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1.
Lazzaro Paraggio Francesco Burzotta Cristina Aurigemma Renato Scalise Antonio Maria Leone Giampaolo Niccoli Italo Porto Lorenzo Genuardi Ilaria Dato Carlo Trani Filippo Crea 《Cardiovascular Revascularization Medicine》2019,20(4):303-310
Background
Optical-coherence-tomography (OCT) is an emerging invasive coronary imaging with still undefined clinical value. Recent data have underlined daily impact of such technique in several clinical settings such as acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) guidance. We aimed at assessing the trends and outcomes of OCT use in a high-volume percutaneous coronary interventions (PCI)-center.Methods
Over 6?years, 1025 coronary artery segments in 877 patients underwent OCT evaluation. Clinical and procedural characteristics were prospectively collected. Clinical setting for OCT was: “Diagnostic OCT” (OCT for lesion evaluation after coronary angiography without further PCI); “PCI-guidance OCT” (OCT as a guidance for complex PCI, both by intention or after diagnostic OCT). Primary study end-point was the occurrence of target-vessel-failure (TVF) during the follow-up.Results
Overall, OCT was successful in 99.1% of attempted lesions. Only one complication (coronary dissection requiring urgent PCI) occurred during OCT. After a follow-up of 695?±?562?days, TVF occurred in 8.2% of cases. Despite similar baseline characteristics, TVF-free survival curves were different in the two populations (5.4% after diagnostic OCT and 9.9% after PCI-guidance OCT). Minimal-lumen-area (MLA) of target lesion was independently associated with TVF (HR 0.7, 95% CI 0.6–0.8). This was mainly driven by a significant impact of MLA in patients not revascularized (HR 0.6, 95% CI 0.4–0.9). TVF did not change according to the study period despite the selection of patients with increasing complexity.Conclusions
OCT has a good safety profile across a broad spectrum of patients encountered in daily practice. The easy-to-assess MLA parameter may help stratify prognosis of patients undergoing OCT. These data call for further evaluations of OCT clinical impact.Summary
OCT is a light-based imaging tool which had subvert the quite ordinary world of coronary imaging and the present study evaluates OCT use in a high-volume center. Our results suggest that application of OCT in “real world” patients presenting higher risk has a good safety profile.Several factors could predict a worse long-term outcome in patients undergoing OCT evaluation, mostly related to more complex clinical conditions. These findings could encourage even low-to intermediate volume centers to improve their OCT use in daily practice. 相似文献2.
Zhenzhen Wang Biming Zhan Huihui Bao Xiao Huang Yanqing Wu Qian Liang Weifang Zhang Long Jiang Xiaoshu Cheng 《The American journal of the medical sciences》2019,357(3):230-241
Background
The present study performed a meta-analysis of randomized and prospective trials to compare the outcomes of percutaneous coronary intervention (PCI) with stents versus coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (UPLM) stenosis.Methods
The Cochrane Library, PubMed and EMBASE databases were systematically searched until July 2017. The Newcastle-Ottawa scale was used for quality assessment.Results
A total of 19 studies with 16,900 participants were included. Pooled analysis showed no significant differences in all-cause mortality (odds ratio [OR] 0.94; 95% CI 0.74-1.20) and cardiac death (OR 1.04; 95% CI 0.74-1.47). However, subgroup analysis showed that PCI was associated with a low all-cause mortality rate at 30-day follow up (OR 0.48; 95% CI 0.26-0.89). The stroke rate in PCI was lower in short-term follow up (OR 0.45; 95% CI 0.23-0.88) and long-term follow up (OR 0.36; 95% CI 0.27-0.47). On the other hand, PCI was associated with higher risk of myocardial infarction (OR 1.59; 95% CI 1.34-1.88), repeat revascularization (OR 2.47; 95% CI 1.80-3.37) and target vessel revascularization (OR 2.10; 95% CI 1.72-2.57) compared to CABG in the pooled analysis.Conclusions
The current evidence suggests that the risk of stroke was significantly reduced in PCI compared to that in CABG. Therefore, PCI is the preferred treatment for patients with a high risk of stroke. Additionally, in short-term follow up, PCI was reported to be safe and effective for UPLM patients compared to CABG. However, CABG caused fewer complications long term. 相似文献3.
