Predisposing Factors, Demographics, Angiographic Features, and the Possible Role of Inflammation in Coronary Perforations—A 10-year Single-center Experience

2011 ◽  
Vol 9 (2) ◽  
pp. 87 ◽  
Author(s):  
Preeti Chandra ◽  
Saurav Chatterjee ◽  
Nishant Koradia ◽  
Deepak Thekkoott ◽  
Bilal Malik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Predisposing Factors ◽  
Covered Stents ◽  
Optimal Management ◽  
Balloon Inflation ◽  
Catheterization Laboratory ◽  
Cell Counts

Background:Coronary perforation during percutaneous coronary intervention is a rare but dreaded complication. The risk factors, optimal management, and outcome remain obscure.Objectives:To determine the predisposing factors, optimal management, and preventive strategies. We retrospectively looked at coronary perforations at our catheterization laboratory over the last 10 years. We reviewed patient charts and reports. Two independent operators, in a blinded approach, reviewed all procedural cineangiograms. Data were analyzed by simple statistical methodology.Results:Nine patients were treated conservatively and six patients were treated with prolonged balloon inflation. Six patients were treated with polytetrafluoroethylene (PTFE)-covered stents. One patient required emergency coronary artery bypass graft. No deaths were reported. Subjects with perforations also had a significantly higher total white blood cell count (means 12,134 versus 6,155, 95 % confidence interval [CI], p< 0.0001, n=22), total absolute neutrophil count (means 74.2 % versus 57.1 %, 95 % CI, p<0.0001, n=22), and neutrophil:lymphocyte ratio (means 3.65 versus 1.50, 95% CI, p<0.0001, n=22).Conclusions:Coronary perforations are rare but potentially fatal events. Hypertension, small vessel diameter, high balloon:artery ratio, use of hydrophilic wires, and presence of myocardial bridging appear to be possible risk factors. Most perforations can be treated conservatively or with prolonged balloon inflation using perfusion balloons. Use of PTFE-covered stents could be a life-saving measure in cases of large perforations. Subjects with perforations also had greater systemic inflammation as indicated by elevated white cell counts.

scholarly journals Relationship Between Diabetes Mellitus and Atrial Fibrillation Prevalence in the Polish Population. A Report From the Non-Invasive Monitoring for Early Detection of Atrial Fibrillation (NOMED-AF) Prospective Cross-Sectional Observational Study

2021 ◽  
Author(s):  
Jakub Janusz Gumprecht ◽  
Gregory Y.H Lip ◽  
Adam Sokal ◽  
Beata Średniawa ◽  
Katarzyna Mitręga ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
European Population ◽  
Cross Sectional ◽  
Study Population ◽  
Shared Risk

Abstract Background:The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence in an asymptomatic, silent form, i.e., silent AF (SAF).The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥65 years, for detection of AF, symptomatic or silent.Methods:A representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9± 9.1days. Results:Overall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM-) [25%, 95%CI 22.5-27.8% vs 17%; 95%CI 15.4-18.5% respectively, p<0.001]. DM patients were commonly associated with SAF [9%; 95%CI 7.9-11.4 vs 7%; 95% CI 5.6-7.5 respectively, p<0.001], and persistent/permanent AF [12.2%; 95% CI 10.3-14.3 vs 6.9%; 95% CI 5.9-8.1 respectively, p<0.001] compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM- patients (5% vs 4.5% respectively, p<0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM- individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery. Conclusions:AF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population. Trial registration: NCT03243474.

Abstract 14445: The Prevalence of Coronary Risk Factors Among Patients Undergoing Their First Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zoya Gurm ◽  
Milan Seth ◽  
Edouard Daher ◽  
Elizabeth Pielsticker ◽  
M. Imran Qureshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Population Level ◽  
Coronary Intervention ◽  
Study Cohort ◽  
Coronary Risk Factors ◽  
Percutaneous Coronary

