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Raquel P. Amier Martijn W. Smulders Wiesje M. van der Flier Sebastiaan C.A.M. Bekkers Alwin Zweerink Cornelis P. Allaart Ahmet Demirkiran Sebastiaan T. Roos Paul F.A. Teunissen Yolande Appelman Niels van Royen Raymond J. Kim Albert C. van Rossum Robin Nijveldt 《JACC: Cardiovascular Imaging》2018,11(12):1773-1781
Objectives
This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.Background
Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.Methods
A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.Results
Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.Conclusions
Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness. 相似文献2.
Joo Myung Lee Doyeon Hwang Ki Hong Choi Tae-Min Rhee Jonghanne Park Hyung Yoon Kim Hae Won Jung Ji-Won Hwang Hyun-Jong Lee Ho-Jun Jang Su Hong Kim Young Bin Song Yun-Kyeong Cho Chang-Wook Nam Joo-Yong Hahn Eun-Seok Shin Yoshiaki Kawase Akiko Matsuo Hitoshi Matsuo 《JACC: Cardiovascular Interventions》2018,11(20):2099-2109
Objectives
The study sought to investigate the prognostic implications of relative increase of fractional flow reserve (FFR) with PCI in combination with post–percutaneous coronary intervention (PCI) FFR.Background
FFR, measured after PCI has been shown to possess prognostic implications. The relative increase of FFR with PCI can be determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the role of relative increase of FFR with PCI has not yet been evaluated.Methods
A total of 621 patients who underwent PCI using second-generation drug-eluting stents based on low pre-PCI FFR (≤0.80) and available post-PCI FFR were analyzed. The relative increase of FFR was calculated by %FFR increase with PCI ([post-PCI FFR – pre-PCI FFR]/pre-PCI FFR × 100). Patients were divided according to the optimal cutoff values of post-PCI FFR (<0.84) and %FFR increase (≤15%). The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel–related myocardial infarction, and clinically driven target vessel revascularization) at 2 years.Results
Among the total population, 66.0% showed high post-PCI FFR (≥0.84) and 69.2% showed high %FFR increase (>15%). Patients with low post-PCI FFR showed a higher risk of 2-year TVF than did those with high post-PCI FFR (9.1% vs. 2.6%; hazard ratio [HR]: 3.367; 95% confidence interval [CI]: 1.412 to 8.025; p = 0.006). Patients with low %FFR increase also showed a higher risk of 2-year TVF compared with those with high %FFR increase (9.2% vs. 3.0%; HR: 3.613; 95% CI: 1.543 to 8.458; p = 0.003). Among the high post-PCI FFR group, there were no significant differences in clinical outcomes according to %FFR increase. Conversely, among the low post-PCI FFR group, those with low %FFR increase showed a significantly higher risk of TVF than did those with high %FFR increase (14.3% vs. 4.1%; HR: 4.334; 95% CI: 1.205 to 15.594; p = 0.025). Percent FFR increase significantly increased discriminant and reclassification ability for the occurrence of TVF when added to a model with clinical risk factors and post-PCI FFR (C-index 0.783 vs. 0.734; relative integrated discrimination improvement 0.702; p = 0.009; category-free net reclassification index 0.479; p = 0.031).Conclusions
Percent FFR increase with PCI showed similar prognostic implications with post-PCI FFR. Adding the relative increase of FFR to post-PCI FFR would enable better discrimination of high-risk patients after stent implantation. (Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE]; NCT01873560) 相似文献3.
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Seoyoung C. Kim Tuhina Neogi Eun Ha Kang Jun Liu Rishi J. Desai MaryAnn Zhang Daniel H. Solomon 《Journal of the American College of Cardiology》2018,71(9):994-1004
Background
Patients with gout are at an increased risk of cardiovascular (CV) disease including myocardial infarction (MI), stroke, and heart failure (HF).Objectives
The authors conducted a cohort study to examine comparative CV safety of the 2 gout treatments—probenecid and allopurinol—in patients with gout.Methods
Among gout patients ≥65 years of age and enrolled in Medicare (2008 to 2013), those who initiated probenecid or allopurinol were identified. The primary outcome was a composite CV endpoint of hospitalization for MI or stroke. MI, stroke, coronary revascularization, HF, and mortality were assessed separately as secondary outcomes. The authors estimated the incidence rate and hazard ratio of the primary and secondary outcomes in the 1:3 propensity score–matched cohort of probenecid and allopurinol initiators.Results
A total of 9,722 probenecid initiators propensity score–matched to 29,166 allopurinol initiators with mean age of 76 ± 7 years, and 54% males were included. The incidence rate of the primary composite endpoint of MI or stroke per 100 person-years was 2.36 in probenecid and 2.83 in allopurinol initiators with a hazard ratio of 0.80 (95% confidence interval: 0.69 to 0.93). In the secondary analyses, probenecid was associated with a decreased risk of MI, stroke, HF exacerbation, and mortality versus allopurinol. These results were consistent in the subgroup analyses of patients without baseline CV disease or those without baseline chronic kidney disease.Conclusions
In this large cohort of 38,888 elderly gout patients, treatment with probenecid appears to be associated with a modestly decreased risk of CV events including MI, stroke, and HF exacerbation compared with allopurinol. 相似文献7.