Ignacio J. Amat-Santos Victoria Martin-Yuste José Antonio Fernández-Díaz Javier Martin-Moreiras Juan Caballero-Borrego Pablo Salinas Soledad Ojeda Fernando Rivero Julio Núñez Villota Mohsen Mohandes Daniela Dubois Francisco Bosa Ojeda Eva Rumiz José M. de la Torre Hernández Jesús Jiménez-Mazuecos Javier Lacunza Paula Tejedor Itziar Gómez Renato Fernandes 《Revista espa?ola de cardiología》2019,72(5):373-382
Introduction and objectives
There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting.Methods
Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers.Results
A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20 mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%.Conclusions
Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality. 相似文献4.
Sex differences in treatment and prognosis of acute coronary syndrome with interventional management
Virginia Ruiz-Pizarro Carlos Ferrera Juan Carlos Gómez-Polo Julián Palacios-Rubio Carmen Rico-García Amado Antonio Fernández-Ortiz Ana Viana-Tejedor 《Cardiovascular Revascularization Medicine》2019,20(3):183-186
Objective
Female sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital.Methods
Patients with ACS admitted to a Spanish tertiary care referral center were included prospectively and consecutively. All patients included in the study underwent a coronary angiography.Results
From the total cohort of 1214 patients, 290 (24%) were women. Women were older (71?±?12.8 vs 64?±?13.4?years, p?<?0.001) and showed lower ischemic risk and higher hemorrhagic risk scores (GRACE 159?±?45 vs 171?±?42, p?=?0.005; CRUSADE 41?±?19 vs 28?±?17, p?<?0.001). There were no significant differences in time to coronary angiography and revascularization rates between sex groups. A lower proportion of women received high-potency antiplatelet agents (29% vs 41.3%, p?=?0.004). In-hospital evolution and one-year mortality were similar between groups.Conclusions
In our population, there were no gender differences in management and prognosis of ACS. Differences in risk profile among groups could have an influence on antiplatelet therapy. 相似文献5.
Gjin Ndrepepa Sebastian Kufner Katharina Mayer Salvatore Cassese Erion Xhepa Massimiliano Fusaro Endri Hasimi Stefanie Schüpke Karl-Ludwig Laugwitz Heribert Schunkert Adnan Kastrati 《Cardiovascular Revascularization Medicine》2019,20(2):101-107
Background
Whether there are sex differences in the outcome of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains controversial. We undertook this study to assess whether there are sex-related differences in the long-term mortality in a large series of patients with CAD after PCI.Methods
The study included 18,334 patients (4735 women and 13,599 men) with CAD treated with PCI. Propensity matching was performed to obtain a group of patients (3000 women and 3000 men) matched for all characteristics available in database. The primary outcome was a composite of cardiac mortality, myocardial infarction or stroke at 3?years of follow-up.Results
The primary outcome occurred in 660 women and 1440 men (Kaplan-Meier [KM] estimates, 15.2% in women and 11.6% in men, unadjusted hazard ratio [HR]?=?1.35, 95% confidence interval [CI] 1.24 to 1.49; P?<?0.001). Women were at higher risk of all-cause mortality (15.4% vs. 12.3%; P?<?0.001), cardiac mortality (10.2% vs. 7.6%; P?<?0.001) and stroke (2.6% vs. 1.4%; P?<?0.001) than men. In matched patients, the primary outcome occurred in 371 women and 322 men (KM estimates, 13.4% vs. 11.6%, HR?=?1.18 [1.01–1.36], P?=?0.033). Women were at higher risk of myocardial infarction (4.2% vs. 3.1%; P?=?0.044) but not cardiac (8.7% vs. 8.2%; P?=?0.306) or all-cause death (12.5% vs. 12.9%; P?=?0.991) or stroke (1.9% vs. 1.6%; P?=?0.550) than men.Conclusions
After propensity matching, women remained at a higher risk of a composite of cardiac mortality, myocardial infarction or stroke up to 3?years after PCI than men. 相似文献6.
