNTAX score was 14 [9, 21]. According to the results of univariate analysis, the number of stenotic CAs and the SYNTAX score were associated with age, smoking history, history of ischemic heart disease, diabetes mellitus (DM), the presence of non-stenotic CA lesions, the GRACE score in NSTE-ACS, and the Charlson comorbidity index. An inverse correlation was found for the level of physical activity and a slightly weaker one for the glomerular filtration rate and high-density lipoprotein cholesterol (HDL-C). In multivariate models, the only independent predictors of the number of stenotic CAs were HDL-C (odds ratio, OR 0.37, 95% confidence interval, CI 0.17-0.81; p=0.012) and the smoking history (OR 1.30, 95% CI 1.12-1.52; p=0.001), a coefficient of determination of the model R2 of 18%, SYNTAX score with a history of myocardial infarction (ß=6.40, 95% CI 3.22-9.58; p<0.001), insulin-dependent DM (ß=9.44, 95% CI 3.50-15.38; p=0.002), GRACE score for NSTE-ACS (ß=0.06, 95% CI 0.01-0.11; p<0.014), and a coefficient of determination of the model R2=20%. CONCLUSION Patients with ACS show significant, independent associations of the severity of coronary atherosclerosis with HDL-C, smoking duration, history of myocardial infarction, insulin-dependent diabetes, and the GRACE score in NSTE-ACS. Variability in the severity of CA lesions is only to a small extent determined by risk factors, clinical characteristics, and the severity of concomitant carotid atherosclerosis.
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Affiliation(s)
- L L Bershtein
- Mechnikov North-Western State Medical University, St. Petersburg
| | - M D Lunina
- Mechnikov North-Western State Medical University, St. Petersburg
| | - D S Evdokimov
- Mechnikov North-Western State Medical University, St. Petersburg
| | - T V Nayden
- Mechnikov North-Western State Medical University, St. Petersburg
| | - V E Gumerova
- Mechnikov North-Western State Medical University, St. Petersburg
| | - I N Kochanov
- Mechnikov North-Western State Medical University, St. Petersburg
| | - A A Ivanov
- Mechnikov North-Western State Medical University, St. Petersburg
| | - S A Boldueva
- Mechnikov North-Western State Medical University, St. Petersburg
| | - E D Resnyanskaya
- Mechnikov North-Western State Medical University, St. Petersburg
| | - E V Zbyshevskaya
- Mechnikov North-Western State Medical University, St. Petersburg
| | - A E Evtushenko
- Saint Petersburg Municipal Pokrov Hospital, St. Petersburg
| | - V Kh Piltakyan
- Saint Petersburg Municipal Pokrov Hospital, St. Petersburg
| | - S A Sayganov
- Mechnikov North-Western State Medical University, St. Petersburg
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Timofeeva TM, Safarova AF, Pavlikov GS, Kobalava ZD. Clinical and Diagnostic Value of ABCDE Stress Echocardiography With Exercise in Patients With Myocardial Infarction. KARDIOLOGIIA 2024; 64:35-43. [PMID: 39784131 DOI: 10.18087/cardio.2024.12.n2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 10/11/2024] [Indexed: 01/12/2025]
Abstract
AIM Evaluation of the clinical and diagnostic role of stepwise stress echocardiography (Stress Echo) with exercise using the ABCDE protocol in patients with myocardial infarction (MI). MATERIAL AND METHODS This single-site study included 75 patients (mean age 61.6±9.8 years; 84% men) after MI. The median time since MI was 1231.0 [381.5; 2698.5] days. All patients underwent Stress Echo using a five-step protocol. Step A identified impaired local contractility, step B identified the sum of B lines, step C identified the left ventricular (LV) contractile reserve, step D identified the coronary reserve in the anterior interventricular branch, and step E identified the heart rate reserve. The Stress Echo result was assessed by scores from 0 (all steps negative) to 5 (all steps positive). The effects of positive steps and the sum of Stress Echo scores on the incidence of the need for repeat revascularization were assessed. RESULTS The frequency of positive results was 36% for step A, 18.7% for step B, 80.0% for step C, 53.3% for step D, and 50.7% for step E. In 4 (5.3%) patients, all steps were negative (score 0); in 3 patients (4%), they were positive (score 5). Coronary angiography after Stress Echo during the follow-up period was performed in 26 (34.7%) patients; the need for repeat revascularization was determined in 17 (22.7%) patients. The predictors of the need for repeat revascularization according to a multivariate analysis were positive step A, chest pain pattern, and LV end-diastolic volume at peak exercise (p<0.001). A statistically significant effect of positive step A on survival without a need for repeat revascularization was observed in patients with a history of MI (p=0.020). CONCLUSION Among all the parameters of the integrated approach with Stress Echo, the emergence of new areas of impaired LV local contractility in patients after MI remains the main guideline for prescribing an angiographic study and a significant predictor of a need for repeated revascularization. However, the study results suggest that a further investigation of the effect of each positive step and the total ABCDE Stress Echo score on the prognosis for postinfarction cardiovascular complications is promising.
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Affiliation(s)
- T M Timofeeva
- Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia, Moscow
| | - A F Safarova
- Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia, Moscow
| | - G S Pavlikov
- Vinogradov University Clinical Hospital (Branch) of the Patrice Lumumba Peoples' Friendship University of Russia, Moscow
| | - Zh D Kobalava
- Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples' Friendship University of Russia, Moscow
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24
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Sartore L, Gitto M, Oliva A, Kakizaki R, Mehran R, Räber L, Spirito A. Recent Advances in the Treatment of Coronary In-Stent Restenosis. Rev Cardiovasc Med 2024; 25:433. [PMID: 39742224 PMCID: PMC11683712 DOI: 10.31083/j.rcm2512433] [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: 06/22/2024] [Revised: 08/10/2024] [Accepted: 08/20/2024] [Indexed: 01/03/2025] Open
Abstract
In-stent restenosis (ISR) remains the predominant cause of stent failure and the most common indication for repeat revascularization. Despite technological advances in stent design, ISR continues to pose significant challenges, contributing to increased morbidity and mortality among patients undergoing percutaneous coronary interventions. In the last decade, intravascular imaging has emerged as an important method for identifying the mechanisms behind ISR and guiding its treatment. Treatment options for ISR have expanded to include balloon angioplasty, cutting or scoring balloons, intravascular lithotripsy, atheroablative devices, drug-eluting stents, drug-coated balloons, surgical revascularization, and intravascular brachytherapy. The aim of the current review is to describe the classification and mechanisms of ISR, provide a comprehensive and updated overview of the evidence supporting different treatment strategies, suggest a management algorithm, and present insights into future developments in the field.
