Showing papers in "Coronary Artery Disease in 2018"
TL;DR: QFR was correlated highly with iFR as well as FFR, suggesting it might be reliable for assessing the physiological severity of coronary stenosis in the angiographic intermediate lesions.
Abstract: ObjectiveQuantitative flow ratio (QFR) is a novel physiological index of the severity of coronary stenosis. The aim of the present study was to investigate the relationship between QFR and the instantaneous wave-free ratio (iFR).Patients and methodsWe analyzed contrast-flow QFR, iFR, and fractional
36 citations
TL;DR: The current scope of the problem for coronary artery disease, emerging constructs in its pathobiology and common clinical phenotypes, potentially useful biomarkers, clinical trials designed specifically to test the 'inflammation hypothesis' of disease, and the interface of pathobiological and precision medicine as a foundation for diagnosis, management, and future advances in the diagnosis, prognosis, natural history, prevention and optimal management are summarized.
Abstract: The worldwide prevalence of cardiovascular disease in general and atherosclerotic coronary artery disease in particular is a health and economic concern of unparalleled proportion. Despite a long history of astute observations beginning in 1575 made by Fallopius, followed by those of von Rokatansky, Virchow, Osler, and Ross, and incremental knowledge of the pathobiology of atherosclerosis to include varying stages of inflammation, response to internally and externally mediated vascular injury, and impaired homeostasis, gaps in the field's understanding persist. Here, we summarize the current scope of the problem for coronary artery disease, emerging constructs in its pathobiology and common clinical phenotypes, potentially useful biomarkers, clinical trials designed specifically to test the 'inflammation hypothesis' of disease, and the interface of pathobiology and precision medicine as a foundation for diagnosis, management, and future advances in the diagnosis, prognosis, natural history, prevention, and optimal management.
34 citations
TL;DR: It is shown that oral hydration is not inferior to intravenous hydration for the prevention of CI-AKI in patients with normal or mild-to-moderate renal dysfunction undergoing coronary angiography or intervention.
Abstract: Background The effectiveness of oral hydration in preventing contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography or intervention has not been well established. This study aims to evaluate the efficacy of oral hydration compared with intravenous hydration and other frequently used hydration strategies. Methods PubMed, Embase, Web of Science, and the Cochrane central register of controlled trials were searched from inception to 8 October 2017. To be eligible for analysis, studies had to evaluate the relative efficacy of different prophylactic hydration strategies. We selected and assessed the studies that fulfilled the inclusion criteria and carried out a pairwise and network meta-analysis using RevMan5.2 and Aggregate Data Drug Information System 1.16.8 software. Results A total of four studies (538 participants) were included in our pairwise meta-analysis and 1754 participants from eight studies with four frequently used hydration strategies were included in a network meta-analysis. Pairwise meta-analysis indicated that oral hydration was as effective as intravenous hydration for the prevention of CI-AKI (5.88 vs. 8.43%; odds ratio: 0.73; 95% confidence interval: 0.36-1.47; P>0.05), with no significant heterogeneity between studies. Network meta-analysis showed that there was no significant difference in the prevention of CI-AKI. However, the rank probability plot suggested that oral plus intravenous hydration had a higher probability (51%) of being the best strategy, followed by diuretic plus intravenous hydration (39%) and oral hydration alone (10%). Intravenous hydration alone was the strategy with the highest probability (70%) of being the worst hydration strategy. Conclusion Our study shows that oral hydration is not inferior to intravenous hydration for the prevention of CI-AKI in patients with normal or mild-to-moderate renal dysfunction undergoing coronary angiography or intervention.
24 citations
TL;DR: In this article, the authors carried out a retrospecific analysis of myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) to determine MINOCA differential characteristics, the main etiologies, and prognostic outcomes.
Abstract: BackgroundMyocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. We aim to determine MINOCA differential characteristics, the main etiologies, and prognostic outcomes.Patients and methodsWe carried out a retrospe
18 citations
TL;DR: This study suggests that AIs may be associated with vascular injury, more pronounced among women with a higher baseline cardiovascular risk factors and among women at high risk for cardiovascular disease who are treated with AIs for hormone receptor-positive breast cancer.