Ki Hong Choi Young Bin Song Joo Myung Lee Sang Yoon Lee Taek Kyu Park Jeong Hoon Yang Jin-Ho Choi Seung-Hyuk Choi Hyeon-Cheol Gwon Joo-Yong Hahn 《JACC: Cardiovascular Interventions》2019,12(7):607-620
Objectives
This study sought to determine whether intravascular ultrasound (IVUS) guidance compared with angiographic guidance reduces long-term risk of cardiac death in patients undergoing complex percutaneous coronary intervention (PCI).Background
Although IVUS is a useful tool for accurate assessment of lesion profiles and optimal stent implantation, there are limited data on long-term clinical outcomes between IVUS-guided and angiography-guided PCI for patients with complex lesions.Methods
From March 2003 through December 2015, a total of 6,005 patients undergoing PCI for complex lesions with drug-eluting stents were enrolled from a prospective institutional registry. All enrolled subjects had at least 1 complex lesion (defined as bifurcation, chronic total occlusion, left main disease, long lesion, multivessel PCI, multiple stent implantation, in-stent restenosis, or heavily calcified lesion). Patients were classified according to use of IVUS or not. Multiple sensitivity analyses, including multivariable adjustment, propensity-score matching, and inverse-probability-weighted method, were performed to adjust baseline differences.Results
Among the study population, IVUS was used in 1,674 patients (27.9%) during complex PCI. The IVUS-guided PCI group had a significantly larger mean stent diameter (3.2 ± 0.4 vs. 3.0 ± 0.4; p < 0.001), and more frequent use of post-dilatation (49.0% vs. 17.9%; p < 0.001) compared with the angiography-guided PCI group. IVUS-guided PCI was associated with a significantly lower risk of cardiac death during 64 months of median follow-up compared with angiography-guided PCI (10.2% vs. 16.9%; hazard ratio: 0.573; 95% confidence interval: 0.460 to 0.714; p < 0.001). Results were consistent after multivariable regression, propensity-score matching, and inverse-probability-weighted method. The risks of all-cause death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, and major adverse cardiac events were also significantly lower in the IVUS-guided PCI group.Conclusions
Among patients with complex coronary artery lesion, IVUS-guided PCI was associated with the lower long-term risk of cardiac death and adverse cardiac events compared with angiography-guided PCI. Use of IVUS should be actively considered for complex PCI. 相似文献7.
Adam C. Salisbury Dimitri Karmpaliotis J. Aaron Grantham James Sapontis Qingrui Meng Elizabeth A. Magnuson Hemal Gada William Lombardi Jeffrey Moses Haiyan Li Suzanne V. Arnold Suzanne J. Baron John A. Spertus David J. Cohen 《JACC: Cardiovascular Interventions》2019,12(4):323-331
Objectives
The aim of this study was to describe the costs of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and the association of complications during CTO PCI with costs and length of stay (LOS).Background
CTO PCI generally requires more procedural resources and carries higher risk for complications than PCI of non-CTO vessels. The costs of CTO PCI using the hybrid approach have not been described, and no studies have examined the impact of complications on in-hospital costs and LOS in this population.Methods
Costs were calculated for 964 patients in the 12-center OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry using prospectively collected resource utilization and billing data. Multivariate models were developed to estimate the incremental costs and LOS associated with complications. Attributable costs and LOS were calculated by multiplying the independent cost of each event by its frequency in the population.Results
Mean costs for the index hospitalization were $17,048 ± 9,904; 14.5% of patients experienced at least 1 complication. Patients with complications had higher mean hospital costs (by $8,603) and LOS (by 1.5 days) than patients without complications. Seven complications were independently associated with increased costs and 6 with LOS; clinically significant perforation and myocardial infarction had the greatest attributable cost per patient. Overall, complications accounted for $911 per patient in hospital costs (5.3% of the total costs) and 0.2 days of additional LOS.Conclusions
Complications have a significant impact on both LOS and in-hospital costs for patients undergoing CTO PCI. Methods to identify high-risk patients and develop strategies to prevent complications may reduce CTO PCI costs. 相似文献8.