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Affiliation(s)
- Luca Sartore
- Department of Cardiology, Bern University Hospital, Inselspital, CH-3010 Bern, Switzerland
| | - Mauro Gitto
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Angelo Oliva
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ryota Kakizaki
- Department of Cardiology, Bern University Hospital, Inselspital, CH-3010 Bern, Switzerland
| | - Roxana Mehran
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, CH-3010 Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Bern University Hospital, Inselspital, CH-3010 Bern, Switzerland
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Wang Y, Fu H, Li J, Xie H, Li C, Du Z, Hao X, Wang H, Wang L, Hou X. The Effect of Percutaneous Coronary Intervention on Patients with Acute Myocardial Infarction and Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation. Rev Cardiovasc Med 2024; 25:449. [PMID: 39742243 PMCID: PMC11683699 DOI: 10.31083/j.rcm2512449] [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: 06/29/2024] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 01/03/2025] Open
Abstract
Background Patients suffering from acute myocardial infarction complicated by cardiogenic shock (AMICS), who undergo veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy, typically exhibit high mortality rates. The benefits of percutaneous coronary intervention (PCI) in these patients remains unclear. This study aims to investigate whether PCI can mitigate mortality among patients with AMICS supported by ECMO. Methods Data from patients ≥18 years, who underwent VA-ECMO assistance in China between January 1, 2017, and June 30, 2022, were retrieved by searching the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. A total of 1623 patients were included and categorised based on whether they underwent PCI. Using propensity score matching, 320 patient pairs were successfully matched. The primary outcome was in-hospital mortality rate. The secondary outcomes included VA-ECMO duration, Hospital stay, ECMO weaning and ECMO related complications. Results In the cohort of 1623 patients, 641 (39.5%) underwent PCI. Upon conducting multivariate logistic regression analysis, it was observed that those who underwent PCI had a lower prevalence of hyperlipidemia (13.1% versus [vs.] 17.8%), chronic respiratory disease (2.5% vs. 4.3%) and lower lactic acid (5.90 vs. 8.40). They also had a more significant history of PCI (24.8% vs. 19.8%) and were more likely to be smokers (42.6% vs. 37.0%). Patients in the PCI group exhibited lower in-hospital mortality before and after matching (40.3% vs. 51.6%; p = 0.005), which persisted in multivariable modeling (adjusted odds ratio [aOR]: 0.69; 95% confidence interval 0.50-0.95; p = 0.024). Patients who received PCI were more successfully weaned from ECMO (88.6% vs. 75.8% before matching). PCI was not a risk factor for ECMO related complications. Conclusions Among patients who received ECMO support for AMICS, PCI was associated with a lower rate of in-hospital mortality.
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Affiliation(s)
- Yan Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Hongfu Fu
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Jin Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Haixiu Xie
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Chenglong Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Xing Hao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Hong Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Liangshan Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
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Stépanian A, Fischer F, Flaujac C, Eschwège V, Delassasseigne C, Leflem L, Loridon F, Voisin S, Lasne D. Light transmission aggregometry for platelet function testing: position paper on current recommendations and French proposals for accreditation. Platelets 2024; 35:2427745. [PMID: 39555668 DOI: 10.1080/09537104.2024.2427745] [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: 09/10/2024] [Revised: 10/17/2024] [Accepted: 11/05/2024] [Indexed: 11/19/2024]
Abstract
Light transmission aggregometry (LTA) is a method used to investigate platelet functions in platelet-rich plasma (PRP), notably when screening for platelet disorders. Various national guidelines and recommendations help in setting up the LTA test in specialized laboratories. However, due to the nature of the sample matrix and its subsequent specificities, more accurate positions are needed to achieve LTA accreditation according to the standard NF EN ISO 15 189. We reviewed guidelines and recommendations as they can be useful in the accreditation process, and we conducted a survey on LTA practice among members of the Société Française de Thrombose et d'Hémostase (SFTH) in 2021. We formulated 28 proposals, which have been approved by vote within the SFTH. All aspects to take into consideration for the proper conduct of LTA assays and their accreditation have been covered. Notably, preanalytical, analytical and postanalytical aspects are depicted, including blood sampling, PRP preparation, instruments, agonists, performance assessment, personnel training and data interpretation. This document, essentially representing a French position paper on the current recommendations and subsequent proposals for LTA accreditation, might prove useful also outside France for relevant laboratories and auditors involved in LTA accreditation.
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Affiliation(s)
- Alain Stépanian
- Service d'Hématologie Biologique, PhyMedExp UMR UM - CNRS 9214 - Inserm U1046, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | | | - Claire Flaujac
- Laboratoire de biologie médicale, secteur hémostase, centre hospitalier de Versailles (André Mignot), Le Chesnay-Rocquencourt, France
| | | | | | - Léna Leflem
- Laboratoire Eurofins, Ivry-sur-Seine, France
| | | | - Sophie Voisin
- Laboratoire d'Hématologie, CHU de Toulouse, Toulouse, France
| | - Dominique Lasne
- Laboratoire d'Hématologie Générale, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
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Niu J, Wang K, Wang W, Liu Y, Yang J, Sun Y, Wang F, Gao W, Ge H. Drug-Coated Balloons versus Drug-Eluting Stents for the Treatment of De Novo Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials. Rev Cardiovasc Med 2024; 25:446. [PMID: 39742237 PMCID: PMC11683689 DOI: 10.31083/j.rcm2512446] [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: 04/20/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 01/03/2025] Open
Abstract
Background Because of the limitations in new-generation drug-eluting stents (DES), treatments advocating for non-stents with a drug-coated balloon (DCB) is now of great interest. Here, we conducted a meta-analysis to testify whether a DCB was more effective and safer than a DES in treating de novo coronary artery disease (CAD). Methods We searched PubMed, Embase, Cochrane Library, and Web of Science to obtain high-quality trials comparing DCB with DES for the treatment of de novo CAD. The primary endpoint was target lesion revascularization (TLR), and the secondary endpoints were in-lesion late lumen loss (LLL), all-cause death, myocardial infarction and binary restenosis. Results We enrolled 1661 patients from seven randomized clinical trials. Compared with the DES group, the MD (mean difference) of in-lesion LLL was significantly lower in the DCB group (MD -0.19, 95% CI -0.23 to -0.16, p < 0.00001, I2 = 0%). The DCB group showed superiority in small vessel disease (SVD) in in-lesion LLL (MD -0.21, 95% CI -0.34 to -0.08, p = 0.001). Conclusions The DCB group exhibited a lower in-lesion LLL compared to the DES group, and DCB was not inferior to DES in other endpoints, including in the SVD subgroup. Hence, to our knowledge, DCB is non-inferior to DES for de novo CVD and SVD. DCB in patients with CVD needs further large and long-term clinical trials to demonstrate its long-term efficacy. The PROSPERO Registration CRD42021268965, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268965.
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Affiliation(s)
- Jialong Niu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
| | - Kexin Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
| | - Wenjie Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
| | - Yixuan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
| | - Jiaxin Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
| | - Yan Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
| | - Furong Wang
- Department of Cardiology, Inner Mongolia Ordos City Dalate Banner People’s Hospital, 017000 Ordos, Inner Mongolia Autonomous Region, China
| | - Wen Gao
- Department of Cardiology, Bayannaoer City Hospital, 015000 Bayannaoer, Inner Mongolia Autonomous Region, China
| | - Hailong Ge
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China
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Gurav A, Revaiah PC, Tsai TY, Miyashita K, Tobe A, Oshima A, Sevestre E, Garg S, Aben JP, Reiber JHC, Morel MA, Lee CW, Koo BK, Biscaglia S, Collet C, Bourantas C, Escaned J, Onuma Y, Serruys PW. Coronary angiography: a review of the state of the art and the evolution of angiography in cardio therapeutics. Front Cardiovasc Med 2024; 11:1468888. [PMID: 39654943 PMCID: PMC11625592 DOI: 10.3389/fcvm.2024.1468888] [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: 07/22/2024] [Accepted: 10/14/2024] [Indexed: 12/12/2024] Open
Abstract
Traditionally, coronary angiography was restricted to visual estimation of contrast-filled lumen in coronary obstructive diseases. Over the previous decades, considerable development has been made in quantitatively analyzing coronary angiography, significantly improving its accuracy and reproducibility. Notably, the integration of artificial intelligence (AI) and machine learning into quantitative coronary angiography (QCA) holds promise for further enhancing diagnostic accuracy and predictive capabilities. In addition, non-invasive fractional flow reserve (FFR) indices, including computed tomography-FFR, have emerged as valuable tools, offering precise physiological assessment of coronary artery disease without the need for invasive procedures. These innovations allow for a more comprehensive evaluation of disease severity and aid in guiding revascularization decisions. This review traces the development of QCA technologies over the years, highlighting key milestones and current advancements. It also explores prospects that could revolutionize the field, such as AI integration and improved imaging techniques. By addressing both historical context and future directions, the article underscores the ongoing evolution of QCA and its critical role in the accurate assessment and management of coronary artery diseases. Through continuous innovation, QCA is poised to remain at the forefront of cardiovascular diagnostics, offering clinicians invaluable tools for improving patient care.