Background: Coronary artery disease (CAD) is the leading cause of death globally and risk factors for CAD are well established. Although there has been a decline in the incidence of CAD in recent years, understanding the risk factor profile of patients presenting with cardiac disease in contemporary practice may help define current unmet challenges in preventing CAD. Objectives: To evaluate the prevalence of CAD risk factors among patients undergoing percutaneous coronary intervention (PCI) and assess how they have changed over time. Methods: We assessed the prevalence of risk factors among patients without a history of prior myocardial infarction, PCI, or coronary artery bypass graft surgery who underwent PCI at 47 non-federal hospitals in the state of Michigan between 1/1/2010 and 3/31/2018 using the BMC2 PCI registry. Results: Our study cohort included 69,970 men and 39,106 women. Traditional risk factors were highly prevalent in this population: 34.4% of men and 31.0% of women were current or recent smokers, hypertension was present in 71.8% of men and 80.6% of women, hyperlipidemia was present in 65.0% of men and 68.9% of women, diabetes was present in 27.8% of men and 35.5% of women, and 44.8% of men and 48.0% of women were obese. Over the study period, the prevalence of diabetes (29% to 32%) and obesity (45% to 48%) increased while a decline in smoking prevalence was noted (34% to 31%). Most patients had 2 or more risk factors with 51.2% having three or more risk factors. Compared with nonsmokers, smokers presented over a decade earlier (age 56.8 versus 66.9 years, p < 0.0001) and obese patients presented 4.0 years earlier (age 61.4 versus 65.4 years, p < 0.0001) (Figure). Conclusions: Modifiable risk factors are widely prevalent among patients undergoing their first PCI. Population-level interventions aimed at controlling obesity and preventing smoking could significantly delay the onset of CAD and the need for PCI.

scholarly journals Cardiovascular Events Are Not Associated with MTHFR Polymorphisms, But Are Associated with Methotrexate Use and Traditional Risk Factors in US Veterans with Rheumatoid Arthritis

2013 ◽  
Vol 40 (6) ◽  
pp. 809-817 ◽  
Author(s):  
Lisa A. Davis ◽  
Grant W. Cannon ◽  
Lauren F. Pointer ◽  
Leah M. Haverhals ◽  
Roger K. Wolff ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Methylenetetrahydrofolate Reductase ◽  
Proportional Hazards ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Cox Proportional Hazards ◽  
Mthfr Polymorphisms ◽  
Traditional Risk Factors

Objective.C677T and A1298C polymorphisms in the enzyme methylenetetrahydrofolate reductase (MTHFR) have been associated with increased cardiovascular (CV) events in non-rheumatoid arthritis (RA) populations. We investigated potential associations of MTHFR polymorphisms and use of methotrexate (MTX) with time-to-CV event in data from the Veterans Affairs Rheumatoid Arthritis (VARA) registry.Methods.VARA participants were genotyped for MTHFR polymorphisms. Variables included demographic information, baseline comorbidities, RA duration, autoantibody status, and disease activity. Patients’ comorbidities and outcome variables were defined using International Classification of Diseases-9 and Current Procedural Terminology codes. The combined CV event outcome included myocardial infarction (MI), percutaneous coronary intervention, coronary artery bypass graft surgery, and stroke. Cox proportional hazards regression was used to model the time-to-CV event.Results.Data were available for 1047 subjects. Post-enrollment CV events occurred in 97 patients (9.26%). Although there was a trend toward reduced risk of CV events, MTHFR polymorphisms were not significantly associated with time-to-CV event. Time-to-CV event was associated with prior stroke (HR 2.01, 95% CI 1.03–3.90), prior MI (HR 1.70, 95% CI 1.06–2.71), hyperlipidemia (HR 1.57, 95% CI 1.01–2.43), and increased modified Charlson-Deyo index (HR 1.23, 95% CI 1.13–1.34). MTX use (HR 0.66, 95% CI 0.44–0.99) and increasing education (HR 0.87, 95% CI 0.80–0.95) were associated with a lower risk for CV events.Conclusion.Although MTHFR polymorphisms were previously associated with CV events in non-RA populations, we found only a trend toward decreased association with CV events in RA. Traditional risk factors conferred substantial CV risk, while MTX use and increasing years of education were protective.

Clinical Implications of the SYNTAX Study

2009 ◽  
Vol 4 (1) ◽  
pp. 48 ◽  
Author(s):  
Patrick Serruys ◽  
Scot Garg ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Syntax Study ◽  
Better Than

Recent years have seen an ongoing debate as to whether coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is the most appropriate revascularisation strategy for patients with coronary heart disease (CAD). The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) study was conducted with the intention of defining the specific roles of each therapy in the management of de novo three-vessel disease or left main CAD. Interim results after 12 months show that PCI leads to significantly higher rates of major adverse cardiac or cerebrovascular events compared with CABG (17.8 versus 12.4; p=0.002), largely owing to increased rates of repeat revascularisation. However, CABG was much more likely to lead to stroke. Interestingly, categorisation of patients by severity of CAD complexity according to the SYNTAX score has shown that there are certain patients in whom PCI can yield results that are comparable to, if not better than, those achieved with CABG. Careful clinical evaluation and comprehensive assessment of CAD severity, alongside application of the SYNTAX score, can aid practitioners in selecting the most suitable therapy for each individual CAD patient.

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