Abstract: Purpose Data on long-term cardiovascular effects of aromatase inhibitors (AIs) are limited and conflicting. We sought to evaluate the effect of AIs on peripheral endothelial function in patients with breast cancer. Patients and methods This is an observational, prospective study of postmenopausal women with breast cancer who were enrolled at the initiation of cancer treatment. All participants underwent baseline and 6-12 months of follow-up, with peripheral endothelial function testing to measure reactive hyperemia index (RHI). The primary aim was to assess endothelial function deterioration between baseline and follow-up. The secondary aim was to assess the correlation of cardiovascular risk factors with RHI change in women treated with versus without AIs. Results Among 97 patients, mean (SD) age was 66 (7) years; 59 (61%) women had AI treatment, and 38 women did not (control group). There were no significant differences in baseline characteristics between the groups. Mean (SD) RHI at baseline in the treatment group did not differ significantly from that in the control group [2.2 (0.6) vs. 2.1 (0.5); P=0.15]. The mean (SD) time between baseline and follow-up studies was 262 (60) days. RHI deterioration, evaluated as a dichotomous variable with a 20% cutoff, was significantly more common in the AI group [17 (29%) vs. 4 (11%); P=0.04]. After adjusting for age, treatment with AIs was significantly associated with an RHI deterioration of at least 20% from baseline (odds ratio: 3.6; 95% confidence interval: 1.10-12.07; P=0.03). Further, in the intervention group, women with at least three traditional cardiovascular risk factors were more likely to have RHI deterioration compared to women with λ2 risk factors [10 (42%) vs. 7 (20%); P=0.04]. Amongst women with three or more cardiovascular risk factors, the percentage with RHI deterioration was higher in the AI group than the control group [10/24 (42%) vs. 3/22 (14%); P=0.04], whereas in women with up to two risk factors, the percentage with RHI deterioration was similar between the groups [7/35 (20%) vs. 1/16 (6%); P=0.21]. Conclusion This study suggests that AIs may be associated with vascular injury. The effect is more pronounced among women with a higher baseline cardiovascular risk factor burden. These findings have potentially important implications, particularly among women at high risk for cardiovascular disease who are treated with AIs for hormone receptor-positive breast cancer.
13 citations
TL;DR: This study gives unique insights into structural myocardial alterations in patients with angina, unobstructed coronaries and abnormal coronary vasomotion, suggesting that a combination of both structural and functional alterations is frequent.
Abstract: BackgroundPatients with angina yet having unobstructed coronaries are found in ∼50% of cases undergoing invasive angiography. Coronary spasm and microvascular dysfunction can be responsible for the clinical presentation in ∼60% of cases. However, little is known about structural changes in the myoca
13 citations
TL;DR: AMI patients with anemia on admission had higher incidence of MI, target vessel revascularization, and total MACE over the 5-year follow-up, compared with patients without anemia.
Abstract: BackgroundAcute myocardial infarction (AMI) is a progressive disease in Korea and active treatment strategies can improve the clinical outcomes. In the CADILLAC trial, anemia on admission was associated strongly with adverse outcomes and increased mortality in AMI. However, it remains controversial
12 citations
TL;DR: The total exercise duration in the modified Bruce treadmill test at the 6-month follow-up did not differ significantly in patients treated with CSWT compared with optimal medical therapy alone, and CSWT exerted a neutral effect on the quality of life and level of angina.
Abstract: BackgroundDespite major advances in managing coronary artery disease and continuous research on alternative techniques to enhance myocardial perfusion and reduce symptoms, coronary artery disease is still one of the leading causes of adult disability worldwide. Cardiac shock-wave therapy (CSWT) has
12 citations
TL;DR: A staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population and was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality.
Abstract: BackgroundThe Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI
11 citations
TL;DR: In patients with ACS caused by plaque erosion who were managed conservatively without stenting, tirofiban provided additional benefit in reducing residual thrombus without an increased risk for bleeding.
Abstract: Objective Recent studies suggest that conservative management with antithrombotic therapy without stenting may be an option in selected patients with acute coronary syndrome (ACS). We evaluated whether a glycoprotein IIb/IIIa inhibitor, tirofiban, would offer additional benefit in patients with plaque erosion presenting with ACS who were treated with antiplatelet therapy without stenting. Patients and methods Forty-nine patients who completed 1-year follow-up optical coherence tomography imaging in the EROSION study were divided into two groups: tirofiban (n=32) versus no tirofiban (n=17). Thrombus volume, thrombus burden, and the incidence of major adverse cardiovascular events were evaluated. Results At baseline, the tirofiban group had similar thrombus volume [3.73 (1.27-12.49) vs. 3.51 (1.70-8.65) mm, P=0.983] and marginally greater thrombus burden [17.9 (10.1-26.1) vs. 10.6 (6.8-19.0)%, P=0.097]. At 1 month, the tirofiban group had smaller residual thrombus volume [0.00 (0.00-1.78) vs. 0.94 (0.07-4.20) mm, P=0.054], thrombus burden [0.0 (0.0-6.4) vs. 7.0 (1.8-14.8)%, P=0.024], and greater reduction of thrombus volume (85.4±24.6 vs. 67.1±27.1%, P=0.021). These differences were maintained up to 1 year. Complete resolution of thrombus at 1 month was more frequent in the tirofiban group (53.1 vs. 17.6%, P=0.031). None of the patients experienced major bleeding during the initial hospitalization. The 1-year major adverse cardiovascular events rate was not different (5.6 vs. 15.0%, P=0.336). Conclusion In patients with ACS caused by plaque erosion who were managed conservatively without stenting, tirofiban provided additional benefit in reducing residual thrombus without an increased risk for bleeding.
