One-year clinical outcomes of dialysis patients after implantation with sirolimus-eluting coronary stents

Background The efficacy of sirolimus-eluting stents (SESs) has not been established in dialysis patients. Methods and Results This study was a non-randomized observational single-center registry in a community hospital: data for 80 consecutive dialysis patients who underwent percutaneous coronary intervention (PCI) with SES were compared with those of a historical group of consecutive 124 dialysis patients treated with bare-metal stents (BMS). After 1 year, the cumulative incidence of major adverse cardiac events (MACE), comprising cardiac death, nonfatal myocardial infarction, stent thrombosis, or target lesion revascularization (TLR), was 25.2% in the SES group and 38.2% in the BMS group (p=0.048). In multivariate analysis, use of SES remained an independent predictor of MACE at 1 year after PCI (risk ratio 0.70, 95% confidence interval 0.52-0.93, p=0.015). Rates of TLR were 21.7% in the SES group and 30.9% in the BMS group and (p=0.15). Subgroup analysis showed that use of SES was effective in patients with small vessels, non-diabetic patients, and patients without highly calcified lesions. Conclusions In dialysis patients, the implantation of SES was moderately effective in reducing MACE at 1 year after PCI as compared with BMS. However, the TLR rate at 1 year was relatively higher than previously reported. (Circ J 2008; 72: 1430 - 1435).     

全动脉化冠状动脉旁路移植术的应用与疗效观察

目的:探讨全动脉化冠状动脉旁路移植术的手术技术。 方法:42例接受全动脉化冠状动脉旁路移植术的患者,其中男性37例,女性5例,年龄28～73岁,平均(57.43±7.45)岁。体外循环下搭桥16例,非体外循环下心脏不停跳搭桥26例。人均旁路3.08支(1～5支),左乳内动脉(IMA)34例,双侧IMA 8例,左侧桡动脉(RA)33例,双侧RA 9例,胃网膜右动脉(GEA)1例。 结果:术后仅1例患者因多器官功能衰竭死亡(死亡率2.4％),41例(97.6％)症状明显改善,康复出院。 结论:全动脉化搭桥手术早期临床效果满意。     

全动脉化冠状动脉旁路移植术的应用与疗效观察

目的探讨全动脉化冠状动脉旁路移植术的手术技术.方法42例接受全动脉化冠状动脉旁路移植术的患者,其中男性37例,女性5例,年龄28～73岁,平均(57.43±7.45)岁.体外循环下搭桥16例,非体外循环下心脏不停跳搭桥26例.人均旁路3.08支(1～5支),左乳内动脉(IMA)34例,双侧IMA 8例,左侧桡动脉(RA)33例,双侧RA 9例,胃网膜右动脉(GEA)1例. 结果术后仅1例患者因多器官功能衰竭死亡(死亡率2.4%),41例(97.6%)症状明显改善,康复出院.结论全动脉化搭桥手术早期临床效果满意.     

Long-term outcomes of women with coronary artery disease following complete coronary revascularization

Background

Although coronary artery disease (CAD) is less prevalent in women than in men, early mortality rate is higher in women with CAD than in men with CAD following coronary revascularization. In terms of the long-term outcomes after coronary revascularization, limited data are available. Especially, in the Japanese CAD population, no data about sex-related differences in long-term outcomes after coronary revascularization exist. The aim of this study was to compare long-term outcomes between men and women following complete revascularization in Japanese patients with CAD.

Methods

We collected data from 1836 consecutive patients who underwent complete revascularization by percutaneous coronary interventions and/or bypass surgeries. All-cause and cardiac mortality and the incidence of stroke were compared between men and women. In addition to the univariate analysis, a multivariate Cox regression was carried out in order to adjust for differences in baseline characteristics.

Results

There were 274 female patients (14.9%). They were older, had greater total cholesterol levels, and were more likely to have multivessel disease than men. During follow-up [mean (SD), 11.4 (2.9) years], 412 patients died (including 131 patients who died of cardiac causes), and 130 had a stroke. In the multivariate analysis, female patients did not have a significant risk for all-cause mortality (hazard ratio [HR], 1.01; p = 0.993), cardiac mortality (HR, 1.41; p = 0.256), or stroke (HR, 0.71; p = 0.309).

Conclusions

In the present study involving CAD patients who underwent complete revascularization, we showed that, although women were older and had more unfavorable risk profiles, they did not have a greater risk of long-term all-cause mortality, cardiac mortality, or stroke incidence, compared to men.     