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Affiliation(s)
- Aishwarya Gurav
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Pruthvi C. Revaiah
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Tsung-Ying Tsai
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Kotaro Miyashita
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Akihiro Tobe
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Asahi Oshima
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Emelyne Sevestre
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | | | - Johan H. C. Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Medis Medical Imaging Systems BV, Leiden, Netherlands
| | - Marie Angele Morel
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Patrick W. Serruys
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
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Zhang X, Du Y, Guo Q, Ma X, Shi D, Zhou Y. Prognostic value of serum glycated albumin in acute coronary syndrome patients without standard modifiable cardiovascular risk factors. Diabetol Metab Syndr 2024; 16:278. [PMID: 39578846 PMCID: PMC11583742 DOI: 10.1186/s13098-024-01524-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 11/12/2024] [Indexed: 11/24/2024] Open
Abstract
BACKGROUND Glycated albumin (GA) has been demonstrated to be associated with adverse outcomes in patients with acute coronary syndrome (ACS). However, as a specific subgroup of ACS, a significant proportion of patients with ACS without standard modifiable cardiovascular risk factors (SMuRFs) are currently being identified. The prognostic value of serum GA for adverse events in such patients remains unexplored. This study aims to evaluate the prognostic value of GA in predicting adverse outcomes in patients with ACS without SMuRFs. METHODS This retrospective study involved 1,140 consecutive patients who were diagnosed with ACS without SMuRFs at the Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35-66 months after discharge. The primary endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACCEs) that included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization. RESULTS The average age of the study participants was 59.55 ± 10.98 years, and men accounted for 61.8%. The average GA level was 14.37 ± 2.42. The median follow-up duration was 48.3 months, during which 220 cases (19.3%) experienced MACCEs. In the fully adjusted model, with GA as a continuous variable, the hazard ratio (HR) for MACCEs in the high GA group was 1.069 (95% confidence interval (CI): 1.008, 1.133), the HR for ischemia-driven revascularization was 1.095 (95% CI: 1.021, 1.175), and the HR for all-cause mortality was 1.155 (95% CI: 1.021, 1.306), all with P values less than 0.05. Similarly, when GA was considered as a categorical variable, in the fully adjusted model, GA was associated with MACCEs, ischemia-driven revascularization, and all-cause mortality, with P values all less than 0.05. The restricted cubic spline curve showed that the relationship between GA and MACCEs was linear (p for non-linear = 0.079; p for overall association = 0.026). Furthermore, GA levels were correlated with poor prognosis in the subgroups of patients. CONCLUSION Serum GA might be an independent predictor of all-cause death and ischemia-driven revascularization in patients with ACS without SMuRFs.
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Affiliation(s)
- Xiaoming Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Qianyun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
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Iwańczyk S, Lazar FL, Onea HL, Pesenti N, Wańha W, Woźniak P, Gościniak W, Prof ML, Cortese B. Sirolimus-coated balloon versus drug-eluting stent for complex coronary lesions. A propensity matched comparison. Int J Cardiol 2024; 415:132436. [PMID: 39153511 DOI: 10.1016/j.ijcard.2024.132436] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/26/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in complex coronary artery disease (CAD) has been established as the standard of care, but stent-related events are not uncommon. Sirolimus-Coated Balloon (SCB)-based angioplasty is an emerging technology, although it needs to be thoroughly evaluated compared with DES in the complex PCI setting. This study aimed to investigate the safety and efficacy of SCB-based angioplasty compared with new-generation DES in complex PCI. METHODS Net adverse cardiovascular events (NACE: all-cause death, target lesion revascularization, non-fatal myocardial infarction, and major bleedings according to BARC classification), as a primary study endpoint was compared between SCB and new-generation DES for complex coronary lesions. RESULTS Among 1782 patients with complex CAD, 1076 were treated with a sirolimus-coated balloon (EASTBOURNE Registry) and 706 with new-generation DES (COMPLEX Registry). After propensity score matching, a total of 512 patients in both groups were analyzed. NACE occurred more significantly in the DES group during the 1-year follow-up (10.5% vs. 3.9%, p = 0.003), mainly due to a higher risk of bleeding (6.6% vs. 0.4%, p = 0.001). The Cox model adjusted for lesion length showed a significantly lower hazard of NACE (HR: 0.23, CI [0.10, 0.52], p < 0.001) and all-cause mortality (HR: 0.07, CI [0.01, 0.66], p = 0.020) in SCB compared to DES group. CONCLUSIONS SCB angioplasty has an advantage over DES for the treatment of complex CAD regarding NACE, significantly reducing the incidence of major bleeding without increasing ischemic endpoints. SCB may be an alternative to DES in selected patients with complex coronary lesions.
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Affiliation(s)
- Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland; DCB Academy, Milano, Italy
| | - Florin-Leontin Lazar
- Medical Clinic Number 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horea-Laurentiu Onea
- Medical Clinic Number 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Italy
| | - Wojciech Wańha
- DCB Academy, Milano, Italy; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Patrycja Woźniak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Weronika Gościniak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak Prof
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bernardo Cortese
- DCB Academy, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Alekyan BG, Navaliev YM. [Percutaneous Coronary Intervention in High-Risk Patients]. KARDIOLOGIIA 2024; 64:3-11. [PMID: 39526513 DOI: 10.18087/cardio.2024.10.n2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/11/2024] [Indexed: 11/16/2024]
Abstract
Ischemic heart disease (IHD) with severe coronary artery disease (SYNTAX score >22 points) in combination with various comorbidities is often a reason for refusal of coronary artery bypass grafting in such patients. Thus, a new term has emerged, "high-risk percutaneous coronary intervention"; however, the criteria, indications and results of these interventions have not yet been sufficiently studied. Therefore, according to current clinical guidelines, the treatment tactics for this patient cohort is determined by the decision of a council, the so-called Heart Team. This analytical review summarizes the criteria for high-risk percutaneous coronary interventions based on the literature, and describes the effect of various comorbidities on the results of direct myocardial revascularization.
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Affiliation(s)
- B G Alekyan
- Vishnevsky National Medical Research Center of Surgery; Russian Medical Academy of Continuous Professional Education
| | - Yu M Navaliev
- Vishnevsky National Medical Research Center of Surgery
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Potievskaya VI, Choronenko VE, Loenko VB, Rerberg AG, Bagiyan ER. [Perioperative Myocardial Infarction and Successful Revascularization in Patient With Primary Metasynchronic Rectal, Gastric and Bladder Cancer]. KARDIOLOGIIA 2024; 64:68-73. [PMID: 39526521 DOI: 10.18087/cardio.2024.10.n2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/11/2024] [Indexed: 11/16/2024]
Abstract
The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.