10 citations
TL;DR: The evidence basis of the recommendations for β-blockers in the US guidelines are assessed and emerging concerns about the use of β- blockers and other heart rate-lowering medications in patients with a preserved ejection fraction are discussed that suggest that their long-term adverse outcomes may outweigh their antianginal benefits.
Abstract: β-Blockers are a recommended therapy in patients with acute myocardial infarction and coronary artery disease. β-Blockers markedly and unequivocally reduce mortality in patients with myocardial infarction and coronary artery disease with heart failure and a reduced ejection fraction. However, the mortality effects of β-blockers in patients with a preserved ejection fraction are not established even though they represent the majority of patients with coronary artery disease. In this review, we will assess the evidence basis of the recommendations for β-blockers in the US guidelines and discuss emerging concerns about the use of β-blockers and other heart rate-lowering medications in patients with a preserved ejection fraction that suggest that their long-term adverse outcomes may outweigh their antianginal benefits.
TL;DR: In the present registry of a high-risk population, clopidogrel was the most used P2Y12 inhibitor at hospital discharge, confirming the ‘paradox’ to treat sicker patients with the less effective drug.
Abstract: Background Patients with diabetes mellitus (DM) and acute coronary syndromes have a greater level of platelet aggregation and a poor response to oral antiplatelet drugs. Clopidogrel is still widely used in clinical practice, despite the current evidence favoring ticagrelor and prasugrel. Aim The aim of this study was to investigate the determinants of clopidogrel use in the population of the multicenter prospective 'Acute Coronary Syndrome and Diabetes Registry' carried out during a 9-week period between March and May 2015 at 29 Hospitals. Patients and methods A total of 559 consecutive acute coronary syndrome patients [mean age: 68.7±11.3 years, 50% ST-elevation myocardial infarction (STEMI)], with 'known DM' (56%) or 'hyperglycemia' at admission, were included in the registry; 460 (85%) patients received a myocardial revascularization. Results At hospital discharge, dual antiplatelet therapy was prescribed to 88% of the patients (clopidogrel ticagrelor and prasugrel to 39, 38, and 23%, respectively). Differences in P2Y12 inhibitor administration were recorded on the basis of history of diabetes, age, and clinical presentation (unstable angina/non-STEMI vs. non-STEMI). On univariate analysis, age older than 75 years or more, known DM, peripheral artery disease, previous myocardial infarction, previous revascularization, complete revascularization, previous cerebrovascular event, creatinine clearance, unstable angina/non-STEMI at presentation, Global Registry of Acute Coronary Events Score, EuroSCORE, CRUSADE Bleeding Score, and oral anticoagulant therapy were significantly associated with clopidogrel choice at discharge. On multivariate analysis, only oral anticoagulant therapy and the CRUSADE Bleeding Score remained independent predictors of clopidogrel prescription. Conclusion In the present registry of a high-risk population, clopidogrel was the most used P2Y12 inhibitor at hospital discharge, confirming the 'paradox' to treat sicker patients with the less effective drug. Diabetic status, a marker of higher thrombotic risk, did not influence this choice; however, bleeding risk was taken into account.
TL;DR: The current evidence suggests that the risk of major adverse cardiac events, repeat revascularization, and cardiac death is reduced by CR, and further large trials are required to provide better guidance for optimum management of patients with STEMI and MVD.
Abstract: Introduction: Despite the recent findings in randomized clinical trials (RCTs) with limited sample sizes and the updates in clinical guidelines, the current available data for the complete revascul ...
TL;DR: The EBI3 rs428253 CC genotype was associated with an increased risk of CHD in the Chinese Zhuang population, although no significant difference in IL-35 levels was observed between genotypes in healthy controls.