Robert W. Yeh Hector Tamez Eric A. Secemsky J. Aaron Grantham James Sapontis John A. Spertus David J. Cohen William J. Nicholson Kensey Gosch Philip G. Jones Linda R. Valsdottir Jeffrey Bruckel William L. Lombardi Farouc A. Jaffer 《JACC: Cardiovascular Interventions》2019,12(7):651-658
Objectives
This study sought to examine depression prevalence among chronic total occlusion (CTO) patients and compared symptom improvement among depressed and nondepressed patients after percutaneous coronary intervention (PCI).Background
Depression in cardiovascular patients is common, but its prevalence among CTO patients and its association with PCI response is understudied.Methods
Among 811 patients from the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry, we evaluated change in health status between baseline and 1-year post-PCI, as measured by the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Score. Depression was defined using the Personal Health Questionnaire-8. The independent association between health status and depression following PCI was assessed using multivariable regression.Results
Among the 811 patients, 190 (23%) screened positive for major depression, of whom 6.3% were on antidepressant therapy at intervention. Depressed patients experienced more baseline angina, but by 1-year post-PCI they experienced greater improvements than nondepressed patients (change in SAQ Summary: 31.4 ± 22.4 vs. 24.2 ± 20.0; p < 0.001). After adjustment, baseline depressed patients had more improvement in health status (adjusted difference in SAQ Summary improvement, depressed vs. nondepressed: 5.48 ± 1.81; p = 0.003).Conclusions
Depression is common among CTO PCI patients, but few were treated with antidepressants at baseline. Depressed patients had more severe baseline angina and significant improvement in health status after PCI. (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion [OPEN-CTO]; NCT02026466) 相似文献9.
Marwa Fathy Ebraheem Rehab Abd-El Raouf Sallam Mona A. Mohsen Basma Ahmed El-Kady Galal E. El-Hawary Azza A Baiomy 《The Egyptian Rheumatologist》2019,41(2)
Background
There is risk of premature atherosclerosis in juvenile idiopathic arthritis (JIA) patients which predisposes to cardiovascular disease (CVD) in adulthood. This can be assessed by flow mediated dilatation (FMD) and carotid intima media thickness (IMT) of the arterial wall and by soluble vascular cell adhesion molecule (sVCAM-1).Aim of the work
To assess endothelial dysfunction in JIA children and to correlate sVCAM with FMD of brachial artery and carotid IMT.Patients and methods
The study was conducted on 55 JIA patients. The following was assessed: body mass index (BMI), blood pressure, juvenile arthritis disease activity score (JADAS27). Childhood Health Assessment Questionnaire (C-HAQ), physical activity questionnaire (PAQ), fatigue assessment using The Pediatric Quality of Life (PedsQL) inventory, full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), serum creatinine and lipid profile, sVCAM-1, FMD and IMT.Results
The patients’ age was 10.9?±?3.9?years and were 28 (50.9%) females. JADAS-27 and CRP was higher in systemic JIA, but fatigue scores were significantly lower. CHAQ was significantly lower in patients with polyarticular disease. Patients with high disease activity had significantly younger age of onset, lower BMI, shorter disease duration, lower fatigue scale and physical activity scores and higher CHAQ. sVCAM-1 significantly correlated with CHAQ, low-density lipoprotein, CRP and ESR while FMD significantly correlated with PedsQL and PAQ.Conclusion
JIA patients had impaired endothelial function and increased cIMT with increased sVCAM-1, impaired lipid profile, decreased physical activity and increased fatigue with a potentially higher cardiovascular risk in this pediatric population. 相似文献10.