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Affiliation(s)
- V I Potievskaya
- Hertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Center; Academy of Postgraduate Education of the Federal Research and Clinical Center
| | - V E Choronenko
- Hertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Center
| | - V B Loenko
- Lopatkin Research Institute of Urology and Interventional Radiology, Branch of the National Medical Research Radiological Center
| | - A G Rerberg
- Hertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Center
| | - E R Bagiyan
- Hertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Center
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Zhang P, Wang C, Hu Z, Hou Z, Song L, Dong Y, Feng W, Zhang Y. Preoperative Quantitative Flow Ratio, Intraoperative Transit Time Flow Measurement Parameters, and Their Predictive Value for Short-Term Graft Failure After Coronary Artery Bypass Grafting. Circ J 2024; 88:1833-1841. [PMID: 38839351 DOI: 10.1253/circj.cj-24-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Studies on the relationship between the preoperative quantitative flow ratio (QFR) and parameters of intraoperative transit time flow measurement (TTFM) are extremely rare. In addition, the predictive value of QFR and TTFM parameters for early internal mammary artery (IMA) failure after coronary artery bypass grafting still needs to be validated. METHODS AND RESULTS We retrospectively collected data from 510 patients who underwent in situ IMA grafting to the left anterior descending (LAD) artery at Fuwai Hospital. Spearman correlation coefficients between preoperative QFR of the LAD artery and intraoperative TTFM parameters of the IMA were -0.13 (P=0.004) for mean graft flow (Qm) and 0.14 (P=0.002) for the pulsatility index (PI). QFR and TTFM exhibited similar and good predictive value for early IMA failure (5.7% at 1 year), and they were better than percentage diameter stenosis (area under the curve 0.749 for QFR, 0.733 for Qm, 0.688 for PI, and 0.524 for percentage diameter stenosis). The optimal cut-off value of QFR was 0.765. Both univariate and multivariable regression analyses revealed that QFR >0.765, Qm ≤15 mL/min, and PI >3.0 independently contributed to early IMA failure. CONCLUSIONS There were statistically significant correlations between preoperative QFR of the LAD artery and intraoperative TTFM parameters (Qm, PI) of the IMA. Preoperative QFR and intraoperative Qm and PI exhibited excellent predictive value for early IMA failure.
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Affiliation(s)
- Pengbin Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Chunyuan Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhan Hu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yubo Dong
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yan Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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Demirkıran T, Akyol FB, Özdem T, Hacızade E, Kubat E, Erol G, Kadan M, Karabacak K. Total coronary revascularization via left anterior thoracotomy: Comparison of early- and mid-term results with conventional surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:402-411. [PMID: 39651056 PMCID: PMC11620525 DOI: 10.5606/tgkdc.dergisi.2024.26471] [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: 05/31/2024] [Accepted: 10/21/2024] [Indexed: 12/11/2024]
Abstract
Background This study aimed to evaluate the efficacy and safety of total coronary revascularization via left anterior thoracotomy (TCRAT) by comparing it to conventional coronary artery bypass grafting (CABG) with median sternotomy. Methods In this retrospective study, 108 patients (95 males, 13 females; mean age: 57.1±8.8; range, 41 to 75 years) who underwent TCRAT (Group 1) and 154 patients (126 males, 28 females; mean age: 61.2±9.8; range, 31 to 79) who underwent conventional CABG (Group 2) between February 1, 2021, and September 1, 2022, were evaluated. The operations were performed by the same surgical team. Preoperative, operative, and postoperative data of patients and mid-term follow-up data were analyzed. Results Mean cardiopulmonary bypass and cross-clamp times, respectively, were 167.70±68.93 and 77.03±38.18 min in Group 1 and 106.64±38.27 and 62.21±24.06 min in Group 2 (p<0.001). During the postoperative period, the all-cause mortality rate was 5.8% (n=9) in Group 2, while it was 0.9% (n=1) in Group 1; there was a statistically significant difference between the two groups (p=0.037). Nevertheless, the mean preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation) II was 2.59±2.3 in Group 2, which was significantly higher than the mean EuroSCORE II of Group 1 (1.37±1.5; p<0.001). The mean hospitalization duration for Group 2 was 6.99±3.37 days, and the mean hospitalization duration for Group 1 was 6.77±4.24 days. Duration of hospitalization was statistically significantly shorter in Group 1 (p=0.047). In addition, the mean perioperative number of erythrocyte suspension transfusions in Group 1 was 1.51±1.74, while it was 1.86±1.75 in Group 2. Significantly fewer erythrocyte suspension transfusions were performed in Group 1 (p=0.033). Conclusion The findings of our study indicate that TCRAT is a safe and viable technique when performed on a select patient group compared to the conventional method.
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Affiliation(s)
- Tuna Demirkıran
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Furkan Burak Akyol
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Tayfun Özdem
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Elgin Hacızade
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Emre Kubat
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Gökhan Erol
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Murat Kadan
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Kubilay Karabacak
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
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Ferrari G, Loayza R, Azari A, Geijer H, Cao Y, Carlsson R, Bojö L, Samano N, Souza D. Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients. J Cardiothorac Surg 2024; 19:570. [PMID: 39354611 PMCID: PMC11443723 DOI: 10.1186/s13019-024-03057-3] [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: 05/24/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
OBJECTIVES To evaluate the long-term angiographic patency of saphenous vein grafts (SVG) harvested using the no-touch technique compared to the conventional technique. METHODS This was a single-center, retrospective, cohort study. The inclusion criteria were individuals who underwent a CABG (coronary artery bypass grafting) between January 1995 and July 2020, and who successively needed a clinically-driven angiography. The primary endpoint was long-term patency. The secondary endpoints were differences in patency based on sub-group analysis (single vs. sequential graft, divided by target vessel). RESULTS The study included 1520 individuals (618 no-touch, 825 conventional and 77 arterial grafts). The mean clinical follow-up time was 8.4 years ± 5.5 years. The patency per patient was 70.7% in the no-touch grafts vs. 46.7% in the conventional grafts (p < 0.001, OR = 2.8). The graft patency was 75.9% in the no-touch grafts vs. 62.8% in the conventional grafts (p < 0.001, OR = 1.8). CONCLUSIONS The no-touch vein grafts were associated with statistically significantly higher patency at long-term compared to the conventional grafts. CLINICAL TRIAL REGISTRATION NCT04656366, 7 December 2020.