Abstract: Objectives Inflammatory cytokines play an important role in the pathogenesis of cardiovascular disease. Few studies have investigated the association between interleukin-35 (IL-35) genetic variants and the risk of coronary heart disease (CHD). We examined the association between IL-35 polymorphisms and CHD in the Chinese Zhuang population. Patients and methods A total of 707 CHD patients and 707 age-matched and sex-matched controls were enrolled in this case-control study. Genotypes of the single nucleotide polymorphisms (SNPs) of IL-35, including rs428253, rs6613, rs9807813, rs2243115, rs568408, rs582054, rs583911, rs4740, and rs393581, were examined by MassArray. Plasma IL-35 level was measured using an enzyme-linked immunosorbent assay. The multivariate logistic regression model was used to evaluate the association between the SNPs and the risk of CHD. Results In the Chinese Zhuang population, compared with the GG genotype of EBI3 rs428253, individuals with the CC genotype had a 2.02-fold (95% confidence interval: 1.07-3.84, P=0.031) higher risk of CHD. Further adjustment for potential risk factors did not alter the positive association (CC vs. GG, odds ratio=2.30, 95% confidence interval: 1.16-4.54, P=0.042). SNPs rs4740, rs2243115, rs568408, and rs582054 were not statistically related to the risk of CHD. The plasma IL-35 levels showed a marginally significant difference between rs428253 genotypes [GG: 13.39 (7.89-19.25) vs. CC+GC: 17.53 (8.98-22.56) pg/ml, P=0.057]. Conclusion The EBI3 rs428253 CC genotype was associated with an increased risk of CHD in the Chinese Zhuang population, although no significant difference in IL-35 levels was observed between genotypes in healthy controls.
TL;DR: Prehospital delay periods for patients undergoing primary PCI showed variations over time, and Multivariate logistic regression model showed that older age, diabetes, female sex, and first STEMI were associated independently with prehospital delay more than 2 h.
Abstract: OBJECTIVE Delay in seeking medical care following symptom onset in patients with acute ST-elevation myocardial infarction (STEMI) is related to increased morbidity and mortality. Actual trends of prehospital delays in patients hospitalized with STEMI have not been well characterized. We evaluated trends in the length of time that had elapsed from symptom onset to hospital presentation among STEMI patients admitted to our hospital. PATIENTS AND METHODS We retrospectively studied 2203 consecutive patients hospitalized for acute STEMI who underwent primary percutaneous coronary intervention (PCI) between January 2008 and December 2016. Information on the delay in time from symptom onset to presentation at hospital was extracted from the patients' medical records. RESULTS Over the 9-year study period, the median duration of prehospital delay for patients undergoing primary PCI showed significant variations, being maximal between the years 2013 and 2014 (150 vs. 90 min, respectively, P<0.001). A significant increase was found in the proportion of patients with prehospital delay less than 2 h, being maximal between the years 2011 and 2013 (64 vs. 47%, P=0.001). An opposite trend was found for decrease in patients with prehospital delay more than 6 h, being maximal between 2008 and 2015 (32 vs. 23%, P=0.001). Multivariate logistic regression model showed that older age, diabetes, female sex, and first STEMI were associated independently with prehospital delay more than 2 h. CONCLUSION Prehospital delay periods for patients undergoing primary PCI showed variations over time. More efforts are needed to educate at-risk populations about seeking early medical assistance.
TL;DR: Nonagenarians undergoing PCI because of SA may have similar outcomes as patients younger than 90 years, and in ACS presentation, they may have worse outcomes than younger counterparts.
Abstract: BACKGROUND Despite an increase in the proportion of nonagenarians in demographic structure, there is still a paucity of data on the utilization and outcome of percutaneous coronary interventions (PCIs) in this population. Also, very old patients are under-represented in randomized clinical trials and their treatment is still an emerging challenge. Thus, we sought to compare patient profiles and periprocedural outcomes of PCI in nonagenarians and patients younger than 90 years. PATIENTS AND METHODS Data were based on the Polish National Registry of PCI (ORPKI). A total of 651 080 consecutive patients with stable angina (SA) (n=260 920) or acute coronary syndrome (ACS) (n=390 160) undergoing PCI with at least one stent implanted were included. Patients were stratified according to age (<90 and ≥90 years). RESULTS Of all included patients, 4413 (0.7%) were older than or equal to 90 years. A similar rate of periprocedural complications was observed in both groups. However, cardiac arrest during both angiography and PCI occurred more often in nonagenarians (0.21 vs. 0.83%; 0.42 vs. 1.07%, respectively, for both P=0.001). Similarly, periprocedural mortality was higher in patients older than or equal to 90 years (0.27 vs. 1.88%; P=0.001). There were no differences in periprocedural outcomes between groups in the SA setting. However, a higher rate of periprocedural cardiac arrest [1971 (0.51%) vs. 43 (1.15%); P=0.001] and mortality [1622 (0.42%) vs. 83 (2.2%); P=0.001] were observed in nonagenarians compared with younger counterparts admitted with ACS. CONCLUSION Nonagenarians undergoing PCI because of SA may have similar outcomes as patients younger than 90 years. In ACS presentation, they may have worse outcomes than younger counterparts.
