Magnitude and Characteristics of Residual Lipid Risk in Patients With a History of Coronary Revascularization: The ICP-Bypass Study

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P<0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

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Lp (a) >50 mg/dl predicts atherosclerotic cardiovascular events in patients with heterozygous familial hypercholesterolemia who achieved LDL-C <2.6 mmol/l

European Heart Journal ◽

10.1093/ehjci/ehaa946.2991 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Funabashi ◽

Y Kataoka ◽

M Hori ◽

M Ogura ◽

K Matsuki ◽

...

Keyword(s):

Familial Hypercholesterolemia ◽

Coronary Revascularization ◽

Statistical Significance ◽

Lipid Lowering ◽

Current Guideline ◽

Potential Therapeutic Target ◽

Heterozygous Familial Hypercholesterolemia ◽

Significant Difference ◽

History Of ◽

Atherosclerotic Cardiovascular Diseases

Abstract Introduction Lipoprotein (a) [Lp (a)] is a plasma lipoprotein which exhibits atherogenic properties. Lp(a) ≥50 mg/dl has been recently shown to associate with a risk of atherosclerotic cardiovascular diseases (ASCVD) in patients with heterozygous familial hypercholesterolemia (HeFH). While current guideline recommends lowering LDL-C as a first-line therapeutic approach in HeFH subjects, it remains to be fully determined whether an elevated level of Lp(a) confers additional ASCVD risks in HeFH patients who achieved a lower LDL-C level. Purpose To investigate cardiovascular outcomes in HeFH subjects with a lower LDL-C but an elevated Lp(a) levels. Methods 182 HeFH patients with on-treatment LDL-C <2.6 mmol/l under lipid-lowering therapies were analyzed. Clinical characteristics and MACE (= a composite of all-cause death, ACS, stroke, PAD and coronary revascularization) were compared in HeFH subjects with Lp(a) ≥ vs. <50 mg/dl. Results The averaged LDL-C and Lp (a) levels were 1.9 mmol/l and 26.8 mg/dl, respectively. 19.2% of study subjects exhibited Lp(a)≥50 mg/dl. HeFH patients with Lp(a) ≥50 mg/dl were more likely to be older and have a history of hypertension, but these comparisons did not meet statistical significance. There was no significant difference in on-treatment LDL-C, HDL-C and Triglyceride level (Table). However, during the observational period (median=4.7 years), there was a 2.7-fold (95% CI, 1.41–5.02; p=0.004) greater likelihood of experiencing MACE in subjects with Lp(a) ≥50 mg/dl (picture). Even after adjusting clinical demographics, Lp(a) ≥50 mg/dl remained an independent predictor for the occurrence of MACE (hazard ratio=2.53, 95% CI: 1.29–4.82, p<0.001). Conclusions Despite achieving on-treatment LDL-C <2.6 mmol/l, an elevated risk of MACE was observed in HeFH patients with Lp(a) ≥50 mg/dl. Our findings suggest an increased level of Lp(a) as a risk stratification marker and a potential therapeutic target in patients with HeFH. Clinical outcome Funding Acknowledgement Type of funding source: None

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Factor Associated with Abnormal Ankle-Brachial Index Among Diabetic Patients in Songklanagarind Hospital: A Retrospective Cohort Study

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201828 ◽

2018 ◽

Vol 36 (4) ◽

pp. 299 ◽

Cited By ~ 1

Author(s):

Supakorn Sripaew ◽

Thanittha Sirirak

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Coronary Revascularization ◽

Ankle Brachial Index ◽

Smoking History ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Previous Stroke ◽