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Affiliation(s)
- Gabriele Ferrari
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Department of Cardiology and Cardiothoracic Surgery, Blekinge Hospital, Karlskrona, 37181, Sweden.
| | - Richard Loayza
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ava Azari
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Håkan Geijer
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Roland Carlsson
- Svensk PCI AB, Regional Hospital of Karlstad, Karlstad, Sweden
| | - Leif Bojö
- Clinical Physiology Division, Regional Hospital of Karlstad, Karlstad, Sweden
| | - Ninos Samano
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Domingos Souza
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Adami G, Zanon S, Fassio A, Pesarini G, Pighi M, Scarsini R, Tavella D, Rossini M, Gatti D, Ribichini F. Diffuse idiopathic skeletal hyperostosis is associated with greater complexity of coronary artery disease burden on coronary angiography. Reumatismo 2024; 76. [PMID: 39351884 DOI: 10.4081/reumatismo.2024.1692] [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: 12/07/2023] [Accepted: 05/12/2024] [Indexed: 12/18/2024] Open
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder characterized by ossification of tendons and ligaments. DISH has been largely associated with an increased risk of metabolic syndrome and type 2 diabetes. The objective of the present study is to investigate the role of DISH in the risk of coronary artery disease (CAD). METHODS We conducted an observational cross-sectional study of patients without a history of rheumatic musculoskeletal diseases who underwent coronary angiography between March 2016 and April 2021. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score was calculated based on coronary angiography images. DISH diagnosis was based on standard X-ray images and computed tomography scans (Resnick criteria). Demographic and clinical characteristics were retrieved from electronic medical records. Multinomial and binary logistic regression models were employed to determine the association between SYNTAX score (dependent variable) and DISH (independent variable). RESULTS The study included 187 patients, 82.9% of whom were men, with valid radiological imaging. 83 (44.4%) patients had a confirmed radiological diagnosis of DISH. Diagnosis of DISH was associated with a higher SYNTAX score [adjusted odds ratio (aOR) 34.1, 95% confidence interval (CI) 1.41-79.2 p=0.049], independently from traditional cardiovascular risk factors. In patients aged <70 years, DISH was associated with a 7-fold higher risk of belonging to the highest category of SYNTAX (≥34), compared to non-DISH (aOR 7.23, 95% CI 1.08-48.4; p=0.041). The extension of vertebral calcification was significantly associated with SYNTAX score (r2 0.378, p<0.0001). CONCLUSIONS DISH diagnosis is common in patients at high risk of cardiovascular disease or with definitive CAD. DISH was independently associated with higher CAD complexity.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona
| | - S Zanon
- Cardiology Unit, University of Verona
| | - A Fassio
- Rheumatology Unit, University of Verona
| | | | - M Pighi
- Cardiology Unit, University of Verona
| | | | - D Tavella
- Cardiology Unit, University of Verona
| | - M Rossini
- Rheumatology Unit, University of Verona
| | - D Gatti
- Rheumatology Unit, University of Verona
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Wan´ha W, Iwan´czyk S, Cortese B. [Drug-coated balloons on the "big stage": is this technology ready for an all-comer population with de novo lesions?]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:266-268. [PMID: 40417344 PMCID: PMC12097340 DOI: 10.24875/recic.m23000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 05/27/2025] Open
Affiliation(s)
- Wojciech Wan´ha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, PoloniaDepartment of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePolonia
- DCB Academy, Milano, ItaliaDCB AcademyDCB AcademyMilanoItalia
| | - Sylwia Iwan´czyk
- DCB Academy, Milano, ItaliaDCB AcademyDCB AcademyMilanoItalia
- 1 Department of Cardiology, Poznan University of Medical Sciences, Poznan´, Polonia1 Department of CardiologyPoznan University of Medical SciencesPoznan´Polonia
| | - Bernardo Cortese
- DCB Academy, Milano, ItaliaDCB AcademyDCB AcademyMilanoItalia
- Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, ItaliaCardiovascular Research CenterFondazione Ricerca e Innovazione CardiovascolareMilanoItalia
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Macaya-Ten F, Gonzalo N, Escaned J, Macaya C. [Inception of the coronary stent: a story of successful collaboration between innovative scientists and the biotechnology industry]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:321-331. [PMID: 40417337 PMCID: PMC12097343 DOI: 10.24875/recic.m24000463] [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: 02/16/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2025] Open
Abstract
All cardiologists should delve into history to understand the current state of the art of their specialty. In the last century, the coronary stent was a pivotal achievement of research and biotechnological engineering. Since then, technology has advanced, and substantial improvements have been incorporated into this device, which has become the gold standard for treating coronary artery disease. This article summarizes the history of the coronary stent from its inception to the present day. The document reviews key historical and scientific milestones that have contributed to making percutaneous angioplasty a safe and highly effective procedure due to coronary stents. The evolution of the stent has been closely linked to the growth and maturation of interventional cardiology to date.
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Affiliation(s)
- Fernando Macaya-Ten
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaInstituto CardiovascularHospital Clínico San CarlosFundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC)MadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
| | - Nieves Gonzalo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaInstituto CardiovascularHospital Clínico San CarlosFundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC)MadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
| | - Javier Escaned
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaInstituto CardiovascularHospital Clínico San CarlosFundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC)MadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
| | - Carlos Macaya
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, EspañaInstituto CardiovascularHospital Clínico San CarlosFundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC)MadridEspaña
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, EspañaFacultad de MedicinaUniversidad Complutense de MadridMadridEspaña
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Xie B, Li J, Li W, Lin Y, Wang H. Evaluating the Impact and Financial Implications of Immediate versus Delayed Stenting Strategies in High Thrombus Burden Acute Myocardial Infarction: A Propensity Score-Matched Analysis. Rev Cardiovasc Med 2024; 25:381. [PMID: 39484147 PMCID: PMC11522752 DOI: 10.31083/j.rcm2510381] [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: 05/02/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 11/03/2024] Open
Abstract
Background The efficacy of delayed stenting strategies in the management of high thrombus burden acute myocardial infarction remains uncertain. We aimed to compare the therapeutic effects and financial implications of immediate and delayed stenting strategies in patients with acute myocardial infarction and high thrombus burden treated at our institution. Methods This was a retrospective analysis of 158 patients who underwent intracoronary thrombus aspiration for acute ST-elevation myocardial infarction (STEMI) at the Second Affiliated Hospital of Shantou University Medical College between 2013 and 2023. Patients were divided into two groups: immediate stenting (immediate group; n = 101) and delayed stenting (delayed group; n = 57), based on the timing of the stenting procedure. Propensity score matching was performed to minimize confounding bias. Therapeutic effects and cost of treatment were compared between the two groups. Results After propensity score matching (n = 52 for each group), there were no significant differences in terms of baseline clinical characteristics, characteristics of vascular lesions (number of diseased vessels, culprit vessels, thrombolysis in myocardial infarction (TIMI) thrombus grade, proximal coronary artery lesion), the incidence of no-reflow/slow flow during the first surgery, or the use of antiplatelet drugs, intraprocedural anticoagulants, intracoronary drugs, and tirofiban. There were no significant between-group differences in terms of in-hospital all-cause mortality, in-hospital major adverse cardiovascular events, or hospitalization costs. However, peak creatine kinase-myocardial band (CK-MB) levels were significantly lower in the delayed group. Conclusions For patients with STEMI undergoing emergency thrombus aspiration, a delayed stenting strategy appears to be non-inferior to immediate stenting strategy in terms of clinical efficacy and hospitalization costs, and may reduce the extent of myocardial injury. Delayed stenting strategy may allow for a more individualized surgical approach based on assessment of thrombus burden and lesion complexity.
