scholarly journals PCI in patients with ostium coronary artery lesions: three-year follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Maximkin ◽  
Z Shugushev ◽  
A Chepurnoy ◽  
O Safonova ◽  
A Mambetov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Target Lesion ◽  
Long Term Results ◽  
Coronary Artery Lesions ◽  
Total Frequency ◽  
Stent Restenosis ◽  
Group I ◽  
Group Ii

Abstract Aims To increase the effectiveness of percutaneous coronary interventions (PCI) in patients with ostium coronary artery lesions. Methods 170 patients were included in the study. Inclusion criteria: ostium atheroslerotic lesions of left arterial descending (LAD) or left circumflex (LCx) >70% according to angiography and intravascular ultrasound (IVUS); myocardial ischemia according stress test and FFR measurement. All patients were randomized into 2 groups. In I group (n=85) according to IVUS, atherosclerotic plaque spread from the ostium of LAD and/or LCx to the left main coronary artery (LMCA), and in group II (n=85) - the plaque did not spread into the LMCA. In Group I all patients were initially treated with “Provisional T” stenting of the LMCA, and in Group II – precision stenting of the ostium LAD or LCx. Long-term results were evaluated on 24 and 48 months. Primary endpoints: frequency of MACE (death, MI, revascularizations). Results During hospitalization of complications associated with PCI was not, survival was 100% in all groups. The conversion to complete bifurcation stenting were in 5 patients from Group I and conversion to provisional stenting were in 3 patients from Group II. The long-term results after 24 months was observe in 70 patients from Group I and 72 patients, from Group II. Nonfatal myocardial infarction (MI) was observed in 2 (2.7%) of patients from group II and not in Group I. The incidence of hemodynamic significant stent restenosis and was observed in 4 patients (5.7%) in Group I, and in 7 patients (9.8%) in Group II (p<0.05). The target lesion revascularization (TLR) was performed in 4 patients (5.7%) in Group I, and in 9 patients (12.5%) in Group II (p<0.05). The total frequency of MACE in groups I and II was 4 (5.7%) and 9 (12.5%), respectively (p<0.05). The survival was 100% in both groups. The long-term results after 48 months was observe in 58 patients from Group I and 54 patients, from Group II. All type of death registration in 1 patient from Group I and 2 patients from Group II. Nonfatal myocardial infarction (MI) was observed in 1 patient (1.7%) and 2 patients from Group II (3.7%) (p>0.05). The incidence of hemodynamic significant stent restenosis was observed in 3 patients (5.7%) in Group I, and in 5 patients (9.3%) in Group II (p<0.05). The target lesion revascularization (TLR) was performed in 4 patient (6.9%) in Group I, and in 7 patient (13%) in Group II (p<0.05). The total frequency of MACE in groups I and II was 5 (8.6%) and 10 (18.5%), respectively (p<0.05). The freedom from cardiac events (Kaplan-Maier analysis) was significant difference (92.5 in Group I and 84.5 in Group II (p<0.05). Conclusions IVUS analysis of ostium stenosis of coronary arteries can help in choosing the optimal stenting technique, as well as reliably improve long-term PCI results. Patients after precision stenting of the ostium have worse long-term results, compared with patients after provisional T-stenting. Funding Acknowledgement Type of funding source: None

scholarly journals Treatment of de novo coronary artery lesions with paclitaxel drug coated balloons (DCB) in diabetic and non-diabetic patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.M.Z Mohd Saad Jalaluddin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
De Novo ◽  
Target Lesion ◽  
Diabetic Group ◽  
Target Lesion Revascularization ◽  
Diabetic Patients ◽  
Coronary Artery Lesions ◽  
Artery Disease