History Of

Objective: To find the correlation between type 2 diabetic patients who had abnormal ankle-brachial index (ABI) among factors affected diabetes and cardiovascular outcomes including acute coronary syndrome (ACS), myocardial infarction (MI), coronary revascularization stroke, renal replacement therapy, leg revascularization and limb amputation Material and Methods: Retrospective cohort study collecting the data of 548 diabetic patients examined ABI at Outpatient Departments from 1st January 2009 to 31st December 2015. Results: From 548 medical records including only normal-ABI group and low-ABI group, we found that hypertension, chronic kidney disease (CKD), smoking, history of previous MI, history of previous stroke and age were the significant associated factor of low-ABI. The survival analyses revealed the significantly higher rate of ACS, MI, and coronary revascularization in low-ABI group (p-value=0.04, <0.01, <0.01 respectively) after exposed to low-ABI around 4 years. However, the study found no significant difference of other outcomes between the 2 groups. Conclusion: Songklanagarind’s diabetic patients with low-ABI were associated with the significantly higher rate of multiple cardiovascular risk factors including hypertension, CKD, smoking, history of previous MI, history of previous stroke and age and they tend to significantly experience more ACS, MI and coronary revascularization after 4 years exposed to low-ABI.

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Abstract P454: The Predictors of Non-adherence of Regular Physical Activity After Coronary Revascularization

Circulation ◽

10.1161/circ.129.suppl_1.p454 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

esra gucuk ipek ◽

Burak Acar ◽

Cengiz Burak ◽

Fatih Bayraktar ◽

Meryem Kara ◽

...

Keyword(s):

Physical Activity ◽

Regression Analysis ◽

Coronary Revascularization ◽

Education Level ◽

Regular Physical Activity ◽

Significant Difference ◽

Low Education ◽

History Of ◽

Physical Activity Adherence

Background: Coronary heart disease the leading cause of mortality worldwide and regular physical activity is a comprehensive management strategy for these patients. We investigated the parameters that influence regular physical activity in patients with a history of coronary revascularization. Methods: We included outpatients who had a history of coronary revascularization at least 6 months prior to enrollment. A questionnaire was filled out with each patient to collect the data of engagement in regular physical activity, demographics, clinical characteristics, and dietary adherence. Results: We enrolled 202 consecutive outpatients (age 61.3±11.2 years, 73% males). The median duration after revascularization was 60 months. One hundred and 4 (51%) patients had previous percutaneous coronary intervention, 67 (33%) patients had coronary by-pass graft surgery, and 31 (15%) patients had both of the revascularization procedures. Of all, 46 (23%) patients were engaging in regular physical activity with a median of 2 days per week. Patients were classified into two subgroups according to their physical activity habits. There was no significant difference in age, comorbid conditions or revascularization type between subgroups. In the univariate regression analysis, absence of regular physical activity was associated with female gender, low education level, unemployment, low household income, implantation of bare metal stent (vs. drug eluted stent) and absence of regular follow-up visits. Stepwise multivariate regression analysis concluded that low education level (p=0.01, OR=3.26, 95%CI: 1.31 -8.11), and absence of regular follow-up visits (p=0.04, OR=2.95, 95%CI: 1.01-8.61) were independent predictors of non-adherence of regular physical activity in study subjects. Conclusion: Regular physical activity rates were lower in outpatients with a history of previous coronary revascularization. Education level and regular follow-up visits could influence physical activity adherence in these patients.

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Abstract 15677: Statin Prescription and Dose Intensity Among Elderly Medicare Beneficiaries, by CV Disease Diagnosis and Prescriber Specialty

Circulation ◽

10.1161/circ.130.suppl_2.15677 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Akeem Yusuf ◽

Christopher Wiggenhorn ◽

Jill Hardin ◽

Ryan D Kilpatrick ◽

Charles A Herzog

Keyword(s):

