scholarly journals Elevated baseline plasma phospholipid protein (PLTP) levels are an independent predictor of long-term all-cause mortality in patients with diabetes mellitus and known or suspected coronary artery disease

2015 ◽  
Vol 239 (2) ◽  
pp. 503-508 ◽  
Author(s):  
Erdal Cavusoglu ◽  
Jonathan D. Marmur ◽  
Sandeep Chhabra ◽  
Mohammad R. Hojjati ◽  
Sunitha Yanamadala ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Independent Predictor ◽  
Plasma Phospholipid ◽  
Suspected Coronary Artery Disease ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

scholarly journals The LDL-C/HDL-C ratio and 4-year risk of coronary artery disease: a retrospective study

2020 ◽  
Author(s):  
shaohui zhang ◽  
Yongliang Zhao ◽  
Xiangting Li ◽  
Wen Dai ◽  
Xueying Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Syntax Score ◽  
Artery Disease

Abstract BackgroundNumerous studies have demonstrated that the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio can reflect the positive correlation index LDL-C and the negative index HDL-C of coronary artery disease (CAD) at the same time, which is increasingly considered as a novel marker to evaluate the risk of CAD. However, whether the short-term evaluation effect of the LDL-C/HDL-C ratio can be maintained during long-term follow-up is unclear. In addition, it is not clear whether the value of LDL-C/HDL-C ratio in the risk assessment of major adverse cardiac events (MACE) varies with different treatments. Our aim of the study was to investigate the link between LDL-C/HDL-C ratio and long-term risk of CAD and find out whether the LDL-C/HDL-C ratio could effectively evaluate the occurrence of MACE in CAD patients under different treatments. MethodsFrom May 2013 to November 2015, a total of 2409 patients who underwent coronary angiography (CAG) with or without revascularization therapy were enrolled in this study. They were divided into two groups based on the LDL-C/HDL-C ratio and three groups based on the treatments: medical therapy alone (MTA), percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).ResultsIn total, 1784 patients (74.1%) were followed for health outcome and 625 patients (25.9%) experienced a MACE event. The median follow-up time was 4.27 years (1560 days). The patients with a higher LDL-C/HDL-C ratio (≥ 2.33) also had a significantly higher incidence of MACE (HR: 1.47, 95% CI: 1.25 to 1.72, p < 0.001). The cumulative incidence of rehospitalization for UA (HR: 1.53, 95% CI: 1.27 to 1.84, p < 0.001) and rehospitalization for HF (HR: 3.70, 95% CI: 1.22 to 22.25, p = 0.021) were significantly higher in high group than in low group. There were no significant differences in MI (HR: 1.25, 95% CI: 0.63 to 2.48, P = 0.521), TLR (HR: 0.98, 95% CI: 0.62 to 1.55, p = 0.947), Stroke (HR: 1.65, 95% CI: 0.64 to 4.25, p = 0.301) and 4-year all-cause death (HR: 1.45, 95% CI: 0.58 to 3.61, p = 0.423). Kaplan-Meier cumulative curve showed that patients with higher LDL-C/HDL-C ratio had a significantly lower MACE-free survival (p < 0.001). Multivariate Cox regression analysis demonstrated that LDL-C/HDL-C ratio (HR: 1.34, 95% CI: 1.14 to 1.60, p < 0.001) together with age, smoking, hypertension, diabetes mellitus, Syntax score and TG were independent predictors of 4-year MACE in the total CAD population (all p < 0.05). Further subgroup analysis showed that age, smoking, Syntax score, TG and LDL-C/HDL-C ratio were the independent predictors of MACE in MAT group (all p < 0.05); However, Syntax score and diabetes mellitus were the only independent predictor of MACE in PCI group and the CABG group, respectively (both p < 0.05). ConclusionsIn this study, we found that LDL-C/HDL-C ratio was an independent predictor of 4-year MACE in the total CAD population. The value of LDL-C/HDL-C ratio in assessing MACE risk varied among CAD patients with different treatments.

scholarly journals Increased Soluble ST2 Predicts Long-term Mortality in Patients with Stable Coronary Artery Disease: Results from the Ludwigshafen Risk and Cardiovascular Health Study

2014 ◽  
Vol 60 (3) ◽  
pp. 530-540 ◽  
Author(s):  
Benjamin Dieplinger ◽  
Margot Egger ◽  
Meinhard Haltmayer ◽  
Marcus E Kleber ◽  
Hubert Scharnagl ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Ratio ◽  
Independent Predictor ◽  
Stable Coronary Artery Disease ◽  
Amino Terminal ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Stable Cad