TL;DR: In this multicenter, prospective registration trial representing contemporary technique, favorable procedural success and early clinical outcomes inform technique and strategy using dedicated CTO guidewires and microcatheters in a high lesion complexity patient population.
Abstract: BackgroundLimited study has detailed the procedural outcomes and utilization of contemporary coronary guidewires and microcatheters designed for chronic total occlusion (CTO) percutaneous revascularization and with application of modern techniques.Patients and methodsA prospective, multicenter, sing
TL;DR: There are significant differences in plaque morphology between East Asian and White patients even after controlling for confounders, and may have to be taken into consideration when interpreting the results of future research.
Abstract: AimsPrevalence of coronary artery disease as well as cardiac mortality varies between Asian and White patients. However, the link between race and plaque characteristics in patients with coronary artery disease remains largely unexplored. Thus, we aimed to investigate the detailed culprit plaque cha
TL;DR: The risk score based on simple clinical parameters might be useful for risk stratification for VF/VT in patients with ST-segment elevation myocardial infarction treated invasively and was strongly dependent on timing of arrhythmia.
Abstract: OBJECTIVES The primary aim of the study was to evaluate risk factors for ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and to develop the risk score for prediction of VF/VT in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. The secondary aim was to assess the effect of VF/VT on mortality depending on timing of arrhythmia. PATIENTS AND METHODS We analyzed 4363 consecutive patients with STEMI treated invasively. Among them, 163 patients with pre-reperfusion arrhythmia were excluded from the study. Group ventricular arrhythmias (VA) encompassed patients with VF/VT - those with reperfusion-induced arrhythmia were included into group VA1, whereas group VA2 consisted of patients with postreperfusion arrhythmia. The control group comprised patients free of VF/VT. RESULTS VF or VT occurred in 313 (7.45%) patients - group VA1 encompassed 103 (32.9%) and group AV2 210 (67.1%) patients. Cardiogenic shock on admission [hazard ratio (HR) 3.5], new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior myocardial infarction (HR 1.6) and symptom-to-balloon time more than 3 h (HR 1.3) were the independent predictors of VF/VT occurrence. In group VA2, the in-hospital and long-term mortality were 4- and 1.5-fold higher than in the arrhythmia-free population (20.5 vs. 4.5% and 36.2 vs. 22.6%, respectively; P<0.001). On the contrary, in group VA1, the long-term mortality was not significantly higher compared with the control group (26.2 vs. 22.6%; P=NS), whereas in-hospital mortality was almost three-fold increased (12.5 vs. 4.5%, respectively; P<0.001). CONCLUSION The risk score based on simple clinical parameters might be useful for risk stratification for VF/VT in patients with STEMI. The predictive value of VF/VT was strongly dependent on timing of arrhythmia.
TL;DR: Short-axis reconstruction during dobutamine stress in the diastolic phase showed no wall motion abnormalities and oblique reconstruction of the LCA during do butamine stress and during systolic phase, which showed no compression of theLCA.
TL;DR: In this large cohort of patients with STEMI, FHx+ was associated with better short-term and long-term outcomes, and may help to construct a prediction model for patients admitted to cardiac ICU.