Internal Medicine ◽

Unstable Angina ◽

Coronary Revascularization ◽

Dose Intensity ◽

Disease Diagnosis ◽

Medicare Beneficiaries ◽

Low Intensity ◽

History Of ◽

Cv Disease ◽

Statin Use

Introduction: Statin use is known to benefit elderly patients with cardiovascular (CV) disease. However, little is known about the rate and dose of statin prescriptions or prescriber specialty among elderly Medicare beneficiaries with a history of various CV diseases. Method: In this retrospective analysis of 2007-2010 Medicare claims data, we identified enrollees with history of prevalent CV disease or diabetes (DM) (N=613,674, 68% women, 7.5% black, mean [±SD] age 76.7 [±8] years). We used a disease hierarchy approach and included 9 subgroups: patients with a history of myocardial infarction (MI), unstable angina, ischemic stroke, stable angina, transient ischemic attack (TIA), carotid stenosis, coronary revascularization (PCI/CAB), peripheral arterial disease (PAD), or DM. We identified statin users at diagnosis or within 12 months post-diagnosis; categorized statin therapy as high-, moderate-, and low-intensity; and examined the clinical specialty of statin prescribers. Results: Overall, 41% of patients had at least one cardiologist visit in 2010. Statin use was highest among PCI/CAB patients (81.5%) and lowest among PAD patients (45.5%) (Table 1). Similar proportions of patients with MI (72.8%) and unstable angina (71.4%) were prescribed statins. High-intensity and low-intensity statins were most commonly prescribed to MI patients (22%) and TIA patients (13.7%), respectively. Overall, family/internal medicine was the most common specialty of statin prescribers across all CV disease groups (Table 2). PCI/CAB patients were most likely to receive prescriptions from cardiologists (23.8%). Endocrinologists prescribed 2.3% of statins for DM patients. Most PAD patients (62.9%) were prescribed statins by family/internal medicine clinicians. Conclusions: Statin use is lower among elderly PAD and TIA patients. More comprehensive assessment of statin use is needed, and of its determinants and associated outcomes in elderly CV patients.

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Abstract 571: Prognostic Value of Albuminuria on One Month Mortality in Acute Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_583-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Francois Schiele ◽

Nicolas Meneveau ◽

Romain Chopard ◽

Vincent Descotes-Genon ◽

Joanna Oettinger ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Revascularization ◽

Multivariable Analysis ◽

Peripheral Vessel ◽

Grace Risk Score ◽

Atherogenic Lipid Profile ◽

History Of ◽

Troponin Release ◽

Atherogenic Lipid

Background: Albuminuria is associated with hypertension, renal and endothelial dysfunction, inflammation, insulin resistance and atherogenic lipid profile. An increase in albuminuria occurs in the early days after acute myocardial infarction. The aim of this study was to assess the relation between albuminuria and 30 day mortality, as well as its incremental predictive value on top of established prognostic parameters. Methods: Demographic, clinical and biological characteristics at admission, in-hospital treatments and one month survival were recorded in 1188 consecutive patients admitted for acute myocardial infarction. Albuminuria was assessed from an 8-hour, overnight urine collection at day 3 using immunonephelemetry. The population was categorized according to albuminuria <20, 20 to 200 and >200 μg/min. Results: Fifty one percent (625/1188) of patients had an albuminuria level below 20 μg/min, 40% (296) between 20 and 200 μg/min and 9% (109) above 200 μg/min. High levels of albuminuria were associated with older age, history of hypertension, previous surgical coronary revascularization, stroke or peripheral vessel disease. Albuminuria was also correlated with troponin release, BNP and high sensitive CRP. At one month, there was a significantly higher mortality rate in groups with higher albuminuria (31/635(5%), 64/477(13%) and 22/109(20%) for albuminuria <20, 20–200 and >200 μg/min respectively). Multivariable analysis showed that albuminuria was an independent predictor of mortality. After adjustment on the GRACE risk score and the use of guidelines-recommended treatments, patients with albuminuria >20 μl/min had a 4-fold higher 30 day mortality, and those >200 μl/min had a 5 fold higher 30 day mortality, as compared with patients with albuminuria <20 μl/min (OR 4 [1.3–12.5] and 5.9 [1.64–20] for albuminuria >20 μl/min and >200 μl/min respectively). Conclusions: Albuminuria level is an independent and powerful predictor of mortality after acute myocardial infarction.