Abstract BACKGROUND Soluble suppression of tumorigenicity 2 (sST2) has emerged as a strong prognostic biomarker in patients with heart failure and myocardial infarction. The aim of this study was to evaluate the long-term prognostic value of sST2 in patients with stable coronary artery disease (CAD). METHODS sST2 plasma concentrations were measured in 1345 patients with stable CAD referred for coronary angiography at a single tertiary care center. The primary endpoint was all-cause mortality. RESULTS During a median follow-up time of 9.8 years, 477 (36%) patients died. The median sST2 plasma concentration at baseline was significantly higher among decedents than survivors (21.4 vs 18.5 ng/mL; P &lt; 0.001). In multivariate Cox proportional hazards regression analysis, sST2 was an independent predictor of all-cause mortality (risk ratio 1.16 per 1-SD increase in log-transformed values; 95% CI 1.05–1.29; P = 0.004). In the same multivariate analysis, amino-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were also independent predictors, whereas galectin-3 was not. Patients with sST2 in the highest quartile (&gt;24.6 ng/mL) displayed a 2-fold increased risk of death in univariate analysis, which was attenuated but remained significant in a fully adjusted model (risk ratio 1.39; 95% CI 1.10–1.76; P = 0.006). Further analysis showed that the prognostic impact of sST2 was additive to NT-proBNP and hs-cTnT. Using a multibiomarker approach combining these 3 complementary makers, we demonstrated that patients with all 3 biomarkers in the highest quartiles had the poorest outcome. CONCLUSIONS In this cohort of patients with stable CAD, increased sST2 was an independent predictor of long-term all-cause mortality and provided complementary prognostic information to hs-cTnT and NT-proBNP.

scholarly journals Treatment of complex coronary artery disease in patients with diabetes mellitus and chronic kidney disease: 10-year results comparing outcomes of CABG and PCI in the SYNTAXES trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Gao ◽  
R.T Wang ◽  
K Takahashi ◽  
H Kawashima ◽  
R.J Van Geuns ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Funding Source ◽  
Private Company ◽  
All Cause Mortality ◽  
Artery Disease

Abstract Background The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of the SYNTAX trial, which was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease. The SYNTAXES study is the first randomized trial that reported the complete 10-year data on all-cause death in patients with complex coronary artery disease. Purpose Patients with coronary artery disease (CAD) and concomitant diabetes mellitus (DM) or chronic kidney disease (CKD) are more susceptible to major adverse cardiovascular and cerebrovascular events. However, to date, the long-term prognosis and which revascularization strategy was associated with better clinical outcomes for patients with complex coronary artery disease and concomitant with DM and CKD have not been documented. Methods In this sub-analysis of the SYNTAXES trial, a total of 1,638 patients were classified into four subgroups according to the DM and CKD status: DM−/CKD− (n=999, 60.1%), DM+/CKD− (n=323, 19.7%), DM−/CKD+ (n=231, 14.1%), and DM+/CKD+ (n=85, 5.2%). The treatment effects of PCI and CABG were analyzed in each subgroup. The primary endpoint was all-cause death at 10 years. Results Compared with the DM−/CKD− patients, patients with DM+/CKD+ were older, more often had a history of stroke, hypertension, heart failure, and were more frequently presented with total occlusion, bifurcation lesion and three-vessel disease. At 10 years, patients with DM+/CKD+ had a 3.94-fold higher incidence of all-cause mortality compared with DM−/CKD− individuals (54.1% versus 18.9%, 95% CI [2.85–5.44]). Patients with DM−/CKD+ (38.1%, HR 2.36; 95% CI [1.83–5.44]) or DM+/CKD− (28.2%, HR 1.61; 95% CI [1.26–2.07]) had intermediate risk profile. For DM+/CKD+ patients, compared with PCI, those who underwent CABG were associated with lower incidence of all-cause mortality (64.3% versus 44.2%, adjusted HR 0.52; 95% CI [0.27–0.99], p=0.047, pinteraction=0.443). The number of needed-to-treat to reduce mortality for CABG was 12. Conclusion In the SYNTAX population, patients with DM and CKD are at markedly increased risk of long-term mortality rate compared with patients one or neither of these risk factors. For patients with both comorbidities, CABG was associated with better clinical outcome compared with PCI. These findings should be interpreted as hypothesis-generating. Figure 1. Kaplan-Meier curves showing the clinical events according to treatment and DM/CKD status. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Boston Scientific Corporation

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