scholarly journals Pre-operative Diagnosis of Silent Coronary Ischaemia May Reduce Post-operative Death and Myocardial Infarction and Improve Survival of Patients Undergoing Lower Extremity Surgical Revascularisation

2020 ◽  
Vol 60 (3) ◽  
pp. 411-420
Author(s):  
Dainis Krievins ◽  
Edgars Zellans ◽  
Gustavs Latkovskis ◽  
Andrejs Erglis ◽  
Ligita Zvaigzne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Extremity ◽  
Operative Death ◽  
Surgical Revascularisation

Applicability of the VOYAGER trial criteria: a cohort study on patients in the nationwide Danish Vascular Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Soegaard ◽  
P.B Nielsen ◽  
F Skjoeth ◽  
T.B Larsen ◽  
N Eldrup
Keyword(s):  
Myocardial Infarction ◽  
Lower Extremity ◽  
Major Adverse Cardiovascular Events ◽  
Funding Source ◽  
Inclusion Criteria ◽  
Private Company ◽  
Exclusion Criteria ◽  
Dual Pathway ◽  
Event Rates ◽  
Lower Extremity Revascularization

Abstract Introduction Peripheral artery disease (PAD) carries a high risk of debilitating stroke, myocardial infarction, and death. The VOYAGER PAD trial investigates whether rivaroxaban 2.5 mg plus aspirin vs aspirin alone leads to a reduction in major adverse cardiovascular events (MACE) in patients with symptomatic PAD undergoing revascularization. However, it is unclear whether patients enrolled in VOYAGER PAD reflect those undergoing lower extremity revascularization in daily clinical practice. Purpose To describe the proportion of patients eligible for the VOYAGER PAD trial within the nationwide Danish Vascular Registry (DVR), the reasons for ineligibility, and rates of cardiovascular outcomes in VOYAGER-eligible and VOYAGER-ineligible patients. Methods We identified and characterized all patients from 2000–2016 undergoing open surgical or endovascular revascularization for symptomatic PAD in the DVR and applied the VOYAGER inclusion and exclusion criteria. We computed one-year rates per 100 person-years of VOYAGER PAD trial endpoints of MACE, myocardial infarction, ischemic stroke, major amputation, major bleeding, cardiovascular (CV) death, and all cause death. Results In the DVR, 32,911 patients underwent lower extremity revascularization for symptomatic PAD and were evaluated for eligibility. Among these, 32.2% had at least one exclusion criteria and an additional 40.6% without exclusion criteria did not fulfil inclusion criteria. The “VOYAGER-eligible” population therefore comprised 27.2% of the identified patients (Figure 1A). Main reasons for exclusion were atrial fibrillation (30.7%), poorly regulated hypertension (19.6%), PCI or ACS within 12 months before (16.0%), treatment with strong inhibitors or inducers of cytochrome P450 (9.2%), active cancer (8.8%), and severe renal failure (8.3%). Main reasons for non-inclusion were aorto-iliac procedures (79.0%), non-successful revascularization (13.1%), and age<50 years (7.1%). Compared with “VOYAGER-eligible” patients, event rates were slightly lower among patients in the DVR not fulfilling inclusion criteria and markedly higher for “VOYAGER excluded” patients (Figure 1B). Conclusion In this nationwide cohort of symptomatic PAD patients undergoing lower extremity revascularization, 27.2% full filled the inclusion and exclusion criteria for dual pathway therapy in the VOYAGER PAD trial. Non-inclusion predominantly related to aorto-iliac procedures and were associated with lower event rates. Future studies are needed to clarify if these patients could also benefit from dual pathway therapy. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG, Berlin, Germany

scholarly journals Early and late results of carotid endarterectomy: retrospective study of 70 operations

2001 ◽  
Vol 119 (6) ◽  
pp. 206-211 ◽  
Author(s):  
Eduardo Toledo de Aguiar ◽  
Alex Lederman ◽  
Celso Higutchi ◽  
Gerd Schreen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Myocardial Infarction ◽  
Magnetic Resonance ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Computerized Tomography ◽  
Late Results ◽  
Resonance Imaging ◽  
Operative Death ◽  
Tomography Scan