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Clinical Outcome of Noncardiac Surgery in Patients With History of Coronary Artery Revascularization by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery

Japanese Clinical Medicine ◽

10.1177/1179670717748945 ◽

2018 ◽

Vol 9 ◽

pp. 117967071774894

Author(s):

Jungchan Park ◽

Seung Hwa Lee ◽

Jeayoun Kim ◽

Myungsoo Park ◽

Hyeon-Cheol Gwon ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Clinical Outcome ◽

Coronary Revascularization ◽

Artery Bypass ◽

Coronary Intervention ◽

Noncardiac Surgery ◽

Percutaneous Coronary ◽

History Of

Objective: Although safety concerns still remain among patients undergoing unanticipated noncardiac surgery after prior percutaneous coronary intervention (PCI), it has not been directly compared with coronary artery bypass grafting (CABG). The objective of this study was to compare clinical outcomes after noncardiac surgery in patients with prior (>6 months) coronary revascularization by PCI or CABG. Methods: From February 2010 to December 2015, 413 patients with a history of coronary revascularization, scheduled for noncardiac surgery were identified. Patients were divided into PCI group and CABG group and postoperative clinical outcome was compared between 2 groups. The primary outcome was composite of all-cause death, myocardial infarction, and stroke in 1-year follow-up. Results: The 413 patients were divided according to prior coronary revascularization types: 236 (57.1%) into PCI and 177 (42.9%) into CABG group. In multivariate analysis within 1-year follow-up, there was no significant difference in clinical outcome which was composite of all-cause death, myocardial infarction, and stroke (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 0.76-2.93; P = .24). The same result was present in propensity-matched population analysis (HR: 1.43; 95% CI: 0.68-3.0; P = .34). Conclusions: In patients undergoing noncardiac surgery with prior coronary revascularization by PCI or CABG performed on an average of 42 months after PCI and 50 months after CABG, postoperative clinical outcome at 1-year follow-up is comparable.

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Natural history of hypercoagulability in patients undergoing coronary revascularization and effect of preoperative myocardial infarction

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2013.10.028 ◽

2014 ◽

Vol 148 (2) ◽

pp. 536-543 ◽

Cited By ~ 12

Author(s):

J. James Edelman ◽

Caroline J. Reddel ◽

Leonard Kritharides ◽

Paul G. Bannon ◽

John F. Fraser ◽

...

Keyword(s):

Myocardial Infarction ◽

Natural History ◽

Coronary Revascularization ◽

History Of

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Vorapaxar in the treatment of cardiovascular diseases

Future Cardiology ◽

10.2217/fca-2019-0090 ◽

2020 ◽

Vol 16 (5) ◽

pp. 373-384

Author(s):

Udaya S Tantry ◽

Kevin P Bliden ◽

Rahul Chaudhary ◽

Marko Novakovic ◽

Amit Rout ◽

...

Keyword(s):

Myocardial Infarction ◽

Peripheral Artery Disease ◽

Coronary Revascularization ◽

Bleeding Risk ◽

Cardiovascular Death ◽

Severe Bleeding ◽

Peripheral Artery ◽

Primary Hemostasis ◽

History Of ◽

Artery Disease

Vorapaxar specifically and effectively inhibits protease activated receptor-1 and may reduce thrombin-mediated ischemic events without interfering primary hemostasis. In the TRA-2P-TIMI 50 trial, vorapaxar reduced the risk of primary ischemic outcome but with increased bleeding risk. In the post hoc analysis, in patients with a history of myocardial infarction, peripheral artery disease, the net clinical outcome favored vorapaxar therapy with 10% reduction in cardiovascular death, myocardial infarction, stroke, urgent coronary revascularization and moderate or severe bleeding. Based on these favorable results, vorapaxar was approved for the reduction of thrombotic cardiovascular events in patients with prior myocardial infarction or with peripheral artery disease on top of standard antiplatelet therapy. A careful patient selection is needed to balance efficacy versus safety.

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