Diabetes complications and adverse health outcomes after coronary revascularization

Aims

To examine effects of diabetes complications on health outcomes following coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), comparing outcomes for patients with diabetes complications to those without diabetes complications.

Methods

Retrospective analysis of discharge data for 61,566 patients with diabetes age 45 or older who had CABG or PCI in 2007 in United States community hospitals, using data from the Nationwide Inpatient Sample. Analysis included propensity score-adjusted logistic regression.

Results

Of all patients, 21.2% of the weighted sample had diabetes complications. Older patients, Blacks and Hispanics, and those with greater illness severity were more likely to have diabetes complications. Unadjusted rates of in-hospital mortality, postoperative stroke, and renal failure were higher for patients with diabetes complications (rate ratios 2.2, 1.8, and 9.8, respectively; all p < 0.0001). In adjusted results, having diabetes complications was associated with higher odds of in-hospital mortality (odds ratio, OR 1.62, 95% confidence interval, CI 1.37–1.91) and renal failure (OR 3.03, CI 1.71–5.39). Compared to CABG, PCI was associated with extra risk of postoperative renal failure for those with diabetes complications.

Conclusion

Among patients with diabetes having revascularization, those with diabetes complications have higher risks of in-hospital death and renal failure irrespective of having CABG or PCI.     

Effect of cardiac rehabilitation on functional outcomes after coronary revascularization

Background Current guidelines recommending cardiac rehabilitation (CR) after coronary revascularization are largely based on early studies that evaluated only a subset of the population and failed to assess the impact of CR on a patient's perception of their functional status. The main objective of this study was to evaluate the impact of CR in a diverse contemporary population on patient functional outcomes. Methods We studied the effect of CR on 6-month SF-36 Physical Functioning (PF) in 700 patients (mean age 67 ± 11 years, 37% women) who underwent coronary bypass grafting or percutaneous intervention from August 1998 to July 2000. Results Overall CR participation was 24%. At baseline, CR participants had higher PF (mean 62.5 vs 52.5, P < .001). After adjusting for baseline clinical variables and PF score, CR was associated with significant improvement in 6-month PF (+5.0, 95% CI 1.0-9.0). This improvement was observed in all patient subgroups, but tended to be greater in magnitude in men versus women, patients aged <70 years versus ≥70 years, and patients with coronary bypass grafting versus patients with percutaneous intervention. CR participants also tended to be more likely to engage in regular exercise (63% vs 55%, P = .06) and modify their diet (82% vs 73%, P = .07). Rates of rehospitalization and repeat revascularization were similar among CR participants and nonparticipants. Conclusions CR after coronary revascularization is associated with improved functional outcomes and adoption of secondary preventive measures. Innovative strategies to facilitate CR enrollment and tailoring programs to better address the needs of all patient subgroups would extend these benefits to more eligible patients. (Am Heart J 2003;145:445-51.)     

One-year clinical outcomes after sirolimus-eluting coronary stent implantation for acute myocardial infarction in the worldwide e-SELECT registry

Background: The aim was to ascertain the 1‐year clinical outcomes of 1,234 patients who underwent implantations of sirolimus‐eluting stents (SES) for acute myocardial infarction (MI) in the multinational e‐SELECT registry. Methods: Fifteen thousand and one hundred and forty‐seven patients treated with SES were entered in the e‐SELECT registry, of whom 1,234 presented within <24 hours of onset of acute MI. Results: At 1 year, the rates of major adverse cardiac events (MACE) (5.5% vs. 4.8%; P = 0.28) were similarly low in the acute and no acute MI groups. The rates of definite/probable stent thrombosis (ST) were higher in the acute MI group (2.1%vs; 0.88%, P < 0.001). ST was a strong independent predictor of death at 1 year (HR 13.4; 95% CI 5.0, 36.0; P < 0.001) and MI (HR 58.9; 95% CI 26.9, 129.1; P < 0.001). Dual antiplatelet therapy (DAPT) compliance at 6 months was 96.0% in the acute MI versus 94.5% in the no acute MI group (P = 0.03). Conclusion: In selected patients presenting within <24 hours of acute MI onset and highly compliant with DAPT, SES implantation was associated with similar rates of MACE, though higher rates of ST, as compared to no acute MI patients. Condensed abstract In the e‐SELECT registry which included 15,147 patients treated with sirolimus‐eluting stent (SES), we ascertained the 1‐year clinical outcomes of 1,234 patients who presented within <24 hours of acute MI onset. In acute MI patients SES implantation was associated with similar rates of MACE, though higher rates of ST, as compared to no acute MI patients (MACE: 5.5% vs. 4.8%; P = 0.28; ST: 2.1 vs. 0.88%, P < 0.001). (J Interven Cardiol 2012;25:253–261)     

