Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention

BACKGROUND: Contrast-induced nephropathy (CIN) is a recognized complication after percutaneous interventions (PCI). We sought to determine the impact of gender on incidence and clinical outcome of CIN. METHODS AND RESULTS: Of a total 8,628 patients who underwent PCI, there were 1,431 (16.5%) who developed CIN (defined as > 25% rise in creatinine after PCI). Patients were followed clinically for one year. CIN was present in 23.6% of female versus 17.4% of male patients (p < 0.0001). Multivariate analysis showed that female gender (OR = 1.4, 95% CI = 1.25 1.60; p < 0.0001), pre-PCI chronic renal failure (CRF) (OR= 1.8, 95% CI = 1.53 2.10, p < 0.0001), diabetes mellitus (OR = 1.5, 95% CI = 1.34 1.70; p < 0.0001), age (OR = 1.01, 95% CI = 1.01 1.02, p < 0.0001), and hypertension (OR = 1.2, 95% CI = 1.06 1.36, p = 0.0035) were independent predictors of CIN. Clinical outcomes after CIN were examined in patients with or without CRF. Among patients without CRF who developed CIN, females (n = 465) had higher rates of one-year mortality, and MACE comparing to males (n = 710) without CRF (14% vs. 10% mortality, 36% vs. 30% MACE; p = 0.05 and 0.06, respectively). In patients with CRF who developed CIN, we found no significant gender differences in one-year clinical events (37% vs. 36% mortality, 42% vs. 45% MACE; p = 0.8 and 0.6, respectively). By multivariate analysis only baseline CRF, diabetes, age, functional NYHA IV class were identified as independent predictors of one-year mortality in patients with CIN after PCI. CONCLUSIONS: Female gender is an independent predictor of CIN development after PCI and a marker of worse 1-year mortality after CIN in patients without baseline CRF. After CIN is developed, pre-PCI CRF, diabetes mellitus, age, severe heart failure (not gender) are independent predictors of one-year mortality.     

Impact of aspirin treatment on long-term outcome (over 10 years) after percutaneous coronary intervention

Aspirin has been shown to reduce cardiovascular morbidity and mortality following percutaneous coronary intervention (PCI). However, its effects on long-term (over 10 years) mortality have not been fully elucidated. This retrospective study recorded the patient characteristics and admission medication for all patients undergoing PCI over an 8-year period from 1984 to 1992. Follow-up information was available for 748 patients (100%) for a mean of 143.6 +/- 43.4 months. A propensity analysis was performed to adjust for presumed selection biases in the administration of aspirin. The baseline clinical characteristics were similar between the group that received aspirin and the group that did not, except for the administration of statins and PCI procedural success rate. Of the 748 patients, 535 (71.5%) received aspirin treatment at the time of PCI. During the 12-year follow-up, 54 patients died from any cause and 20 patients from cardiac death. Kaplan-Meier analysis showed that aspirin treatment led to a significant reduction in all cause mortality (10% versus 16.4%; P = 0.01) and cardiac death (3.7% versus 8.0%; P = 0.02) compared to other antiplatelet drugs. The hazard ratio (HR) for the total mortality and cardiac mortality rates was adjusted using the Cox-proportional hazard model for confounding variables and propensity score. The all cause (HR, 0.49; 95%CI [0.29-0.80], P = 0.005) and cardiac mortality rates (HR, 0.32; 95%CI [0.14-0.72], P = 0.006) for patients receiving aspirin remained lower than for those not receiving aspirin. Aspirin treatment at the time of PCI significantly reduced the risk of death from any cause and cardiac death. The administration of aspirin had a positive impact on the over 10-year long-term outcomes of patients who underwent PCI.     

Impact of female sex on long-term outcomes in patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention

Background

Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI).

Methods

This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95% confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men.

