Ten‐year clinical outcomes in patients with intermediate coronary stenosis according to the combined culprit lesion

Abstract Background Vasospastic angina (VSA), which is one of the important functional cardiac disorders, may also play a role in the pathogenesis of atherosclerosis. Conversely, organic coronary stenosis is also known as an independent predictor for poor clinical outcomes in VSA patients. Although VSA patients have a variable degree of organic coronary stenosis in clinical setting, the functional importance of organic stenosis in those patients remains to be elucidated. Purpose The aim of this study was to examine the clinical importance and prognostic impact of fractional flow reserve (FFR) in patients with VSA and organic coronary stenosis. Methods We enrolled 236 consecutive patients with suspected vasospastic angina who underwent acetylcholine provocation test for coronary spasm (M/F 148/88, 63.6±12.0 [SD] yrs.). Among them, 175 patients (74.1%) were diagnosed as having VSA, while the remaining non-VSA patients were regarded as controls (Group-C, n=61). We divided the VSA patients into 3 groups based on angiographical findings and FFR values; VSA with no organic stenosis (>50% luminal stenosis) (Group-N, n=110), organic stenosis and high FFR (≥0.80) (Group-H, FFR 0.87±0.05, n=36), and organic stenosis and low FFR (<0.80) (Group-L, FFR 0.71±0.07, n=29). We evaluated the incidence of major adverse cardiovascular events (MACE), including cardiovascular death (CVD), non-fatal myocardial infarction (MI), urgent percutaneous coronary intervention (PCI), and hospitalization due to unstable angina pectoris (UAP) during the median follow-up period of 656 days. Results The groups with organic stenosis (Groups H and L) were characterized by higher prevalence of diabetes mellitus (Group-C/N/H/L, 23.0/20.9/44.4/34.5%, P=0.03) and dyslipidemia (Group-C/N/H/L, 37.7/39.1/50.0/65.5%, P=0.03) as compared with Group-C. After provocation test, all VSA patients received calcium channel blockers (CCBs). In addition, 20 days (median) after provocation test, 26 patients (92.9%) in Group-L underwent elective PCI with coronary stents, while no patient underwent PCI in Groups N or H. The incidence of MACE during follow-up was significantly higher in Group-L (Group-C/N/H/L; 1.6/3.6/5.6/27.6%, log-rank P<0.001), whereas clinical outcomes were comparable among the remaining 3 groups (Figure). Importantly, all 8 patients with MACE in Group-L had poor outcomes (CVD/MI/urgent PCI/UAP; 2/1/3/2) despite complete revascularization and the prevention of coronary spasm with CCBs, indicating that they might be resistant to standard contemporary therapies. They were characterized by less frequent use of angiotensin convert enzyme inhibitor (0 vs. 47.6%, P=0.02) and higher prevalence of multi-vessel organic lesions (37.5 vs. 4.8%, P=0.052) compared with those without MACE. Figure 1 Conclusions These results provide the first evidence that evaluation of coronary functional abnormalities with FFR is useful for making therapeutic strategies in VSA patients with organic coronary stenosis.

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CRT-100.84 Long-term Clinical Outcomes After the Treatment of Coronary Stenosis With Sirolimus-coated Balloon Angioplasty: Results From NANOLUTE Real-World Registry

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2018.01.073 ◽

2018 ◽

Vol 11 (4) ◽

pp. S24

Author(s):

Sameer Dani ◽

Keyur Parikh ◽

Prathap Kumar N. Pillai ◽

Ranjan Shetty ◽

Jagdish Hiremath ◽

...

Keyword(s):

Clinical Outcomes ◽

Balloon Angioplasty ◽

Real World ◽

Coronary Stenosis

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Sex differences in clinical characteristics and long-term outcomes in patients with vasospastic angina: results from the VA-Korea registry, a prospective multi-center cohort

Biology of Sex Differences ◽

10.1186/s13293-020-00341-4 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Hack-Lyoung Kim ◽

Sang-Ho Jo ◽

Hyun-Jin Kim ◽

Min-Ho Lee ◽

Won-Woo Seo ◽

...