CONTEXT: Indications and results of carotid endarterectomy have been defined from clinical multicentric trials like the European Carotid Surgery Trialists, North-American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. The patients included in these trials were highly selected, as were the surgeons performing the operations. Clinical practice is different but the same results should be achieved. OBJECTIVE: To study indications, technique, early and late results, and whether carotid endarterectomy has been performed in accordance with standards defined by multicentric trials. DESIGN: Retrospective case report study. SETTING: A tertiary care private hospital. PARTICIPANTS: 57 patients, on whom 70 carotid endarterectomies were performed over a 10-year period. The median age was 66.4 ± 7.8 years; 43 (75.4%) were male, 41 (71.9%) hypertensive, 36 (63.1%) current smokers and 24 (21.0%) had diabetes. Bilateral carotid stenosis was present in 31 (54.3%) patients, peripheral arterial occlusions in 32 (56.1%) and ischemic cardiopathy in 25 (43.1%). All patients had had angiography and 41 (71.9%) had also had a duplex-scan of neck arteries. Cerebral imaging via computerized tomography scan or magnetic resonance imaging was obtained for 36 patients. Patients were followed up over a period of one to 122 months. MAIN MEASUREMENTS: early and late post-operative death, early and late post-operative stroke, and recurrence of atheroma plaque and symptoms relative to carotid stenosis. RESULTS: There was one post-operative death (1.4%) caused by myocardial infarction and two early strokes (2.8%): a total complication rate of 4.2%. After 3 and 5 years, 95.4% and 81.3% of patients respectively were stroke-free and 72.8% and 67.3% were alive. There were four recurrences and two of them related to stroke. Forty-nine (70%) stenoses operated on were symptomatic. Brain infarction was detected in 59.2% of patients who underwent computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Carotid endarterectomy was done in accordance with international standards. The most frequent cause of late death was myocardial infarction, and recurrences were related to stroke. Patients should be followed up closely.

Abstract 13769: Assessing the Risk for Cardiovascular Diseases According to Lipoprotein(a) Levels

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Narek A Tmoyan ◽  
Marat V Ezhov ◽  
Olga I Afanasieva ◽  
Uliana V Chubykina ◽  
Elena A Klesareva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Carotid Artery ◽  
Lower Extremity ◽  
Carotid Artery Disease ◽  
Lipoprotein A ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Introduction: There is no common opinion about threshold lipoprotein(a) [Lp(a)] concentration for atherosclerotic cardiovascular diseases (ASCVD) risk. Different clinical guidelines and consensus documents postulated cut-off Lp(a) level as 30 mg/dL or 50 mg/dL. We assessed the concentration of Lp(a) that associated with ASCVD of different locations. Methods: The study included 1224 patients with ASCVD. Lp(a) concentration was measured by enzyme-linked immunosorbent assay in serum. Patients were divided into 3 groups: group I - Lp(a)<30 mg/dL, group II - 30≤Lp(a)<50 mg/dL, group III - Lp(a)≥50 mg/dL (table). Results: Coronary heart disease, carotid artery disease, lower extremity artery disease, myocardial infarction and ischemic stroke were diagnosed in 61%; 34%; 23%; 42% and 11% patients, respectively. Lower extremity artery disease, carotid artery disease and myocardial infarction were more frequent in patients with Lp(a) concentration from 30 to 50 mg/dL compared to patients with Lp(a) <30 mg/dL: 36%, 41%, 48% vs. 17%, 30%, 36% respectively, p<0.01 for all. Subjects with Lp(a) 30-50 mg/dL (n=182, 15%) had a greater odds ratio of lower extremity artery disease, carotid artery disease and myocardial infarction compared to patients with Lp(a) <30 mg/dL (table). ROC analysis demonstrated that Lp(a) cut-off levels for lower extremity artery disease, carotid artery disease, coronary heart disease and myocardial infarction were 26; 21; 37 and 36 mg/dL, respectively. Conclusions: Our results demonstrate that in case of Lp(a) cut-off level of 50 mg/dL about 15% of patients are underestimated for the risk of ASCVD. Lp(a) cut-off level for ASCVD is between 20 and 40 mg/dL regarding the atherosclerosis location.

scholarly journals Lung tumor presenting with acute myocardial infarction and lower extremity arterial embolism

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jichun Liu ◽  
Hao Chen ◽  
Xiangrong Xie ◽  
Yuwen Yang ◽  
Shengxing Tang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lower Extremity ◽  
Left Atrium ◽  
Lung Tumor ◽  
Simultaneous Occurrence ◽  
Arterial Embolism ◽  
Case Presentation ◽  
Tumor Embolism ◽  
Tumor Embolization

Abstract Background Lung tumor embolization leading to acute myocardial infarction (AMI) is rare. Previouscases of lung tumor embolization were reported in the coronary artery. We describe here a case of lung tumor embolization leading to the simultaneous occurrence of AMI and lower extremity arterial embolism. Case presentation A 64-year-old patient was admitted to the emergency department complaining of chest pain and was diagnosed with AMI.An echocardiography showed a mass in the left atrium that was speculated to be a myxoma. An emergency coronary angiography found no evidence of atherosclerosis. On the second day of admission, the patient was diagnosed with lower extremity arterial embolism. Initially, we speculated that the left atrium myxoma caused an embolism resulting in the AMI and lower extremity arterial embolism.However, a lung tumor was the real cause of both conditions. Unfortunately, the patient abandoned treatment when he learned of his disease and died three days later after being discharged from the hospital. Conclusions Lung tumor embolism is an extremely rare cause of AMI. Even rarer is the case presented here, in which a lung tumor embolism caused AMI and lower extremity arterial embolism. Clinicians should recognize lung tumor embolism as a potential cause of AMI.