Results

Among 481 patients, median age 66 years old, 138 (28.7%) were women. Women were older than men (72 vs 63 years, P < 0.001), had a higher prevalence of hypertension (68% vs 54%, P = 0.006), diabetes (27% vs 19%, P = 0.04), and Killip class ≥ 3 at admission (19% vs 10%, P = 0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9% vs 18.4%, unadjusted HR 1.86; 95% CI, 1.26-2.74; P = 0.002), driven mainly by heart failure (unadjusted HR 2.47; 95% CI, 1.12-5.41; P = 0.024), without significant differences in death (unadjusted HR 1.49; 95% CI, 0.88-2.53; P = 0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95% CI, 0.78-3.27; P = 0.19) and no increase in target lesion revascularization (9.4% vs 12.5%, unadjusted HR 0.77; 95% CI, 0.42-1.44; P = 0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95% CI, 0.84-2.06; P = 0.23).

Conclusions

Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.     

Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital

Survivors of cardiac arrest due to ventricular arrhythmias are at risk for recurrent events. The role of revascularization in secondary prevention for survivors of cardiac arrest has been addressed in various studies with conflicting results. A total of 142 survivors of cardiac arrest with coronary artery disease were evaluated according to a standardized protocol, including 2-dimensional echocardiography, myocardial perfusion scintigraphy, coronary angiography, and electrophysiologic testing. Revascularization of scintigraphically documented ischemic myocardial regions was performed in 44 patients (31%). Final therapy was based on the results of electrophysiologic testing. Four-year survival rates were 100% for revascularized noninducible patients, 84% for revascularized inducible patients, 91% for nonrevascularized noninducible patients, and 72% for nonrevascularized inducible patients. Only 1 patient (<1% of study population) died suddenly. Recurrences were much more frequent in patients without revascularization (38% vs 7%, p <0.001) and the recurrence rate was 0% in the revascularized noninducible patients. Thus, revascularization of ischemically jeopardized myocardium in survivors of cardiac arrest resulted in excellent survival; moreover, in absence of inducible ventricular arrhythmias, the recurrence rate was 0%. Systematic evaluation of survivors of cardiac arrest due to ventricular arrhythmias allows risk stratification and guidance of subsequent antiarrhythmic therapy.     

既往经皮冠状动脉介入对冠状动脉旁路移植术效果的影响

随着经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗的发展，接受PCI治疗的冠心病患者不断增加。由于支架内再狭窄、未处理节段冠状动脉粥样硬化进展，既往接受PCI治疗行冠状动脉旁路移植术（coronary artery bypass grafting，CABG）的患者亦不断增加。既往PCI对CABG手术效果是否存在影响仍有争议，本文对此作一综述。     

Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome

BACKGROUND: The seven-component Thrombolysis In Myocardial Infarction (TIMI) score has been used to risk stratify, and to guide the medical management of, patients with unstable angina or non-ST-elevation myocardial infarction. We assessed the usefulness of the risk score in predicting in-hospital and 30-day outcomes in such patients who were undergoing percutaneous coronary intervention. METHODS: Using the TIMI score, 2501 patients with unstable angina or non-ST-elevation myocardial infarction were divided into low-risk (zero to two risk factors; n = 974), intermediate-risk (three to four risk factors; n = 1339), and high-risk (five to seven risk factors; n = 188) groups, and outcomes were compared. RESULTS: Angiographic/clinical success and the rate of minor procedural events were similar among the three groups. A higher TIMI risk score was associated with more cardiac comorbid conditions and more complicated angiographic lesions: longer lesions (P = 0.0009), more thrombotic lesions (P = 0.03), more multivessel disease (P <0.0001), and more American College of Cardiology/American Heart Association type B2/C lesions (P = 0.05). Although the risk score did not predict interventional technical success or intraprocedural complications, a high score was associated with prolonged hospital stay, higher postprocedural peak troponin levels, and 30-day major adverse cardiac events. Stepwise logistic regression showed that in conjunction with lesion length and patient sex, a high score was an independent predictor of 30-day major adverse cardiac events (odds ratio = 2.3; 95% confidence interval: 1.1 to 4.1; C statistic = 0.62). CONCLUSION: Although a higher TIMI risk score in patients with unstable angina or non-ST-elevation myocardial infarction who were undergoing percutaneous coronary intervention correlated with adverse clinical outcome, the score alone cannot be used to guide diagnostic or therapeutic strategies.     