急性冠状动脉综合征患者血运重建的预后

目的 入选2003年7月1日至2005年9月30日在我院接受血运重建治疗的6005例患者,1年后对患者进了解接受血运重建治疗的急性冠状动脉综合征患者的近期和长期预后.方法 行电话或门诊随访.比较ST段抬高心肌梗死(STEMI)、非ST段抬高急性心肌梗死(NSTEMI)和不稳定性心绞痛患者的临床和预后[不良心脑血管事件(MACCE)包括伞因死亡、非致死性心肌梗死、非致死性卒中和再次血运重建]情况.结果 共4865例患者,其中STEMI患者955例,NSTEMI患者263例,不稳定性心绞痛患者3647例,3组患者的院内和18个月生存率(分别为96%、98%和98%)差异无统计学意义,不稳定性心绞痛患者18个月MACCE发生率较低(STEMI,NSTEMI和不稳定性心绞痛3组无事件生存率分别为86%、86%和89%).结论 接受血运重建的STEMI、NSTEMI和不稳定性心绞痛患者临床情况有所差异,但是近期和长期病死率相似,不稳定性心绞痛患者的长期MACCE发生率低.

Abstract：

Objective To evaluate short-term and long-term prognosis of revascularization in patients with acute coronary syndrome. Methods A total of 6005 patients who received coronary revascularization in our institution between July 2003 and September 2005 were enrolled. The patients were followed up in clinic or by telephone after discharge between September 2006 and November 2006. The clinical and prognosis data of all-cause mortality, neo-myocardial infarction, nonfatal stroke, and rerevascularization of ST-segment elevation myocardial infarction ( STEMI ) , non ST-segment elevation myocardial infarction ( NSTEMI) and major adverse cardiovascular and cerebrovascular events ( MACCE) were analyzed. Results Among 4865 acute coronary syndrome patients, 955 cases were STEMI; 263 cases were NSTEMI; and 3647 cases were unstable angina ( UA) pectoris. There were no significant difference for in-hospital mortality and late mortality ( 18 month survival 96% , 98% and 98% ) between patients with STEMI, NSTEMI and UA. Patients with UA had lower MACCE rate (18 month non-MACCE survival of STEMI, NSTEMI and UA group were 86% , 86% , and 89% respectively). Conclusions Despite different clinical characteristics, patients with STEMI, NSTEMI and UA undergoing revascularization had similar short-term and long-term mortality. Patients with UA had lower MACCE rate.     

One-year clinical outcomes of protected and unprotected left main coronary artery stenting.

AIMS: To evaluate outcomes for left main coronary artery (LMCA) stenting and compare results between protected (left coronary grafted) and unprotected LMCA stenting in the current bare-metal stent era. METHODS: We reviewed outcomes among 142 consecutive patients who underwent protected or unprotected LMCA stenting since 1997. All-cause mortality, myocardial infarction (MI), target-lesion revascularization (TLR), and the combined major adverse clinical event (MACE) rates at one year were computed. RESULTS: Ninety-nine patients (70%) underwent protected and 43 patients (30%) underwent unprotected LMCA stenting. In the unprotected group, 86% were considered poor surgical candidates. Survival at one year was 88% for all patients, TLR 20%, and MACE 32%. At one year, survival was reduced in the unprotected group (72% vs. 95%, P<0.001) and MACE was increased in the unprotected patients (49% vs. 25%, P=0.005). CONCLUSIONS: In the current era, stenting for both protected and unprotected LMCA disease is still associated with high long-term mortality and MACE rates. Stenting for unprotected LMCA disease in a high-risk population should only be considered in the absence of other revascularization options. Further studies are needed to evaluate the role of stenting for unprotected LMCA disease.     