Manabu Kashiwagi Takashi Tanimoto Hironori Kitabata Yu Arita Yasunori Yamamoto Kazuya Mori Kosei Terada Tsuyoshi Nishiguchi Akira Taruya Takashi Kubo Atsushi Tanaka Takashi Akasaka 《Cardiovascular Revascularization Medicine》2019,20(4):311-315
Introduction and objectives
Transradial cardiac catheterization reduces access site complications and is more comfortable for patients than the transfemoral approach. However, failure of the transradial approach is more common than the transfemoral approach. This study aimed to investigate whether ultrasound-guided rescue could facilitate transradial cardiac catheterization.Methods
We retrospectively analyzed 592 consecutive patients who underwent coronary angiography and/or percutaneous coronary intervention. Patients were divided into 2 groups: the palpation technique (PT) (n?=?280) and the ultrasound guidance (UG) available group (n?=?312). The application and the timing of introduction of ultrasound guidance in the UG group were at the discretion of the individual operators.Results
Real-time ultrasound guidance was used in 98 patients (31.4%) in the UG group. No statistically significant intergroup differences were observed in the incidence of hematoma (6.8% vs. 5.8%, p?=?0.62). Although the procedural time in the UG group was longer than that in the PT group (303?s vs. 357?s, p?<?0.01), the success rate of sheath insertion was significantly higher in the UG group (97% vs. 92%, p?<?0.01). Multivariate analysis revealed that the availability of UG was the only independent predictor of success of sheath insertion (odds ratio 2.79, 95% confidence interval 1.24–6.31, p?=?0.01).Conclusions
Although UG maneuvers require additional procedural time for setting up systems, UG rescue was effective for successful transradial cardiac catheterization. 相似文献11.
Abdulla A. Damluji Karen Bandeen-Roche Carol Berkower Cynthia M. Boyd Mohammed S. Al-Damluji Mauricio G. Cohen Daniel E. Forman Rahul Chaudhary Gary Gerstenblith Jeremy D. Walston Jon R. Resar Mauro Moscucci 《Journal of the American College of Cardiology》2019,73(15):1890-1900
Background
Older adults ≥75 years of age carry an increased risk of mortality after ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock.Objectives
The purpose of this study was to examine the use of percutaneous coronary intervention (PCI) in older adults with STEMI and shock and its influence on in-hospital mortality.Methods
We used a large publicly available all-payer inpatient health care database sponsored by the Agency for Healthcare Research and Quality between 1999 and 2013. The primary outcome was in-hospital mortality. The influence of PCI on in-hospital mortality was assessed by quintiles of propensity score (PS).Results
Of the 317,728 encounters with STEMI and shock in the United States, 111,901 (35%) were adults age ≥75 years. Of these, 53% were women and 83% were Caucasians. The median number of chronic conditions was 8 (interquartile range: 6 to 10). The diagnosis of STEMI and cardiogenic shock in older patients decreased significantly over time (proportion of older adults with STEMI and shock: 1999: 42% vs. 2013: 29%). Concomitantly, the rate of PCI utilization in older adults increased (1999: 27% vs. 2013: 56%, p < 0.001), with declining in-hospital mortality rates (1999: 64% vs. 2013: 46%; p < 0.001). Utilizing PS matching methods, PCI was associated with a lower risk of in-hospital mortality across quintiles of propensity score (Mantel-Haenszel odds ratio: 0.48; 95% confidence interval [CI]: 0.45 to 0.51). This reduction in hospital mortality risk was seen across the 4 different U.S. census bureau regions (adjusted odds ratio: Northeast: 0.41; 95% CI: 0.36 to 0.47; Midwest: 0.49; 95% CI: 0.42 to 0.57; South: 0.51; 95% CI: 0.46 to 0.56; West: 0.46; 95% CI: 0.41 to 0.53).Conclusions
This large and contemporary analysis shows that utilization of PCI in older adults with STEMI and cardiogenic shock is increasing and paralleled by a substantial reduction in mortality. Although clinical judgment is critical, older adults should not be excluded from early revascularization based on age in the absence of absolute contraindications. 相似文献12.