Female sex and risk of contrast nephropathy after percutaneous coronary intervention

BACKGROUND: Women undergoing percutaneous coronary intervention (PCI) seem to have a higher in-hospital mortality than men. The reason for this difference in outcome is unknown. Contrast nephropathy (CN) remains a major complication of PCI and a common cause of acute renal failure. OBJECTIVE: To test the hypothesis that women have a higher incidence of CN, which April contribute in part to their increased in-hospital mortality following PCI. METHODS: Sex-based differences in the development of CN were studied in 1383 patients undergoing PCI who were included in a randomized trial of two hydration regimens. Baseline renal function was assessed by calculating the glomerular filtration rate (GFR) using the abbreviated Modification of Diet in Renal Disease Study equation. CN was defined as an increase in serum creatinine of at least 44 micromol/L within 48 h. RESULTS: Women and men differed in several baseline characteristics. Women were older and had a higher incidence of arterial hypertension and diabetes. In addition, baseline GFR was significantly lower in women than in men. The incidence of CN was significantly higher in women. CN developed in 10 of 354 (2.8%) women compared with nine of 1029 (0.9%) men (odds ratio 3.3, 95% CI 1.3 to 8.2, P=0.01). After adjusting for confounders including baseline GFR and incidence of arterial hypertension, female sex was no longer a significant independent predictor of CN (odds ratio 2.2, 95% CI 0.8 to 5.6, P=0.12). CONCLUSIONS: The significantly higher incidence of CN after PCI in women seemed largely due to their less favourable baseline characteristics, including lower GFR and higher incidence of arterial hypertension, rather than to female sex itself.     

Operator experience and long term outcome after percutaneous coronary intervention

OBJECTIVES: To investigate the impact of operator experience on long term outcome of patients undergoing percutaneous coronary intervention (PCI). METHODS: Two hundred and fifty consecutive patients with 334 lesions undergoing elective PCI by three highly experienced (greater than 600 PCI, mean 1100) and three less experienced (fewer than 400 PCI, mean 250) high volume operators at a single tertiary care centre were prospectively studied. Quantitative assessment of the six-month angiography was possible in 273 lesions (82%). Clinical follow-up at 24 months was complete in all patients. RESULTS: Baseline characteristics of the 159 lesions treated by the highly experienced operators were comparable with the 175 lesions treated by the less experienced operators. Six months following PCI, the minimal lumen diameter at the lesion site was similar for both more experienced and less experienced operators (1.68+/-0.95 mm versus 1.63+/-0.89 mm, P=0.66), as was net lumen gain (0.97+/-1.02 mm versus 0.98+/-0.93 mm, P=0.96) and the rate of restenosis (33% versus 32%, P=0.87). By multivariate analysis, lower operator experience was not a predictor of restenosis (odds ratio 0.97, 95% CI 0.75 to 1.25, P=0.81). In addition, 24-month clinical follow-up did not reveal any relevant difference in the combined end point of death, myocardial infarction or clinically driven revascularization between more experienced (29 events in 116 patients) and less experienced operators (35 events in 134 patients; 25% versus 26%, P=0.84). CONCLUSIONS: Less experienced high volume operators seem to achieve similar long term results as more experienced high volume operators.     

高龄急性冠状动脉综合征患者经皮冠状动脉介入治疗的临床观察

目的评价高龄急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)的效果和预后。方法收集入住本院的61例行PCI术的高龄ACS患者的临床资料,其中男性38例,女性23例,年龄为80~88(82±2)岁。19例行急诊PCI术,42例为择期PCI术,观察近期(住院期间)和远期主要不良心脑血管事件(MACCE)的发生和临床预后。结果61例患者中3支血管病变39例(64%),双支血管病变16例(26%),单支血管病变6例(10%);完全闭塞病变25例(41%);14例(34%)患者合并肾动脉狭窄。手术操作成功率97%,术后心肌梗死溶栓试验3级达97%,术后并发症发生率13%,其中造影剂肾病6例(10%)。住院期间MACCE发生率3%,均为心源性死亡,4个月至4年9个月随访期间MACCE发生率22%,包括3例心脑源性死亡、2例其他原因死亡。结论高龄ACS患者行PCI术手术操作成功率高,住院期间病死率和随访期间MACCE发生率较低,但患者病变重,并发症尤其是造影剂肾病发生率相对较高。     