Guido Kranenburg Pim A. de Jong Jonas W. Bartstra Suzanne J. Lagerweij Marnix G. Lam Jeannette Ossewaarde-van Norel Sara Risseeuw Redmer van Leeuwen Saskia M. Imhof Harald J. Verhaar Job J. de Vries Riemer H.J.A. Slart Gert Luurtsema Annemarie M. den Harder Frank L.J. Visseren Willem P. Mali Wilko Spiering 《Journal of the American College of Cardiology》2018,71(10):1117-1126
Background
In pseudoxanthoma elasticum (PXE), low pyrophosphate levels may cause ectopic mineralization, leading to skin changes, visual impairment, and peripheral arterial disease.Objectives
The authors hypothesized that etidronate, a pyrophosphate analog, might reduce ectopic mineralization in PXE.Methods
In the Treatment of Ectopic Mineralization in Pseudoxanthoma Elasticum trial, adults with PXE and leg arterial calcifications (n = 74) were randomly assigned to etidronate or placebo (cyclical 20 mg/kg for 2 weeks every 12 weeks). The primary outcome was ectopic mineralization, quantified with 18fluoride positron emission tomography scans as femoral arterial wall target-to-background ratios (TBRfemoral). Secondary outcomes were computed tomography arterial calcification and ophthalmological changes. Safety outcomes were bone density, serum calcium, and phosphate.Results
During 12 months of follow-up, the TBRfemoral increased 6% (interquartile range [IQR]: ?12% to 25%) in the etidronate group and 7% (IQR: ?9% to 32%) in the placebo group (p = 0.465). Arterial calcification decreased 4% (IQR: ?11% to 7%) in the etidronate group and increased 8% (IQR: ?1% to 20%) in the placebo group (p = 0.001). Etidronate treatment was associated with significantly fewer subretinal neovascularization events (1 vs. 9, p = 0.007). Bone density decreased 4% ± 12% in the etidronate group and 6% ± 9% in the placebo group (p = 0.374). Hypocalcemia (<2.20 mmol/l) occurred in 3 versus 1 patient (8.1% vs. 2.7%, p = 0.304). Eighteen patients (48.6%) treated with etidronate, compared with 0 patients treated with placebo (p < 0.001), experienced hyperphosphatemia (>1.5 mmol/l) and recovered spontaneously.Conclusions
In patients with PXE, etidronate reduced arterial calcification and subretinal neovascularization events but did not lower femoral 18fluoride sodium positron emission tomography activity compared with placebo, without important safety issues. (Treatment of Ectopic Mineralization in Pseudoxanthoma elasticum; NTR5180) 相似文献8.