Abstract: BACKGROUND A positive family history (FHx+) of coronary artery disease (CAD) is a well-known risk factor for the development of coronary pathology in first-degree relatives. We sought to evaluate the association between FHx+ of CAD and clinical outcomes in patients presenting with a first ST-elevation myocardial infarction (STEMI). PATIENTS AND METHODS A historical cohort study of all patients with a first STEMI, who were admitted to cardiac ICU between 2007 and 2016, was carried out. Univariate and multivariate analyses were carried out to compare patients with or without a FHx+ of CAD. In further analysis, propensity score matching was used to reduce differences in baseline characteristics. RESULTS The study included 1785 patients, 365 (20%) of whom had FHx+ of CAD. FHx+ was associated with decreased in-hospital major adverse events and long-term mortality rates (hazard ratio=0.208, 95% confidence interval: 0.051-0.857; P=0.03). After propensity score matching, patients with FHx+ had decreased long-term mortality rates (hazard ratio=0.105, 95% confidence interval: 0.033-0.33; P<0.001). CONCLUSION In this large cohort of patients with STEMI, FHx+ was associated with better short-term and long-term outcomes. Understanding the rule of FHx in patients with STEMI is important to evaluate the prognosis and may help to construct a prediction model for patients admitted to cardiac ICU.
TL;DR: It is suggested that high CACS measured with CTCA influences the occurrence of periprocedural myocardial infarction, which is associated with worse cardiovascular outcomes.
Abstract: BACKGROUND This study aimed to evaluate whether the coronary artery calcium score (CACS) measured with computed tomography coronary angiography (CTCA) predicts periprocedural myocardial infarction (PMI) in patients undergoing an elective percutaneous coronary intervention (PCI). PATIENTS AND METHODS A total of 197 patients with stable angina underwent elective PCI after CTCA. We evaluated CACS using CTCA and assessed the clinical risk factors for PMI. PMI was defined as an elevation of troponin I levels exceeding five times the upper limit of normal within 24 h after PCI. Patients were followed up for major adverse cardiovascular events for a median of 4.6 years. RESULTS The prevalence of PMI was 18.7% (37 patients) and patients with PMI showed a trend toward a higher CACS (721±779 vs. 498±842, P=0.142). The prevalence of PMI showed a positive correlation with the CACS distribution [8.0%, first interquartile range (IQR); 14.3%, second IQR; 22.4%, third IQR; 30.6%, fourth IQR; P=0.002]. The CACS cut-off value for PMI was greater than 113 (area under the curve: 0.670; 95% confidence interval: 0.600-0.736; P<0.001). Patients with CACS greater than 113 before PCI showed a higher prevalence of PMI (26.2 vs. 5.6%, odds ratio: 5.994; P<0.001). Multivariate analysis showed that CACS greater than 113 was the main predictor for PMI (odds ratio: 3.61, 95% confidence interval: 1.145-11.363; P=0.028). In this study, the cumulative incidence of major adverse cardiovascular event was higher in patients with PMI (54.1 vs. 10.6%; P<0.001). CONCLUSION This study suggests that high CACS measured with CTCA influences the occurrence of PMI, which is associated with worse cardiovascular outcomes.
TL;DR: Improved procedural technique and more strict patient selection may explain a significant decrease in the absorb BVS thrombosis rates during the recruitment period of the large-scale German–Austrian ABSORB RegIstRy.
Abstract: BACKGROUND In randomized clinical trials, the risk of thrombotic events with the absorb bioresorbable vascular scaffold (BVS) was significantly higher than with metallic drug-eluting stents. We evaluated predictors of scaffold thrombosis in the large-scale, multicenter German-Austrian ABSORB RegIstRy. METHODS AND RESULTS 3178 patients with treatment of 4252 lesions using 5020 scaffolds were included. Follow-up rate at 6 months was 97.4%. Forty-five (1.42%) patients experienced definite/probable scaffold thrombosis during follow-up. Multiple regression analysis showed implantation of absorb BVS in bifurcation lesions [odds ratio (OR): 4.43; 95% confidence interval (CI): 1.69-11.59; P=0.0024] or treatment in the years 2013/2014 (OR: 1.88; 95% CI: 1.02-3.47; P=0.04) to be significant predictors of scaffold thrombosis. Excluding bifurcation lesions, the incidence of definite/probable scaffold thrombosis decreased from 1.8% (95% CI: 1.17-2.64%) in 2013/2014 to 0.89% (95% CI: 0.5-1.46%) in 2015/2016. In the latter period, absorb BVS were implanted more often in younger patients with less complex de novo lesions, and debulking devices and postdilatation were used more frequently. Between the two treatment periods, there was a significant reduction in myocardial infarction (2.73-1.24%, P<0.01; OR: 0.45; 95% CI: 0.26-0.77), definite/probable scaffold thrombosis (1.79-0.88%, P<0.05; OR: 0.49; 95% CI: 0.26-0.93), and target lesion failure and revascularization during follow-up. CONCLUSION Improved procedural technique and more strict patient selection may explain a significant decrease in the absorb BVS thrombosis rates during the recruitment period of the large-scale German-Austrian ABSORB RegIstRy. In addition, treatment of bifurcation lesions was identified as an independent predictor of definite/probable scaffold thrombosis.