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Affiliation(s)
- Bin Xie
- Department of Cardiovascular, The Second Affiliated Hospital of Medical College of Shantou University, 515000 Shantou, Guangdong, China
| | - Jilin Li
- Department of Cardiovascular, The Second Affiliated Hospital of Medical College of Shantou University, 515000 Shantou, Guangdong, China
| | - Weiwen Li
- Department of Cardiovascular, The Second Affiliated Hospital of Medical College of Shantou University, 515000 Shantou, Guangdong, China
| | - Ying Lin
- Department of Cardiovascular, The Second Affiliated Hospital of Medical College of Shantou University, 515000 Shantou, Guangdong, China
| | - Huaiwen Wang
- Department of Cardiovascular, The Second Affiliated Hospital of Medical College of Shantou University, 515000 Shantou, Guangdong, China
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40
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Saito Y, Kobayashi Y. Advances in Technology and Technique in Percutaneous Coronary Intervention: A Clinical Review. Intern Med 2024:4505-24. [PMID: 39343561 DOI: 10.2169/internalmedicine.4505-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
Percutaneous coronary intervention (PCI) has become the standard procedure for patients with angina and acute coronary syndrome. From the perspective of technology and technique, PCI has advanced over the last four decades, resulting in considerably improved clinical outcomes in patients with coronary artery disease in the current era. In this review article, we summarize recent advances, promising technologies, and areas for research in the field of PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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Bedford J, Fields KG, Collins GS, Lip GYH, Clifton DA, O’Brien B, Muehlschlegel JD, Watkinson PJ, Redfern OC. Atrial fibrillation after cardiac surgery: identifying candidate predictors through a Delphi process. BMJ Open 2024; 14:e086589. [PMID: 39322590 PMCID: PMC11425939 DOI: 10.1136/bmjopen-2024-086589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
OBJECTIVES This study was undertaken to identify potential predictors of atrial fibrillation after cardiac surgery (AFACS) through a modified Delphi process and expert consensus. These will supplement predictors identified through a systematic review and cohort study to inform the development of two AFACS prediction models as part of the PARADISE project (NCT05255224). Atrial fibrillation is a common complication after cardiac surgery. It is associated with worse postoperative outcomes. Reliable prediction of AFACS would enable risk stratification and targeted prevention. Systematic identification of candidate predictors is important to improve validity of AFACS prediction tools. DESIGN This study is a Delphi consensus exercise. SETTING This study was undertaken through remote participation. PARTICIPANTS The participants are an international multidisciplinary panel of experts selected through national research networks. INTERVENTIONS This is a two-stage consensus exercise consisting of generating a long list of variables, followed by refinement by voting and retaining variables selected by at least 40% of panel members. RESULTS The panel comprised 15 experts who participated in both stages, comprising cardiac intensive care physicians (n=3), cardiac anaesthetists (n=2), cardiac surgeons (n=1), cardiologists (n=4), cardiac pharmacists (n=1), critical care nurses (n=1), cardiac nurses (n=1) and patient representatives (n=2). Our Delphi process highlighted candidate AFACS predictors, including both patient factors and those related to the surgical intervention. We generated a final list of 72 candidate predictors. The final list comprised 3 demographic, 29 comorbidity, 4 vital sign, 13 intraoperative, 10 postoperative investigation and 13 postoperative intervention predictors. CONCLUSIONS A Delphi consensus exercise has the potential to highlight predictors beyond the scope of existing literature. This method proved effective in identifying a range of candidate AFACS predictors. Our findings will inform the development of future AFACS prediction tools as part of the larger PARADISE project. TRIAL REGISTRATION NUMBER NCT05255224.
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Affiliation(s)
- Jonathan Bedford
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Merseyside, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Region Nordjylland, Denmark
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Benjamin O’Brien
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Perioperative Medicine, Barts Health NHS Trust, London, UK
| | - Jochen D Muehlschlegel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Oliver C Redfern
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Lombardi M, Vergallo R, Costantino A, Bianchini F, Kakuta T, Pawlowski T, Leone AM, Sardella G, Agostoni P, Hill JM, De Maria GL, Banning AP, Roleder T, Belkacemi A, Trani C, Burzotta F. Development of machine learning models for fractional flow reserve prediction in angiographically intermediate coronary lesions. Catheter Cardiovasc Interv 2024; 104:472-482. [PMID: 39091119 DOI: 10.1002/ccd.31167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/02/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Fractional flow reserve (FFR) represents the gold standard in guiding the decision to proceed or not with coronary revascularization of angiographically intermediate coronary lesion (AICL). Optical coherence tomography (OCT) allows to carefully characterize coronary plaque morphology and lumen dimensions. OBJECTIVES We sought to develop machine learning (ML) models based on clinical, angiographic and OCT variables for predicting FFR. METHODS Data from a multicenter, international, pooled analysis of individual patient's level data from published studies assessing FFR and OCT on the same target AICL were collected through a dedicated database to train (n = 351) and validate (n = 151) six two-class supervised ML models employing 25 clinical, angiographic and OCT variables. RESULTS A total of 502 coronary lesions in 489 patients were included. The AUC of the six ML models ranged from 0.71 to 0.78, whereas the measured F1 score was from 0.70 to 0.75. The ML algorithms showed moderate sensitivity (range: 0.68-0.77) and specificity (range: 0.59-0.69) in detecting patients with a positive or negative FFR. In the sensitivity analysis, using 0.75 as FFR cut-off, we found a higher AUC (0.78-0.86) and a similar F1 score (range: 0.63-0.76). Specifically, the six ML models showed a higher specificity (0.71-0.84), with a similar sensitivity (0.58-0.80) with respect to 0.80 cut-off. CONCLUSIONS ML algorithms derived from clinical, angiographic, and OCT parameters can identify patients with a positive or negative FFR.
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Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genova, Italy
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tomasz Pawlowski
- Department of Cardiology, Central Hospital of Internal Affairs and Administration Ministry, Postgraduate Medical Education Centre, Warsaw, Poland
| | - Antonio M Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | | | - Giovanni L De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Tomasz Roleder
- Department of Cardiology, Hospital Wroclaw, Wroclaw, Poland
| | | | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
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Baranska M, Rychlik-Sych M, Dudarewicz M, Wiktorowska-Owczarek A, Owczarek J. Polymorphism rs662 (Q192R) of paraoxonase-1 and susceptibility to atherosclerosis of the coronary arteries. Arch Med Sci 2024; 20:1328-1333. [PMID: 39439706 PMCID: PMC11493066 DOI: 10.5114/aoms/192273] [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: 04/03/2024] [Accepted: 08/13/2024] [Indexed: 10/25/2024] Open
Abstract
Introduction The present study concerns a connection of the Q192RPON1 polymorphism with atherosclerosis requiring percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the Polish population. Methods A total of 282 individuals who underwent coronary angiography took part in this study. The polymorphism was determined with the PCR-RFLP method. Results The odds ratio for atherosclerosis in carriers of the 192RR genotype was 2.50 (p = 0.002). The median HDL-C concentration was significantly lower in the study group than the control group (p = 0.02). Conclusions The presence of the 192RR genotype and 192R allele are indicative of at least a two-fold increased risk of atherosclerosis requiring PCI or CABG in the Polish population.