Impact of subclinical hypothyroidism on clinical outcome of patients coronary heart disease undergoing percutaneous coronary intervention

<正>Objective To compare the clinical outcome of coronary heart disease patients with normal TSH (ET) and subclinical hypothyroidism (SCH) after PCI. Methods This prospective cohort study analyzed the impact of different levels of thyroid stimulating hormone (TSH) on clinical outcomes in patients with coronary heart disease     

Impact of poly-vascular disease on longterm outcome of coronary artery disease patients post percutaneous coronary intervention

<正>Objective To investigate the impact of poly vascular disease(PVD) on long-term outcomes in coronary artery disease(CAD) patients undergoing percutaneous coronary intervention(PCI).Methods A total of 10 287 consecutive patients undergoing PCI in Beijing Fuwai Hospital from January 2013 to December 2013 were enrolled.According to the history of PVD,patients were     

冠状动脉血栓性病变早期和延迟介入治疗的疗效观察

目的　探讨冠状动脉内血栓形成对介入治疗早期疗效的影响。方法　自 1995年 10月至 2 0 0 2年 3月我院共对 115例有冠状动脉内血栓形成的患者进行了介入治疗 ,其中 4 8例即刻行冠状动脉介入治疗 (即刻治疗组 ) ,其他患者在肝素或溶栓治疗 7d后行介入治疗 (延迟治疗组 )。结果即刻治疗组和延迟治疗组的手术成功率相似 (91 7%比 97 1% ,P >0 0 5 ) ,但冠状动脉急性闭塞和严重心脏不良事件的发生例数即刻治疗组明显高于延迟治疗组 (3例比 0例和 2 7例比 16例 ,P值均 <0 0 5 )。结论　当冠状动脉内存在血栓形成时 ,在适时肝素治疗后行冠状动脉介入治疗可明显降低严重心脏不良事件的发生率。     

Impact of obesity on disease-specific health status after percutaneous coronary intervention in coronary disease patients

OBJECTIVE: Several investigators have focused on obesity as a specific risk factor for mortality in patients undergoing bypass surgery, but few have examined it as a risk factor among patients undergoing percutaneous coronary interventions (PCI). In addition, none have evaluated the impact of obesity on post-PCI quality of life or disease-specific health status. This study examined whether obesity is a risk factor for poor quality of life or diminished health status 12-months postprocedure among a large cohort of PCI patients. RESEARCH METHODS AND PROCEDURES: A total of 1631 consecutive PCI patients were enrolled into the study and classified as underweight (BMI <20 kg/m2), normal weight range (BMI >/=20 and <25 kg/m2), overweight (BMI >/=25 and <30 kg/m2), class I obese (BMI >/=30 kg/m2), or class II and III obese (BMI >/=35 kg/m2). The 12-month postprocedure outcomes included need for repeat procedure, survival, quality of life and health status, assessed using the Seattle Angina Questionnaire (SAQ) and the Short Form-12. RESULTS: Obese patients with and without a history of revascularization were significantly younger than overweight, normal weight range, or underweight patients at the time of PCI. However, obese patients demonstrated similar long-term recovery and improved disease-specific health status and quality of life when compared to patients in the normal weight range after PCI. In addition, mortality and risk for repeat procedure was similar to those patients in the normal weight range patients at 12-months postrevascularization. Underweight patients who had no previous history of revascularization reported lower quality of life (F=3.02; P=0.018) and poorer physical functioning (F=2.82; P=0.024) than other BMI groups. CONCLUSION: Obese patients presenting for revascularization were younger when compared to patients in the normal weight range, regardless of previous history of revascularization. However, weight status was not a significant predictor of differences in long-term disease-specific health status, quality of life, repeat procedures, or survival. Underweight patients demonstrated less improvement in quality of life and physical functioning than other BMI groups.