TL;DR: Oxygen inhalation did not benefit patients with AMI with normal oxygen saturation and, compared with no oxygen group, oxygen therapy did not reduce the risk of all-cause mortality.
Abstract: Background Oxygen therapy is widely used for patients with acute myocardial infarction (AMI). However, there is uncertainty about its safety and benefits. The aim of this study is to perform a systematic review and meta-analysis to assess the effectiveness and safety of oxygen therapy for patients with AMI. Materials and methods We searched MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials from 1 January 1967, through 31 December 2017. We included randomized controlled clinical trials that used oxygen therapy for patients with suspected or confirmed AMI less than 24 h of symptoms onset. Hyperbaric and aqueous oxygen therapy trials were excluded. Results A total of six randomized controlled clinical trials with 7190 individuals were included in this meta-analysis. Compared with no oxygen group, oxygen therapy did not reduce the risk of all-cause mortality [pooled risk ratio (RR): 1.06, 95% confidence interval (CI): 0.56-2.02, P=0.19], recurrent myocardial infarction (pooled RR: 1.57, 95% CI: 0.88-2.80, P=0.18), and pain (pooled RR: 0.97, 95% CI: 0.82-1.14, P=0.25). Conclusion In this meta-analysis, oxygen inhalation did not benefit patients with AMI with normal oxygen saturation.
TL;DR: In patients undergoing either urgent or elective PCI, hemorheological parameters might contribute to myocardial injury and, if furtherly confirmed, to an unfavorable outcome.
Abstract: BACKGROUND Abnormal blood viscosity favors atherosclerosis owing to endothelial dysfunction and changes in shear stress. Its effect on coronary microvasculature during percutaneous coronary intervention (PCI) is still unknown. We aimed to investigate the role of hemorheological parameters in the incidence of microvascular obstruction (MVO) and the periprocedural necrosis after primary or elective PCI, and secondarily, we evaluated their prognostic significance. MATERIALS AND METHODS We enrolled 25 patients with ST-elevation myocardial infarction (STEMI), 30 patients with non-ST-elevation myocardial infarction (NSTEMI), and 30 patients with stable angina (SA) undergoing PCI. MVO in patients with STEMI and periprocedural necrosis in patients with NSTEMI and those with SA were assessed using angiographic/electrocardiographic and laboratory methods, respectively. Hemorheological profile included blood viscosity (η) at shear rates 200 s and 1 s, the erythrocyte aggregation index (η1/η200), and plasma viscosity. Major adverse cardiovascular events occurrence was evaluated at follow-up. RESULTS Patients with STEMI experiencing angiographic MVO (28%) had higher η200 (5.42±1.28 vs. 3.98±1.22 mPa[BULLET OPERATOR]s; P=0.015). Similarly, patients with STEMI experiencing electrocardiographic MVO (56%) had higher η200 (4.58±0.36 vs. 3.94±0.19 mPa[BULLET OPERATOR]s; P<0.001). Among patients with SA and patients with NSTEMI, those experiencing periprocedural necrosis (23.3%) had higher η200 (5.30±0.86 vs. 4.37±0.88 mPa[BULLET OPERATOR]s; P=0.001), η1 (19.52±9.62 vs. 13.29±7.65 mPa[BULLET OPERATOR]s; P=0.015) and η1/η200 values (3.64±1.50 vs. 2.72±0.92; P=0.007). These significant differences were maintained after adjustment for age, sex, and cardiovascular risk factors. At follow-up (30±6 months), 25 (29.4%) patients presented major adverse cardiovascular events, and they had higher η200 (5.18±1.00 vs. 4.25±1.01 mPa[BULLET OPERATOR]s; P<0.001). CONCLUSION In patients undergoing either urgent or elective PCI, hemorheological parameters might contribute to myocardial injury and, if furtherly confirmed, to an unfavorable outcome.
TL;DR: Even in the second-generation drug-eluting stent era, CABG is still superior for preventing revascularization in patients on chronic HD, however, PCI with EES implantation might not have disadvantages compared with CABGs in terms of MACE.