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Affiliation(s)
- Malgorzata Baranska
- Department of Hospital Pharmacy, Laboratory of Pharmacogenetics, Medical University of Lodz, Poland
| | - Mariola Rychlik-Sych
- Department of Hospital Pharmacy, Laboratory of Pharmacogenetics, Medical University of Lodz, Poland
| | - Michal Dudarewicz
- Department of Hospital Pharmacy, Laboratory of Pharmacogenetics, Medical University of Lodz, Poland
| | | | - Jacek Owczarek
- Department of Hospital Pharmacy, Laboratory of Pharmacogenetics, Medical University of Lodz, Poland
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Ebik M, Gürdoğan M, Özkan U. The impact of being in the COVID-19 pandemic on in-hospital mortality of non-infected patients aged 80 years and older with ST-elevation myocardial ınfarction. J Geriatr Cardiol 2024; 21:768-774. [PMID: 39183956 PMCID: PMC11341530 DOI: 10.26599/1671-5411.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Affiliation(s)
- Mustafa Ebik
- Department of Cardiology, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey
| | - Muhammet Gürdoğan
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Uğur Özkan
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
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Zhang X, Du Y, Zhang T, Zhao Z, Guo Q, Ma X, Shi D, Zhou Y. Prognostic significance of triglyceride-glucose index in acute coronary syndrome patients without standard modifiable cardiovascular risk factors. Cardiovasc Diabetol 2024; 23:270. [PMID: 39044255 PMCID: PMC11267681 DOI: 10.1186/s12933-024-02345-5] [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: 02/28/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND A significant percentage of patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) are being identified. Nonetheless, the prognostic influence of the TyG index on adverse events in this type of patient remains unexplored. The aim of this study was to assess the prognostic value of the TyG index among ACS patients without SMuRFs for predicting adverse outcomes. METHODS This study involved 1140 consecutive patients who were diagnosed with ACS without SMuRFs at Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35 to 66 months after discharge. The objective of this study was to examine major adverse cardiac and cerebrovascular events (MACCE), which included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, as well as ischemia-driven revascularization. RESULTS During the median follow-up period of 48.3 months, 220 (19.3%) MACCE events occurred. The average age of the participants was 59.55 ± 10.98 years, and the average TyG index was 8.67 ± 0.53. In the fully adjusted model, when considering the TyG index as either a continuous/categorical variable, significant associations with adverse outcomes were observed. Specifically, for each 1 standard deviation increase in the TyG index within the highest TyG index group, there was a hazard ratio (HR) of 1.245 (95% confidence interval CI 1.030, 1.504) for MACCE and 1.303 (95% CI 1.026, 1.653) for ischemia-driven revascularization (both P < 0.05), when the TyG index was analyzed as a continuous variable. Similarly, when the TyG index was examined as a categorical variable, the HR (95% CI) for MACCE in the highest TyG index group was 1.693 (95% CI 1.051, 2.727) (P < 0.05) in the fully adjusted model, while the HR (95% CI) for ischemia-driven revascularization was 1.855 (95% CI 0.998, 3.449) (P = 0.051). Additionally, the TyG index was found to be associated with a poor prognosis among the subgroup. CONCLUSION The TyG index is correlated with poor prognosis in patients with ACS without SMuRFs, suggesting that it may be an independent predictive factor of adverse events among these individuals.
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Affiliation(s)
- Xiaoming Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Tianhao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Zehao Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Qianyun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
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Bai XP, Li JX, Ma JL, Tian XB, Han C, Wang Y. A comparative study examining the impact of coronary artery bypass grafting surgery with non-extracorporeal circulation on heart function and structure in patients with various forms of coronary heart diseases. Medicine (Baltimore) 2024; 103:e38844. [PMID: 39029005 PMCID: PMC11398806 DOI: 10.1097/md.0000000000038844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 07/21/2024] Open
Abstract
The aim of this study is to assess alterations in heart function and structure in patients diagnosed with non-ST segment elevation acute myocardial infarction (NSTEAMI), unstable angina (UA), and stable angina (SA) 1 year after undergoing off-pump coronary artery bypass grafting (OPCABG) performed without extracorporeal circulation. A total of 182 patients who underwent OPCABG were included and classified into 3 groups based on their preoperative diagnosis: the NSTEAMI group (n = 68), the UA group (n = 64), and the SA group (n = 50). Cardiac ultrasonography data were collected for all groups both preoperatively and 1 year postoperatively. Clinical data were subjected to statistical analysis. In the NSTEAMI group, postoperative observations revealed increases in left ventricular stroke volume and left ventricular end-systolic diameter, along with reductions in left ventricular end-diastolic volume (LVEDV) and left ventricular end-diastolic diameter (LVEDD) 1-year post-surgery. The UA group demonstrated decreases in LVEDV and LVEDD 1-year post-surgery. Similarly, the SA group exhibited an increase in left ventricular ejection fraction (LVEF) and reductions in LVEDV and LVEDD 1-year post-surgery. Comparative analysis of cardiac ultrasonography data revealed that the NSTEAMI group displayed significantly lower left ventricular stroke volume and notably higher left ventricular end-systolic diameter and volume compared to the UA and SA groups 1-year post-surgery. Furthermore, the SA group exhibited significantly elevated LVEF compared to the UA and NSTEAMI groups 1-year post-surgery. Cardiac ultrasonography findings indicate that all 3 groups exhibited improvements in cardiac function and left ventricular structure 1-year post-surgery. However, the NSTEAMI group demonstrated more substantial improvements in comparison to the UA and SA groups.
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Affiliation(s)
- Xue-Peng Bai
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jia-Xing Li
- Department of Cardiovascular Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jin-Lan Ma
- Department of Intensive Care Unit Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Xin-Bao Tian
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Chao Han
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Ningxia, China
| | - Yun Wang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Ningxia, China
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Monizzi G, Di Lenarda F, Gallinoro E, Bartorelli AL. Myocardial Ischemia: Differentiating between Epicardial Coronary Artery Atherosclerosis, Microvascular Dysfunction and Vasospasm in the Catheterization Laboratory. J Clin Med 2024; 13:4172. [PMID: 39064213 PMCID: PMC11277575 DOI: 10.3390/jcm13144172] [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: 05/10/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Ischemic heart disease is currently the most common cause of mortality and morbidity worldwide. Although myocardial ischemia is classically determined by epicardial coronary atherosclerosis, up to 40% of patients referred for coronary angiography have no obstructive coronary artery disease (CAD). Ischemia with non-obstructive coronary artery disease (INOCA) has typically been underestimated in the past because, until recently, its prognostic significance was not completely clear. This review aims to highlight differences and patterns in myocardial ischemia caused by epicardial obstructive CAD, coronary microvascular dysfunction (CMD) or vasomotor abnormalities and to elucidate the state of the art in correctly diagnosing these different patterns.
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Affiliation(s)
- Giovanni Monizzi
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (F.D.L.); (E.G.); (A.L.B.)
| | - Francesca Di Lenarda
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (F.D.L.); (E.G.); (A.L.B.)
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (F.D.L.); (E.G.); (A.L.B.)
| | - Antonio Luca Bartorelli
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy; (F.D.L.); (E.G.); (A.L.B.)