Nora Cazzagon Carlo Dal Lin Giulia Famoso Roberta Montisci Irene Franceschet Annarosa Floreani Francesco Tona 《Digestive and liver disease》2019,51(4):542-548
Background
It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).Methods
Our inclusion criterion was a diagnosis of PBC with no clinical evidence of heart disease or metabolic syndrome. Coronary flow velocity in the left anterior descending coronary artery was measured using transthoracic Doppler echocardiography at rest (DFVr), and during adenosine infusion (DFVh). The corrected CFR (cCFR) was defined as the ratio of DFVh to DFVr corrected for cardiac workload (cDFVr). Microvascular resistance was also assessed in baseline (BMR) and hyperemic conditions (HMR).Results
37 PBC patients and 37 sex- and age-matched controls were considered. The cCFR was significantly lower in PBC patients (2.8?±?0.7 vs. 3.7?±?0.7, p?<?0.0001), and abnormal (≤2.5) in 13 (35%) of them, but in none of the controls (p?<?0.0001). The cDFVr was higher in patients with abnormal cCFR (29.0?±?6.0 vs. 20.4?±?4.5?cm/sec, p?<?0.0001). The CFR and cCFR did not correlate with any characteristics of PBC, comorbidities or Framingham risk scores. The BMR and HMR correlated with time since PBC diagnosis and duration of symptoms.Conclusion
The CFR is reduced in PBC, apparently due to mechanisms correlating with the time since diagnosis. In particular, the higher cDFVr with a lower basal resistance in patients with cCFR?≤?2.5 suggests a compensatory mechanism against any cardiomyocyte bioenergetics impairment. 相似文献13.
Chun Shing Kwok Binita Shah Jassim Al-Suwaidi David L. Fischman Lene Holmvang Chadi Alraies Rodrigo Bagur Vinayak Nagaraja Muhammad Rashid Mohamed Mohamed Glen P. Martin Evan Kontopantelis Tim Kinnaird Mamas Mamas 《JACC: Cardiovascular Interventions》2019,12(8):734-748
Objectives
The aim of this study was to describe the rates and causes of unplanned readmissions at different time periods following percutaneous coronary intervention (PCI).Background
The rates and causes of readmission at different time periods after PCI remain incompletely elucidated.Methods
Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for the rates, causes, predictors, and costs of unplanned readmission between 0 and 7 days, 8 and 30 days, 31 and 90 days, and 91 and 180 days after index discharge.Results
This analysis included 2,412,000 patients; 2.5% were readmitted between 0 and 7 days, 7.6% between 8 and 30 days, 8.9% between 31 and 90 days, and 8.0% between 91 and 180 days (cumulative rates 2.5%, 9.9%, 18.0%, and 24.8%, respectively). The majority of readmissions during each time period were due to noncardiac causes (53.1% to 59.6%). Nonspecific chest pain was the most common identifiable noncardiac cause for readmission during each time period (14.2% to 22.7% of noncardiac readmissions). Coronary artery disease including angina was the most common cardiac cause for readmission during each time period (37.4% to 39.3% of cardiac readmissions). The second most common cardiac cause for readmission was acute myocardial infarction between 0 and 7 days (27.6% of cardiac readmissions) and heart failure during all subsequent time periods (22.2% to 23.7% of cardiac readmissions).Conclusions
Approximately 25% of patients following PCI have unplanned readmissions within 6 months. Causes of readmission depend on the timing at which they are assessed, with noncardiovascular causes becoming more important at longer time points. 相似文献14.
Yoichi Otaki Takashi Ashikaga Taro Sasaoka Ken Kurihara Shunji Yoshikawa Mitsuaki Isobe 《Cardiovascular Revascularization Medicine》2019,20(2):120-125
Background
Long-term clinical outcomes of permanent polymer everolimus-eluting stent (PP-EES) implantation after rotational atherectomy (RA) have not been fully evaluated. We sought to investigate the long-term clinical outcomes of PP-EES implantation after RA and assess the impact of hemodialysis on this treatment strategy.Methods
Patients who underwent percutaneous coronary intervention (PCI) with PP-EES at 22 institutions between January 2010 and December 2011 were enrolled in this multicenter, observational trial. From a total of 1918 registered patients, 113 patients with 115 de-novo lesions who underwent PCI with PP-EES following RA were retrospectively analyzed. The primary endpoint was a major adverse cardiac event (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically driven target lesion revascularization (TLR).Results
Long-term follow-up was available for 112 patients (99.1%). The median follow-up period was 2.9 (interquartile range 1.9–3.6) years. The mean age of the patients was 72.3?±?8.8?years and 64 patients (56.6%) had chronic kidney disease (≥stage 3, 42 on hemodialysis). The cumulative incidences of MACE, non-fatal MI, and TLR were 22.1%, 5.3%, and 10.6%, respectively. Cox's proportional hazards analysis showed that the independent predictors of TLR were hemodialysis and chronic total occlusion. (HR, 14.1; 95% CI, 1.74–155.5; p?=?0.01, HR, 9.01; 95% CI, 1.34–62.5; p?=?0.02).Conclusions
PP-EES implantation after lesion modification by RA is considered to be a feasible treatment strategy for heavily calcified lesions. Hemodialysis and chronic total occlusion appeared to be associated with TLR. 相似文献15.