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Kenji Watanabe Takayuki Matsumoto Tadakazu Hisamatsu Hiroshi Nakase Satoshi Motoya Naoki Yoshimura Tetsuya Ishida Shingo Kato Tomoo Nakagawa Motohiro Esaki Masakazu Nagahori Toshiyuki Matsui Yuji Naito Takanori Kanai Yasuo Suzuki Masanori Nojima Mamoru Watanabe Toshifumi Hibi 《Clinical gastroenterology and hepatology》2018,16(4):542-549.e1
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Mateusz Tajstra Tomasz Hrapkowicz Michał Hawranek Krzysztof Filipiak Marek Gierlotka Marian Zembala Mariusz Gąsior Michael Oscar Zembala 《JACC: Cardiovascular Interventions》2018,11(9):847-852
Objectives
This study aimed to investigate the 5-year clinical follow-up of the HYBRID (Hybrid Revascularization for Multivessel Coronary Artery Disease) trial.Background
The HYBRID trial, the only randomized study involving thorough analysis of outcome after the 2 procedures, suggested that hybrid coronary revascularization (HCR) is feasible in selected patients with multivessel coronary disease referred for conventional coronary artery bypass grafting (CABG). There are currently no long-term outcome data from randomized trials in this setting.Methods
A total of 200 patients with multivessel coronary disease referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG. The primary endpoint was the occurrence of all-cause mortality at 5 years.Results
Nine patients (4 in HCR and 5 in CABG group) were lost to the 5-year follow-up. Finally, 191 patients (94 in HCR and 97 in CABG group) formed the basis of this study. The groups were well balanced in terms of pre-procedural characteristics. All-cause mortality at 5-year follow-up was similar in the 2 groups (6.4% for HCR vs. 9.2% for CABG; p = 0.69). The rates of myocardial infarction (4.3% vs. 7.2%; p = 0.30), repeat revascularization (37.2% vs. 45.4%; p = 0.38), stroke (2.1% vs. 4.1%; p = 0.35), and major adverse cardiac and cerebrovascular events (45.2% vs. 53.4%; p = 0.39) were also similar in the 2 groups.Conclusions
HCR has similar 5-year all-cause mortality when compared with conventional coronary bypass grafting (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease; NCT01035567) 相似文献13.
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William L. Hasler Laura A. Wilson Linda A. Nguyen William J. Snape Thomas L. Abell Kenneth L. Koch Richard W. McCallum Pankaj J. Pasricha Irene Sarosiek Gianrico Farrugia Madhusudan Grover Linda A. Lee Laura Miriel James Tonascia Frank A. Hamilton Henry P. Parkman 《Clinical gastroenterology and hepatology》2019,17(7):1285-1294.e1
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Sofia Chatzidou Christos Kontogiannis Diamantis I. Tsilimigras Georgios Georgiopoulos Marinos Kosmopoulos Elektra Papadopoulou Georgios Vasilopoulos Stylianos Rokas 《Journal of the American College of Cardiology》2018,71(17):1897-1906
Background
Electrical storm (ES), characterized by unrelenting recurrences of ventricular arrhythmias, is observed in approximately 30% of patients with implantable cardioverter-defibrillators (ICDs) and is associated with high mortality rates.Objectives
Sympathetic blockade with β-blockers, usually in combination with intravenous (IV) amiodarone, have proved highly effective in the suppression of ES. In this study, we compared the efficacy of a nonselective β-blocker (propranolol) versus a β1-selective blocker (metoprolol) in the management of ES.Methods
Between 2011 and 2016, 60 ICD patients (45 men, mean age 65.0 ± 8.5 years) with ES developed within 24 h from admission were randomly assigned to therapy with either propranolol (160 mg/24 h, Group A) or metoprolol (200 mg/24 h, Group B), combined with IV amiodarone for 48 h.Results
Patients under propranolol therapy in comparison with metoprolol-treated individuals presented a 2.67 times decreased incidence rate (incidence rate ratio: 0.375; 95% confidence interval: 0.207 to 0.678; p = 0.001) of ventricular arrhythmic events (tachycardia or fibrillation) and a 2.34 times decreased rate of ICD discharges (incidence rate ratio: 0.428; 95% CI: 0.227 to 0.892; p = 0.004) during the intensive care unit (ICU) stay, after adjusting for age, sex, ejection fraction, New York Heart Association functional class, heart failure type, arrhythmia type, and arrhythmic events before ICU admission. At the end of the first 24-h treatment period, 27 of 30 (90.0%) patients in group A, while only 16 of 30 (53.3%) patients in group B were free of arrhythmic events (p = 0.03). The termination of arrhythmic events was 77.5% less likely in Group B compared with Group A (hazard ratio: 0.225; 95% CI: 0.112 to 0.453; p < 0.001). Time to arrhythmia termination and length of hospital stay were significantly shorter in the propranolol group (p < 0.05 for both).Conclusions
The combination of IV amiodarone and oral propranolol is safe, effective, and superior to the combination of IV amiodarone and oral metoprolol in the management of ES in ICD patients. 相似文献16.
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Renato D. Lopes Roberto Rordorf Gaetano M. De Ferrari Sergio Leonardi Laine Thomas Daniel M. Wojdyla Peter Ridefelt John H. Lawrence Raffaele De Caterina Dragos Vinereanu Michael Hanna Greg Flaker Sana M. Al-Khatib Stefan H. Hohnloser John H. Alexander Christopher B. Granger Lars Wallentin 《Journal of the American College of Cardiology》2018,71(10):1063-1074