scholarly journals Is aspirin resistance or female gender associated with a high incidence of myonecrosis after nonurgent percutaneous coronary intervention? Reply

2005 ◽  
Vol 45 (4) ◽  
pp. 636
Author(s):  
Wai-Hong Chen ◽  
Pui-Yin Lee ◽  
William Ng ◽  
Hung-Fat Tse ◽  
Chu-Pak Lau
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Female Gender ◽  
Coronary Intervention ◽  
Aspirin Resistance ◽  
Percutaneous Coronary ◽  
High Incidence

Abstract 17428: Impact of Asymptomatic Cerebral Microbleeds or Lacunar Infarction on Clinical Outcome in Patients With Coronary Artery Disease (CAD) Requiring Percutaneous Coronary Intervention

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Seiji Hokimoto ◽  
Noriaki Tabata ◽  
Tomonori Akasaka ◽  
Kenji Sakamoto ◽  
Kenichi Tsujita ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcome ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Cerebral Microbleeds ◽  
Lacunar Infarction ◽  
Percutaneous Coronary ◽  
High Incidence ◽  
Artery Disease

Background: Patients with coronary artery disease (CAD) are often complicated with cerebrovascular disease (CVD). Although there are many reports on the relation between stoke with symptomatic signs and CAD, there are few studies on cerebral microbleeds or lacunar infarction without symptomatic signs. The aim was to examine the prevalence of cerebral microbleeds or lacunar infarction without symptoms and clinical outcome in CAD patients. Methods: Among 1,091 consecutive CAD patients who required percutaneous coronary intervention (PCI), patients with non-lacunar infarction more severe than lacunar infarction or old cerebral hemorrhage by computed tomography (CT) or magnetic resonance imaging (MRI) were excluded. We analyzed CAD patients with cerebral microbleeds or lacunar infarction without overt neurological signs (ML group; n=98, 71males) compared with patients without cerebral findings of CT or MRI and stroke history as control (N group; n=762, 525males). Clinical endpoints were cardiovascular death, myocardial infarction (MI), stroke, unstable angina and urgent revascularization. Results: ML group had a high age (72.9±9.6 vs. 69.2±10.8ys; P=0.001), high incidence of diabetes mellitus (58.2 vs. 47.2%; P=0.042), peripheral artery disease (21.4 vs. 11.5%; P=0.005), and renal dysfunction (49.0 vs. 37.3%; P=0.025), and high levels of fibrinogen (435 vs. 402mg/dl; P=0.005), and high brachial-ankle pulse wave velocity (1975 vs. 1786cm/sec; P=0.001) compared with N group. Cardiovascular event rate was significantly higher in ML group than in N group (11.2 vs. 4.7%, P=0.008). Details in clinical outcome were as follows: cardiovascular death (ML group vs. N group, 0 vs. 0.9%; P=0.341), MI (1.0 vs. 0.5%; P=0.544), stroke (4.1 vs.0.7%; P=0.002), unstable angina (5.1 vs. 2.5%; P=0.140), revascularization (2.0 vs. 0.7%; P=0.498), respectively. Multiple regression analysis identified findings of microbleeds or lacunar infarction as a predictor of clinical events (OR, 2.830; 95%CI, 1.328-6.031; P=0.007). Conclusions: There was high incidence of brain MRI or CT findings without symptom in CAD patients. We should pay attention to the asymptomatic patients with microbleeds or lacunar infarction irrespective of overt previous stroke.

Abstract 4017: Reduced Anti-Platelet Response to Clopidogrel in Diabetic Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jorge Saucedo ◽  
Anand Singla ◽  
Karin Mauer ◽  
Kevin P Bliden ◽  
Mark J Antonino ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Aggregation ◽  
Light Transmission ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Aspirin Resistance ◽  
Diabetic Patients ◽  
Loading Dose ◽  
Platelet Response ◽  
Percutaneous Coronary

Despite dual antiplatelet therapy with aspirin and clopidogrel, patients with diabetes mellitus (DM) suffer from frequent recurrent ischemic events. Previous studies have shown that DM patients have a higher prevalence of aspirin resistance than non-DM patients. The aim of this analysis was to determine if DM patients have a decreased antiplatelet response to either maintenance or high loading clopidogrel administration when compared to non-DM patients. One hundred and thirty eight patients that underwent percutaneous coronary intervention (PCI) in the Clear Platelets-2 Study were included in this analysis. Patients were grouped according to clopidogrel dose use and presence of DM. Subjects were either on maintenance therapy with 75mg of clopidogrel (C75 group; n=72) or received a loading dose of 600mg of clopidogrel immediately after PCI (C600 group; n=66). All patients received 325-mg aspirin. Platelet function was measured by Light Transmission Aggregometry using ADP (5 and 20μM), TRAP (15 μM), and collagen (2μg/ml). Overall, DM patients in the C75 group had higher platelet aggregation using 5 and 20μM ADP and 2μg/ml collagen. DM patients had lower relative platelet inhibition at 24hrs with 5 μM ADP and 2μg/ml collagen in the C600 group when compared to non-DM patients (Table ). DM patients undergoing PCI exhibit higher platelet aggregation when receiving standard clopidogrel maintenance dose and lower relative platelet inhibition with high clopidogrel loading dose. Higher doses of clopidogrel or more potent P2Y12 receptor antagonists may be needed in DM patients to obtain comparable platelet inhibition to non-DM patients.

Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention

Kardiologiia ◽  
2020 ◽  
Vol 60 (9) ◽  
pp. 38-45
Author(s):  
M. V. Zykov ◽  
N. V. D’yachenko ◽  
O. A. Trubnikova ◽  
A. D. Erlih ◽  
V. V. Kashtalap ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Fold Increase ◽  
Female Gender ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Patients At Risk ◽  
Emergency Percutaneous Coronary Intervention

Aim        To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods        The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results   Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion            This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification. 

scholarly journals Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yusuke Mizuno ◽  
Kenichi Sakakura ◽  
Hiroyuki Jinnouchi ◽  
Yousuke Taniguchi ◽  
Takunori Tsukui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Myocardial Damage ◽  
Coronary Intervention ◽  
Slow Flow ◽  
Percutaneous Coronary ◽  
High Incidence ◽  
Periprocedural Myocardial Infarction

AbstractComplications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA). However, it remains unclear whether the high incidence of slow flow results in the high incidence of periprocedural myocardial infarction (PMI), reflecting real myocardial damage. The aim of this study was to compare the incidence of PMI between PCI with versus without RA using propensity score-matching. We included 1350 elective PCI cases, which were divided into the RA group (n = 203) and the non-RA group (n = 1147). After propensity score matching, the matched RA group (n = 190) and the matched non-RA group (n = 190) were generated. The primary interest was to compare the incidence of PMI between the matched RA and non-RA groups. Before propensity score matching, the incidence of slow flow and PMI was greater in the RA group than in the non-RA group. After matching, the incidence of slow flow was still greater in the matched RA group than in the matched non-RA group (16.8% vs. 9.5%, p = 0.048). However, the incidence of PMI was similar between the matched RA and matched non-RA group (7.4% vs. 5.3%, p = 0.528, standardized difference: 0.086). In conclusion, although use of RA was associated with greater risk of slow flow, use of RA was not associated with PMI after a propensity score-matched analysis. The fact that RA did not increase the risk of myocardial damage in complex lesions would have an impact on revascularization strategy for severely calcified coronary lesions.

P5491Gender differences in long-term outcomes and predictors of all-cause mortality after percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Conradie ◽  
E Chowdhury ◽  
A Whelan ◽  
S Worthley ◽  
T Rafter ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Female Gender ◽  
Coronary Intervention ◽  
Multivariate Logistic Regression ◽  
Female Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Background Gender disparities have been consistently reported in the nature, presentation, and treatment of coronary artery disease, leading to significant outcome differences. Previous reports have suggested that after adjusting for differing baseline and procedural characteristics female gender was an independent predictor of all-cause mortality after Percutaneous Coronary Intervention (PCI). We examined this issue using data from the Genesis Cardiovascular Outcomes Registry (GCOR). Methods We prospectively collected data on 10,989 PCI procedures from January 2009 to January 2018 from 12 Australian Hospitals, and compared the baseline patient and procedural characteristics and 1-year mortality by gender. Results Female patients were more likely than males to present with NSTEMI (23.0% vs. 21.1%, p=0.042), however less likely to have prior MI (19.5% vs. 24.2%, p<0.001) or PCI (28.8% vs 33.6%, p<0.001). Procedural success rates were similar between females and males (97.2%). On multivariate logistic regression, female gender had a higher rate of all cause mortality (OR 0.58, 95% CI 0.31 to 1.07; P=0.08) but similar rates of MACE (OR 0.84, 95% CI 0.55 to 1.07, P=0.42). Variables contributing to an increased risk of mortality in female patients, included a history of previous heart failure (OR 2.45, 95% CI 1.15 to 5.22; p=0.02), myocardial infarction (OR 2.06, 95% CI 1.09 to 3.90; p=0.026), and peripheral vascular disease (OR 2.69, 95% CI 1.32 to 5.47; p=0.006). Performing PCI to the LMCA significantly increased the risk of mortality in female patients (OR 3.84, 95% CI 1.14 to 12.9; p=0.029), and the use of BMS vs DES contributed to a worse outcome in women compared to men (OR 0.46, 95% CI 0.25 to 0.84; p=0.012). The presence of hypercholesterolaemia in women significantly increased the risk of mortality (OR 0.44, 95% CI 0.22 to 0.86; p=0.016). Multivariate logistic regression assessing 1-year outcome by gender for all-cause mortality, MACE, and unplanned admissions Outcome Male (vs female) Odds ratio 95% CI P-value Death (143) 0.58 0.31 to 1.07 0.08 MACE (334) 0.84 0.55 to 1.28 0.42 Unplanned readmission (888) 0.79 0.63 to 0.98 0.04 Conclusion Women have significant differences in baseline characteristics and increased all-cause mortality at 1 year compared to men, although overall MACE rates are similar. This study increases awareness of women at high risk, highlighting the need to improve the care of women undergoing PCI.

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