Chutatip Limkunakul Ian H. de Boer Bryan R. Kestenbaum Jonathan Himmelfarb T. Alp Ikizler Cassianne Robinson-Cohen 《Journal of diabetes and its complications》2019,33(4):296-301
Context
Diabetic kidney disease (DKD) is the leading cause of end stage kidney disease (ESKD) and is associated with a considerably shortened lifespan. While glucose-lowering therapy targeting glycated hemoglobin (HbA1c) <7% is proven to reduce the risk of developing DKD, its effects on complications of DKD are unclear.Objective
We examined the associations of HbA1c with risks of progression to ESKD and death within a clinic-based study of CKD. We hypothesized that higher HbA1c concentrations would be associated with increased risks of ESKD and death.Design and setting
We studied 618 participants from the Seattle Kidney Study (mean eGFR 42?ml/min), 308 of whom had diabetes, and tested associations of baseline HbA1c with time to a composite outcome of initiation of renal replacement therapy or death.Results
During a median follow-up of 4.2?years, there were 343 instances of the composite outcome (11.5 per 100 person-years). Among participants with diabetes, in both crude and adjusted analyses, higher HbA1c levels (examined continuously or categorically) were not associated with the risk of the composite outcome (HR (95% CI): 0.99 (0.88, 1.10) per 1% additional HbA1c, p?=?0.79). HbA1c was not associated with ESKD or mortality when the outcomes were examined separately, nor when stratified between insulin users and non-users.Conclusion
In a referred population of established DKD, higher HbA1c was not associated with higher risk of ESKD or death. These data support current recommendations to be conservative with glycemic control among patients with advanced diabetes complications, such as CKD. 相似文献16.
17.
Rosli Mohd Ali Muhamad Ali S.K. Abdul Kader Wan Azman Wan Ahmad Tiong Kiam Ong Houng Bang Liew Al-Fazir Omar Ahmad Syadi Mahmood Zuhdi Amin Ariff Nuruddin Beatrix Schnorr Bruno Scheller 《JACC: Cardiovascular Interventions》2019,12(6):558-566
Objectives
The aim of this randomized controlled trial was to investigate a novel sirolimus-coated balloon (SCB) compared with the best investigated paclitaxel-coated balloon (PCB).Background
Treatment of coronary in-stent restenosis (ISR) remains challenging. PCBs are an established treatment option outside the United States with a Class I, Level of Evidence: A recommendation in the European guidelines. However, their efficacy is better in bare-metal stent (BMS) ISR compared with drug-eluting stent (DES) ISR.Methods
Fifty patients with DES ISR were enrolled in a randomized, multicenter trial to compare a novel SCB (SeQuent SCB, 4 μg/mm2) with a clinically proven PCB (SeQuent Please Neo, 3 μg/mm2) in coronary DES ISR. The primary endpoint was angiographic late lumen loss at 6 months. Secondary endpoints included procedural success, major adverse cardiovascular events, and individual clinical endpoints such as stent thrombosis, cardiac death, target lesion myocardial infarction, clinically driven target lesion revascularization, and binary restenosis.Results
Quantitative coronary angiography revealed no differences in baseline parameters. After 6 months, in-segment late lumen loss was 0.21 ± 0.54 mm in the PCB group versus 0.17 ± 0.55 mm in the SCB group (p = NS; per-protocol analysis). Clinical events up to 12 months also did not differ between the groups.Conclusions
This first-in-man comparison of a novel SCB with a crystalline coating shows similar angiographic outcomes in the treatment of coronary DES ISR compared with a clinically proven PCB. (Treatment of Coronary In-Stent Restenosis by a Sirolimus [Rapamycin] Coated Balloon or a Paclitaxel Coated Balloon [FIM LIMUS DCB]; NCT02996318) 相似文献18.