One-year outcome after combined coronary artery bypass grafting and transmyocardial laser revascularization for refractory angina pectoris

Long-term outcomes after coronary artery bypass graft surgery (CABG) plus transmyocardial revascularization (TMR) are largely unknown. We report the results of 30-day and 3-, 6-, and 12-month clinical follow-up after CABG plus TMR in a consecutive series of patients with refractory angina pectoris and ≥1 myocardial ischemic area not amenable to CABG. All patients who underwent CABG plus TMR (n = 169) (mean age 63 ± 10 years, 70% men, 51% with previous CABG, 82% were deemed inoperable at other heart surgery centers due to small vessels or diffuse disease) between March 1996 and February 2000 were clinically followed and end points of interest (survival, stroke, acute myocardial infarction, and revascularization) and angina class were recorded at 30 days and 3, 6, and 12 months after CABG. At 1 year, actuarial survival and event-free survival were 85% and 81%, respectively. At the end of the first year after the procedure, 7 patients (4%) had angina class III/IV versus 152 patients (90%) at baseline (p <0.001). Predictors of major adverse cardiac events were advanced age (odds ratio [OR] 3.4, 95% confidence intervals [CI] 1.2 to 9.4, P = 0.01), prolonged intensive care unit stay (OR 3.3, CI 1.1 to 9.7, p <0.001), new-onset atrial fibrillation (OR 2.8, CI 1.1 to 7.0, P = 0.02), and in-hospital myocardial infarction (OR 1.5, CI 1.3 to 1.7, p <0.001). Thus, procedural success at 30 days and overall event-free and actuarial survival in a high-risk population setting shows that CABG plus TMR is a safe revascularization option for patients with intractable angina pectoris.     

体质量指数对非ST段抬高急性冠状动脉综合征患者血运重建的影响

目的:了解体质量指数(BMI)对非ST段抬高急性冠状动脉综合征患者血运重建治疗后的预后影响。方法:以DESIRE Ⅱ(The second drug-eluting stent impact on revascularization registry Ⅱ)为单中心回顾性注册研究,入选2003年7月1日至2005年9月30日在我院接受血运重建治疗的6 005例患者,2006年9月1日至11月30日对患者进行电话或门诊随访。本研究入选其中有体质量指数资料的非ST段抬高急性冠状动脉综合征病例3 001例。将这些患者按BMI分为2组,体质量指数(BMI)<23组和BMI≥23组,比较2组之间的临床情况和预后情况。不良心脑血管事件(MACCE)包括全因死亡、非致死性心肌梗死、非致死性卒中和再次血运重建。结果:共3 001例患者,BMI<23组506例和BMI≥23组2 495例,与BMI<23组的患者相比,BMI≥23组的患者年龄较小,伴随危险因素(高血压、糖尿病和高脂血症)较多,完全血运重建率低,总病死率低[HR 0.461,95%CI 0.262～0.808],2组心血管病死率和总MACCE发生率差异无统计学意义。结论:在非ST段抬高急性冠状动脉综合征患者中,尽管BMI≥23组相对BMI<23者有更多的危险因素,但是接受血运重构治疗后的总病死率低。     

冠状动脉多支血管病变伴慢性肾功能不全患者血管重建策略与预后的关系

目的对比多支血管病变伴慢性肾脏疾病（CKD）患者经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的2年临床预后。方法根据改良MDRD公式对北京安贞医院2004年到2006年因多支冠状动脉病变接受药物洗脱支架（DES）或CABG的患者的肾小球滤过率（GFR）进行计算,GFR＆lt;60mL/min诊断为CKD。共入选CKD患者1069例,其中724例接受DES,345例接受CABG。首要终点为2年内死亡、心肌梗死（MI）以及脑血管事件（CVE）的复合终点,次级终点为再次血管重建。结果在2年随访中,CABG组首要终点的发生率为9.9%,DES组为11.3%（P=0.528）。两组之间死亡率差异也无统计学意义（CABG组与DES组分别为3.5%比4.7%,P=0.422）。而DES组2年再次血管重建的比例显著高于CABG组（9.0%比4.1%,P=0.004）。Cox多因素回归分析表明,年龄、糖尿病、左心室功能不全（LVEF＆lt;30%）和急性冠状动脉综合征是复合终点发生的独立预测因素。结论在冠状动脉多支病变伴CKD患者中,CABG和DES两种血管重建策略显示出相同的死亡率和MI、CVE发生率。但DES组患者再次血管重建的发生率依然高于CABC组患者。     

Recurrent angina after coronary revascularization: a clinical challenge.

Coronary revascularization procedures by means of percutaneous coronary interventions or coronary artery bypass graft surgeries are performed worldwide daily for the symptomatic treatment of patients with myocardial ischaemia. Nevertheless, angina remains a significant clinical problem. Management of angina recurring or persisting after coronary revascularization is particularly challenging. This review attempts to summarize the most common causes of recurrent chest pain after coronary revascularization, to analyse the possible diagnostic approaches, and to discuss the potential treatment modalities.