Abstract: Background It remains controversial whether coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) should be optimized to treat coronary artery disease in patients on chronic hemodialysis (HD). Recently, further refinement of drug-eluting stents, such as the everolimus-eluting stent (EES), has led to marked development in this field. We compared long-term clinical outcomes after CABG versus PCI with EES implantation in patients on chronic HD. Patients and methods We compared 138 patients undergoing CABG and 187 patients treated with EES implantation. The endpoint was major adverse cardiac events (MACE) as a composite outcome, including any revascularization, nonfatal myocardial infarction, or mortality. To reduce the selection bias for the two procedures, propensity score-matching was performed. Results During the follow-up period (43 months), 95 (29.2%) MACEs, including 43 (13.2%) revascularizations, 14 (4.3%) nonfatal myocardial infarctions, and 63 (19.4%) deaths, occurred. The freedom rate from MACE and mortality at 5 years were comparable between groups (69.7 vs. 66.7%, P=0.82 and 75.0 vs. 80.6%, P=0.10, respectively); however, those from revascularization at 5 years was higher in the CABG group than the EES group (89.4 vs. 81.0%, P=0.030). In propensity score-matched patients (n=92), the freedom rate from revascularization at 5 years was still higher in the CABG group than in the EES group (93.4 vs. 79.1%, P=0.013). Similarly, the freedom rates from MACE and mortality were comparable (70.0 vs. 66.3%, P=0.69 and 73.8 vs. 79.7%, P=0.30, respectively). Conclusion Even in the second-generation drug-eluting stent era, CABG is still superior for preventing revascularization in patients on chronic HD. However, PCI with EES implantation might not have disadvantages compared with CABG in terms of MACE.
TL;DR: Struts on the normal segment were less covered and had thinner neointima than struts onThe lipid plaque at the stent edge within 3 months after zotarolimus-eluting stent implantation.
Abstract: BackgroundThe aim of this study was to investigate whether the underlying plaque type affects the neointimal coverage after drug-eluting stent implantation.MethodsA total of 1793 struts in 22 zotarolimus-eluting stents were assessed using optical coherence tomography imaging within 3 months of impla
TL;DR: Higher exposure concentrations and longer exposure duration of PM10 increased the risk of CAS, which provides a plausible mechanism that links air pollution to vasospastic angina and provide new insights into environmental factors.
Abstract: BackgroundWe evaluated the effect of chronic exposure to air pollutants (APs) on coronary endothelial function and significant coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACH) provocation test.Patients and methodsA total of 6430 patients with typical or atypical chest pai
TL;DR: Use of the Essential PCB for treating de-novo coronary lesions in small vessels was safe, with low TLF and MACE rates at the 12-month follow-up.
Abstract: BACKGROUND Paclitaxel-coated balloon (PCB) coronary angioplasty is an alternative treatment for de-novo coronary lesions in small vessels. This study with the new Essential PCB aimed to evaluate early and mid-term clinical outcomes following angioplasty with the Essential PCB in the treatment of de-novo lesions in small vessels. PATIENTS AND METHODS We included all patients who underwent PCB angioplasty for treating de-novo coronary lesions in small vessels (reference diameter <2.5 mm) between October 2015 and June 2016 in 2 centres. The primary endpoint was the 12-month target lesion failure (TLF) rate: a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization. The secondary endpoints were rates of target vessel failure and global major adverse cardiac events (MACE). RESULTS A total of 71 patients (comprising 71 lesions) were included, with a mean age of 66±11 years. A 56% were diabetic and 70% had an acute coronary syndrome as an indication for coronary revascularization. The mean vessel diameter and lesion length were 2.21±0.41 and 20.7±9.2 mm, respectively. Predilatation was performed in 85.9% of patients. The median diameter, length, and inflation pressure of the Essential balloon were 2.0 [interquartile range (IQR): 2.0-2.5] mm, 20 (IQR: 15-30) mm, and 12±2 atmospheres, respectively. Angiographic success was achieved in 97.2% of cases, and bail-out stenting was required in nine (12.7%) cases. The incidence of TLF at the 12-month follow-up was 4.2%, with a target lesion revascularization rate of 4.2%. Target vessel failure and global MACE rates were 4.2 and 9.9%, respectively. CONCLUSION Use of the Essential PCB for treating de-novo coronary lesions in small vessels was safe, with low TLF and MACE rates at the 12-month follow-up.
TL;DR: It is demonstrated that RAS blockers were effective preventive therapies for reducing long-term cardiovascular events in patients with SCAD without heart failure who underwent percutaneous coronary intervention with drug-eluting stent.
Abstract: BackgroundThe effects of renin–angiotensin system (RAS) blockade on the clinical outcome in patients with stable coronary artery disease (SCAD) are conflicting. We evaluated the long-term effects of RAS blockers (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) on the clinica