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, 20122 Milan, Italy
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Shamkhani W, Rashid M, Moledina S, Ludman P, Curzen N, Wijeysundera HC, Grines CL, Mamas MA. Complex High-Risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Nonsurgical Centres. Can J Cardiol 2024; 40:1237-1246. [PMID: 38215968 DOI: 10.1016/j.cjca.2024.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Limited data are available on complex high-risk percutaneous coronary intervention (CHiP) trends and outcomes in nonsurgical centres (NSCs), particularly in health care systems where most centres are NSCs. METHODS Using data from a national registry, we studied the characteristics and outcomes of CHiP procedures performed for stable angina from 2006 to 2017 according to the presence or absence of on-site surgical cover. Multivariate regression analyses and propensity score matching were used to determine risks for in-hospital death, major bleeding, and major cardiovascular or cerebral events (MACCE). RESULTS Out of 134,730 CHiP procedures, 42,433 (31.5%) were performed in NSCs, increasing from 12.5% in 2006 to 42% in 2017. Compared with surgical centres (SCs), patients who had a CHiP procedure undertaken in NSCs were, on average, 2.4 years older and had a greater prevalence of cardiovascular risks. Common CHiP procedures performed in NSCs included poor left ventricular function (41.6%), chronic renal failure (38.8%), and chronic total occlusion percutaneous coronary intervention (31.1%). NSC-based CHiP is associated with lower odds of mortality (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.5-0.8) and major bleeding (aOR 0.7, 95% CI 0.6-0.8). In both groups, MACCE odds were similar (aOR 1.0, 95% CI 0.9-1.1). CONCLUSIONS CHiP numbers have steadily increased in NSCs. NSC patients were older and had a higher prevalence of cardiovascular risks than SC patients. Mortality and major bleeding odds were significantly lower in those cases undertaken in NSCs, although MACCE odds were not different between the groups.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, United Kingdom
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom; Coronary Research Group, University Hospital Southampton, Southampton, United Kingdom
| | | | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Sádaba Sagredo M, Subinas Elorriaga A, Romaní Méndez S, Valcárcel Paz D, Llanos RA, García CL, Quirós A, Muñoz García E, Sánchez Recalde Á, Robles Alonso J, Lozano Ruiz-Poveda F, Irazusta FJ, Redondo A, Abellás Sequeiros RA, Rodríguez-Leor O. [Discordance between fractional flow reserve and nonhyperemic index with a fiber-optic pressure wire. READI EPIC-14]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:158-165. [PMID: 40415774 PMCID: PMC12097321 DOI: 10.24875/recic.m24000448] [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: 10/30/2023] [Accepted: 01/23/2024] [Indexed: 05/27/2025] Open
Abstract
Introduction and objectives Functional assessment of coronary stenosis severity with the piezo-electric sensor pressure wire has shown a discrepancy of up to 20% between hyperemic and nonhyperemic indexes. No data are available with fiber-optic pressure wires. The aim of this study was to evaluate the incidence and factors related to the diagnostic discordance between these indexes with a fiber-optic pressure wire. Secondary aims were to assess diagnostic reproducibility in 2 consecutive measurements of fractional flow reserve (FFR) and diastolic pressure ratio (dPR) and evaluate the drift rate. Methods We conducted a prospective, observational multicenter study in patients undergoing functional assessment with a fiber-optic pressure wire. We took 2 consecutive measurements of the dPR (cutoff point 0.89) and FFR (cut-off point 0.80) in each lesion analyzed. The diagnostic correlation between 2 measurements with the same technique and between the 2 techniques (dPR and FFR) was assessed. Clinical and angiographic factors associated with discordance (FFR-/dPR+ and FFR+/dPR-) between the 2 techniques were analyzed. Results We included 428 cases of stenosis (361 patients). Diagnostic reproducibility was 95.8% for the dPR, with a correlation coefficient between the 2 measurements (dPR1 and dPR2) of 0.974 (P < .0001). For FFR, the diagnostic reproducibility was 94.9% with a correlation coefficient (FFR1 and FFR2) of 0.942 (P < .0001). The diagnostic discordance was 18.2% (FFR+/dPR- 8.2% and FFR-/dPR+ 10%). Among the variables analyzed, the factors significantly associated with FFR-/dPR+ discordance in the multivariate analysis were hypertension and intracoronary adenosine. The only factors significantly associated with FFR+/dPR- discordance were age < 75 years and stenosis > 60%. The drift rate was 5.7%. Conclusions Although FFR and dPR measurements with a fiber-optic pressure wire have excellent reproducibility and a low drift rate, the discordance rate remains similar to those in previous studies with a piezo-electric pressure wire. FFR-/dPR+ discordance is associated with intracoronary adenosine and hypertension. FFR+/dPR- discordance is related to age < 75 years old and stenosis > 60%.
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Affiliation(s)
- Mario Sádaba Sagredo
- Servicio de Cardiología, OSI Galdakao-Barrualde, Galdakao, Bizkaia, EspañaServicio de CardiologíaOSI Galdakao-BarrualdeBizkaiaEspaña
| | - Asier Subinas Elorriaga
- Servicio de Cardiología, OSI Galdakao-Barrualde, Galdakao, Bizkaia, EspañaServicio de CardiologíaOSI Galdakao-BarrualdeBizkaiaEspaña
| | - Sebastián Romaní Méndez
- Servicio de Cardiología, Hospital San Pedro de Alcántara, Cáceres, EspañaServicio de CardiologíaHospital San Pedro de AlcántaraCáceresEspaña
| | - Daniel Valcárcel Paz
- Servicio de Cardiología, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, EspañaServicio de CardiologíaCorporación Sanitaria Parc TaulíSabadellEspaña
| | - Rocío Angulo Llanos
- Servicio de Cardiología, Hospital General Universitario de Guadalajara, Guadalajara, EspañaServicio de CardiologíaHospital General Universitario de GuadalajaraGuadalajaraEspaña
| | - Carlos Lara García
- Servicio de Cardiología, Hospital Regional Universitario Carlos Haya, Málaga, EspañaServicio de CardiologíaHospital Regional Universitario Carlos HayaMálagaEspaña
| | - Alicia Quirós
- Departamento de Matemáticas, Universidad de León, León, EspañaDepartamento de MatemáticasUniversidad de LeónLeónEspaña
| | - Erika Muñoz García
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, EspañaServicio de CardiologíaHospital Clínico Universitario Virgen de la VictoriaMálagaEspaña
| | - Ángel Sánchez Recalde
- Servicio de Cardiología, Hospital Sanitas La Moraleja, Alcobendas, Madrid, EspañaServicio de CardiologíaHospital Sanitas La MoralejaMadridEspaña
| | - Javier Robles Alonso
- Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, EspañaServicio de CardiologíaHospital Universitario de BurgosBurgosEspaña
| | - Fernando Lozano Ruiz-Poveda
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Cuidad Real, EspañaServicio de CardiologíaHospital General Universitario de Ciudad RealCuidad RealEspaña
| | - Francisco Javier Irazusta
- Servicio de Cardiología, Policlínica Gipuzkoa, Donostia, Bizkaia, EspañaServicio de CardiologíaPoliclínica GipuzkoaDonostiaEspaña
| | - Alfredo Redondo
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, EspañaServicio de CardiologíaHospital Clínico Universitario de ValladolidValladolidEspaña
| | - Rosa Alba Abellás Sequeiros
- Servicio de Cardiología, Hospital Lucus Augusti, Lugo, EspañaServicio de CardiologíaHospital Lucus AugustiLugoEspaña
| | - Oriol Rodríguez-Leor
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, EspañaServicio de CardiologíaHospital Universitari Germans Trias i PujolBarcelonaEspaña
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50
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Doolub G, Ly HQ, Marquis-Gravel G. Should Rotational Atherectomy Be Used More Often in STEMI to Treat Calcified Culprit Lesions? Can J Cardiol 2024; 40:1234-1236. [PMID: 38278320 DOI: 10.1016/j.cjca.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Affiliation(s)
- Gemina Doolub
- From the Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Hung Q Ly
- From the Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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