Naglaa S. Ghazy Rasha A. Abdel Noor Maaly M. Mabrouk Wael F. Mohammed 《The Egyptian Rheumatologist》2019,41(2)
Background
End stage renal disease can decrease lupus activity especially after renal replacement therapy, so assessment of activity after starting hemodialysis (HD) is essential to avoid immunosuppressive complications and prevent flares.Aim of the work
To assess lupus activity in patients on regular HD and determine the differences in activity and number of lupus flares between patients who were maintained on steroids and immunosuppressives and those not.Patients and methods
Thirty-five systemic lupus erythematosus (SLE) patients on regular HD. were recruited from 14 hemodialysis centers in five cities in Gharbia Governorate, Egypt. The patient?s files were reviewed and SLE disease activity index (SLEDAI) was measured.Results
The mean age of patients was 30.7?±?9.2?years and were 29 females and 6 males with a median disease duration of 6?years and SLEDAI of 3. 57.1% of the cases did not record lupus flare after dialysis while 42.9% were active; 11 (31.4%) of them had 1 flare, 3 (8.6%) had 2 flares and 1 (2.9%) had 3 flares. and according to the SLEDAI grading, 77.2% had no flare, 11.4% had mild flare and 11.4% moderate; none had a severe flare. There was no significant difference between those maintained on steroids or immunosuppressives and patients who stopped treatment after HD as regard number of flares and disease activity grading.Conclusions
Lupus activity is not uncommon after starting hemodialysis but giving a prolonged immunosuppressive therapies is not necessary in all cases and should be given cautiously to avoid their side effects. 相似文献19.
Serdar Farhan Björn Redfors Akiko Maehara Thomas McAndrew Ori Ben-Yehuda Bernard De Bruyne Roxana Mehran Gennaro Giustino Ajay J. Kirtane Patrick W. Serruys Gary S. Mintz Gregg W. Stone 《JACC: Cardiovascular Imaging》2019,12(4):733-741
Objectives
The aim of this study was to investigate the impact of pre-diabetes (pre-DM) on coronary plaque characteristics and ischemic outcomes in patients with acute coronary syndromes (ACS).Background
Pre-DM (i.e., the early stages of glucometabolic disturbance) is common among patients with ACS, but the extent to which pre-DM influences coronary plaque characteristics and the risk for adverse ischemic events is unclear.Methods
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in Coronary Tree) study, patients with ACS underwent quantitative coronary angiography, grayscale intravascular ultrasound, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention. Patients were divided into 3 groups according to their glucometabolic status, as defined by the American Diabetes Association: normal glucose metabolism (NGM), pre-DM, and diabetes mellitus (DM). These groups were compared with regard to coronary plaque characteristics and the risk for major adverse cardiac events (MACEs) (defined as cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina).Results
Among 547 patients, 162 (29.6%) had NGM, 202 (36.9%) had pre-DM, and 183 (33.4%) had DM. There were no significant differences between the groups with regard to intravascular ultrasound findings indicative of vulnerable plaques. Patients with DM had a higher crude rate of MACEs than those with pre-DM or NGM (25.9% vs. 16.3% and 16.1%; p = 0.03 and p = 0.02, respectively). In an adjusted Cox regression model using NGM as the reference group, DM (hazard ratio: 2.20; 95% confidence interval: 1.25 to 3.86; p = 0.006) but not pre-DM (hazard ratio: 1.29; 95% confidence interval: 0.71 to 2.33; p = 0.41) was associated with increased risk for MACEs.Conclusions
Impaired glucose metabolism is common among patients presenting with ACS. DM but not pre-DM is associated with an increased risk for MACEs. Thus, preventing patients from progressing from pre-DM to DM is important. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466) 相似文献20.
Abbed K.M. Hameed Tamer O. El-Said Hamdia Y. Askar Basma A. ElKady 《The Egyptian Rheumatologist》2019,41(2)