Keyword(s):

Body Mass Index ◽

Sex Differences ◽

Clinical Outcomes ◽

Sex Difference ◽

Coronary Stenosis ◽

Clinical Characteristics ◽

Composite Events ◽

Male Patients

Abstract Background Sex differences in clinical characteristics and prognosis of vasospastic angina (VA) have not been well elucidated. This study was performed to investigate sex-specific characteristics and predictors for long-term clinical outcomes in patients with VA. Methods We analyzed 1838 patients (55 years and 62% male) who were diagnosed with definite (n = 680) or intermediate (n = 1212) VA in ergonovine provocation test from a nation-wide VA registry. The primary study end-point was composite events including cardiac death, acute coronary syndrome, ventricular tachycardia or fibrillation, and atrioventricular block during clinical follow-up. Results Male patients were younger, and there were more smokers and alcohol drinkers in male patients than in female patients. During the median follow-up period of 760 days (interquartile range, 336–1105 days), there were 73 cases (3.97%) of composite events. There was no sex difference in the occurrence of composite events (log-rank p = 0.649). Concomitant significant (≥ 50%) organic coronary stenosis was associated with worse clinical outcomes in both male (hazard ration [HR], 1.97; 95% confidence interval [CI], 1.01–3.85; p = 0.047) and female (HR, 3.26; 95% CI, 1.07–9.89; p = 0.037) patients. Obesity (body mass index ≥ 25 kg/m2) was associated with better prognosis in female VA patients (HR, 0.22; 95% CI, 0.07–0.68; p = 0.008). Even when only patients with definite diagnosis of VA were considered, there was no significant sex difference in clinical outcomes (log-rank p = 0.876). Conclusions In VA patients, there were several different clinical characteristics according to sex; however, long-term clinical outcome was similar between sexes. Significant organic coronary stenosis in both sexes and low body mass index (< 25 kg/m2) in females were associated with worse prognosis in VA patients.

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Comparison of Short-term Clinical Outcomes of Proximal Versus Non-Proximal Culprit Lesion Location in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Heart Lung and Circulation ◽

10.1016/j.hlc.2017.06.069 ◽

2017 ◽

Vol 26 ◽

pp. S73-S74

Author(s):

S. Noaman ◽

S. Vogrin ◽

C. Goh ◽

A. Brennan ◽

N. Adrianopoulos ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Culprit Lesion ◽

Short Term ◽

Lesion Location ◽

Percutaneous Coronary ◽

St Elevation

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P5583Comparison of short-term clinical outcomes of proximal versus non-proximal culprit lesion in patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehx493.p5583 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

S. Noaman ◽

S. Vogrin ◽

C.Y. Goh ◽

Y. Cheng ◽

A.L. Brennan ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Culprit Lesion ◽

Short Term ◽

Percutaneous Coronary ◽

St Elevation

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P6439Clinical outcomes of acute coronary syndrome with intact-fibrous cap plaque at the culprit lesions in diabetic and non-diabetic patients

European Heart Journal ◽

10.1093/eurheartj/ehz746.1033 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Niida ◽

T Yonetsu ◽

T Lee ◽

M Nakao ◽

S Nakagama ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Diabetic Patients ◽

Culprit Lesion ◽

Coronary Syndrome ◽

Fibrous Cap ◽

Significant Difference ◽

The Impact ◽

Lesion Morphology

Abstract Background Previous studies revealed that the morphological substrates of the culprit lesion assessed by optical coherence tomography (OCT) in acute coronary syndrome (ACS), which includes ruptured plaque (RP) and intact fibrous cap (IFC) plaque, are associated with subsequent clinical outcomes. Nevertheless, the impact of culprit morphology on clinical outcomes has not been evaluated in patients with diabetes mellitus (DM), which is one of the major determinants of clinical prognosis. Purpose We sought to investigate the association of the culprit lesion morphology with clinical outcomes in patients with DM and those without DM. Methods We retrospectively investigated a total of 508 patients with acute myocardial infarction (AMI) experiencing their first episode of ACS in whom OCT-guided, primary percutaneous coronary intervention (PCI) was performed and a culprit lesion was observed by OCT with sufficient image quality. Patients were divided into two groups according to the culprit lesion morphology into patients with RP (RP group) and those without RP (IFC group). The rate of major adverse cardiac events (MACE) including death, myocardial infarction, target or non-target lesion revascularizations were compared between RP and IFC groups in patients with DM (DM) and those without DM (non-DM), separately. Results MACE was captured in 80 patients during the median follow-up of 505 (IQR 274–1300) days. In non-DM, RP group showed significantly worse MACE-free rate than in IFC group (Figure), In DM, there was no significant difference between RP and IFC groups (Figure). Figure 1 Conclusion Culprit lesion morphology assessed by OCT was not associated with clinical outcomes in DM patients unlike non-DM patients. Distinct strategy for secondary prevention may be required for DM patients.

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