Abstract 511: Adverse Outcomes in Patients with Diabetes Mellitus Following Stenting for Lower Extremity Peripheral Arterial Disease

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Sarah Kiani ◽  
Usman Salahuddin ◽  
Haekyung Jeon Slaughter ◽  
Atif Mohammad ◽  
Emmanouil S Brilakis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Lower Extremity ◽  
Adverse Outcomes ◽  
Endovascular Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Event Analysis ◽  
Patients With Diabetes ◽  
Baseline Characteristics ◽  
Artery Disease

Introduction: There is limited data on outcomes of percutaneous endovascular intervention for lower extremity peripheral artery disease (PAD) in patients with diabetes mellitus (DM). We assessed the hypothesis that patients with DM, in comparison to patients without DM, have higher rates of major adverse cardiovascular and limb events after lower extremity PAD stenting. Methods: 1,006 patients with primary stent implant procedures between January 2005 and October 2015 enrolled in the observational XLPAD registry (NCT01904851) were analyzed for 12 month major adverse cardiovascular events (MACE; all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE; target limb repeated endovascular intervention, surgical revascularization, and major amputation). Cochran-Mantel-Haenszel statistics was used for overall association of categorical baseline characteristics; Cox proportional regressions and Kaplan-Meier curves were used for median time to event analysis. Results: At baseline, patients with DM had higher prevalence of coronary artery disease (74.9% vs. 56.2%; p<0.0001), heart failure (22.9% vs. 10.9%; p<0.001), prior myocardial infarction (27.3% vs. 22.5%; p=0.0076) and prior stroke (10.3% vs. 5.8%; p<0.0001) in comparison to patients without DM. Cox proportional regressions after adjusting for baseline characteristics showed significantly higher MACE (8.5% vs. 4.0%; Hazard ratio (HR) 1.99; 95% CI 1.26-3.50; p=0.003, Figure 1A ) as well as MALE (49.0% vs. 40.9%; HR 1.22; 95% CI 1.01-1.48; p=0.043, Figure 1B ) in patients with DM at 12-months. Conclusion: PAD in patients with DM is associated with significantly higher rates of major adverse cardiovascular and limb events.

The timing of surgical revascularisation in acute myocardial infarction: when should we intervene?

2021 ◽  
Author(s):  
Thomas H. YAU ◽  
Ming H. CHONG ◽  
Zachary M. BRIGDEN ◽  
Dorette NGEMOH ◽  
Amer HARKY ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Surgical Revascularisation

Antithrombotic Therapy for Peripheral Revascularisation

2020 ◽  
Vol 18 (3) ◽  
pp. 223-236
Author(s):  
Marco De Carlo ◽  
Marco Angelillis ◽  
Riccardo Liga
Keyword(s):  
Lower Extremity ◽  
Coagulation Cascade ◽  
Limb Amputation ◽  
Antiplatelet Treatment ◽  
Risk Factor Modification ◽  
Public Health Burden ◽  
Surgical Revascularisation ◽  
Anticoagulant Drugs ◽  
Depth Analysis ◽  
Artery Disease

: Lower extremity artery disease (LEAD) represents a major public health burden, affecting hundreds of millions of people worldwide. Although risk-factor modification, exercise training and medical treatment are the mainstays of the management of LEAD, endovascular or surgical revascularisation is recommended when there is the risk of limb amputation and when drug-resistant claudication severely affects patient lifestyle. Over recent years, the number of peripheral vascular interventions (PVI) has soared worldwide, driven by the improvements in endovascular techniques and devices. This growth was accompanied by a large number of clinical trials aimed at assessing the safety and efficacy of the various revascularisation modalities, while very little evidence was collected regarding the best antithrombotic treatment in patients undergoing peripheral revascularisation. In particular, considering the extensive length of diseased vessels usually treated in PVI, an optimised approach to both platelet function and coagulation cascade is of paramount importance. However, the role of antiplatelet and anticoagulant drugs following lower extremity revascularisation is largely extrapolated from the coronary field. Current guidelines recommend long-term single antiplatelet treatment for the majority of both endovascular and surgical revascularisation procedures, preceded by an initial short-term dual antiplatelet treatment in case of PVI. : We present an overview of the indications and techniques of both endovascular and surgical peripheral revascularisation, followed by an in-depth analysis of the available evidence regarding type and duration of antiplatelet and anticoagulant treatment following revascularisation.

Sign in / Sign up

Export Citation Format

Share Document