Abstract Background Drug-coated balloon has been widely used to treat In-Stent Restenosis as recommended by ESC/EACT coronary intervention guideline. However, trials of effectiveness of DCB in treating de novo lesions in diabetic patients are limited. This study will highlight the impact of DCB in diabetic patients with only de novo lesions against non-diabetic patients. Aim To compare the outcomes of Paclitaxel Drug Coated Balloon (DCB) in Diabetic and non-diabetic patients with only de novo coronary artery disease. Methods A retrospective, single center study was conducted from January 2016 till December 2018. All diabetic and non-diabetic patients underwent angioplasty to only de novo coronary artery lesions were included in the study. Patients' baseline characteristic, angiographic data, post procedural and 12 months follow-up outcomes including major adverse coronary artery event (MACE), target lesion revascularization (TLR) and myocardial infarction (MI) are compared. Results A total of 1257 patients (726 diabetic and 531 non-diabetic patients) with total 1385 de novo coronary artery lesions (791 lesions in diabetic group and 594 lesions in non-diabetic group) were included in this study. Mean age for non-diabetic group was 57.6±10.6 years and diabetic group was 59.6±9.6 years with male predominance (91.1% in non-diabetic group, n=484 and 79.2% in diabetic group, n=575). Majority of diabetic group has hypertension (83.7%, n=608 vs 58.6%, n+311), chronic renal failure (10.3%, n=75 vs 1.9%, n=10), documented coronary artery disease (55.6%, n=404 vs 47.5%, n=252) and previous coronary angioplasty 39.5%, n=287 vs 28.8%, n=153). Adequate pre-dilatation was done in both groups (98.5%, n=585 in non-diabetic group and 99.4%, n=786 in diabetic group; p=0.000). Mean DCB diameter and length were almost similar in both groups. Mean residual stenosis after DCB was 11.15±16.9% in non-diabetic group and 13.13±13.4% in the diabetic group (p=0.008). 74.6% of non-diabetic group (n=396) and 77.1% of diabetic group (n=560) were on double antiplatelet therapy for 12 months. 86.8% (n=461) of non-diabetic and 88.4% (n=642) of diabetic patients were available for follow up. MACE events were significantly higher (p=0.000) in diabetic group (4.3%, n=31) as compare to non-diabetic group (0.6%, n=3). Target lesion revascularization (TLR) and myocardial infarction (MI) was also significantly higher in diabetic group (TLR 1.4%, N=10 vs 0.6%, n=3, p=0.049; MI 2.6%, n=19 vs 0.4%, n=2, p=0.002). Conclusion Treating de novo coronary lesions in diabetic patients with DCB associated with significantly higher MACE events, target lesion revascularization and myocardial infarction. Diabetic patients appear to have a greater volume of atherosclerotic plaque and increased propensity for atherosclerotic plaque rupture. Funding Acknowledgement Type of funding source: None

scholarly journals Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

2021 ◽  
Vol 38 (6) ◽  
pp. 5-15
Author(s):  
Soslan T. Enginoev ◽  
Dmitriy A. Kondratiev ◽  
Gasan M. Magomedov ◽  
Tamara K. Rashidova ◽  
Bakytbek K. Kadyraliev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Group I ◽  
Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

2020 ◽  
Vol 30 (7) ◽  
pp. 911-918
Author(s):  
Etsuko Tsuda
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Adverse Effects ◽  
Stent Implantation ◽  
Long Term Results ◽  
Coronary Artery Lesions ◽  
Coronary Syndrome ◽  
Coronary Stent Implantation

AbstractFifty years have passed since the first report of Kawasaki disease in 1967, and the prevalence of acute coronary syndrome in Kawasaki disease patients with coronary artery lesions exceeding 40 years old has increased. Primary coronary stent implantation is currently an acceptable method in ischaemic coronary heart disease in adults. However, it is unknown whether the stent implantation is effective or not in this population. As the clue to answer this question, I reviewed the references on Kawasaki disease patients who underwent the stent implantations between 1997 and 2019. Thirty-three patients underwent stent implantations for 34 coronary arteries. Adverse effects in the late period were found in 19 (68%) of 28 vessels with follow-up angiograms. There were complete occlusion 9, restenosis 8, and migration 2. A new aneurysm formation was found in 7 (37%) among the 19 vessels, and 6 (86%) of the 7 vessels were drug-eluting stent and 5 were found after the procedure for chronic total occlusion. The adverse effects free-rate at 1 year and 3 years were 57 and 25%, respectively. At present, the usefulness of stent implantation in the long-term results was scarce. Even if primary percutaneous coronary intervention without a stent implantation is performed for acute coronary syndrome, it can be expected to maintain the patency of the culprit lesion for several years. It is better to avoid a stent implantation as long as possible in this population. Knowing the long-term efficacy and complications of stent implantations is important for deciding the procedure.

scholarly journals Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Si-Da Jia ◽  
Yi Yao ◽  
Ying Song ◽  
Xiao-Fang Tang ◽  
Xue-Yan Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Left Main ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objectives. We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background. PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods. A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p=0.034), myocardial infarction (7.1% vs. 1.8%, p<0.001), in-stent thrombosis (4.5% vs. 0.8%, p<0.001), and stroke (7.1% vs. 6.4%, p=0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p=0.011). Conclusion. LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.

scholarly journals The Long-Term Results of ReLEX® SMILE Depending on the Degree of the Corrected Myopia

2020 ◽  
Vol 17 (4) ◽  
pp. 711-718
Author(s):  
O. A. Klokova ◽  
R. O. Damashauskas ◽  
S. V. Kostenev ◽  
E. N. Kalaidin
Keyword(s):  
Visual Acuity ◽  
Laser System ◽  
Study Groups ◽  
Individual Characteristics ◽  
Long Term Results ◽  
Efficiency Coefficient ◽  
Group Iii ◽  
Group I ◽  
Group Ii

The purpose: prospective study of the long-term refractive and visual results of ReLEx® SMILE, depending on the degree of corrected myopia.Material and methods. The three study groups included 71 patients; the mean age was 26.48 ± 5.5 years. Group I consisted of 20 patients (39 eyes) mean SE –2.62 ± 0.87 D, group II — 26 patients (51 eyes), mean SE 4.68 ± 0.74 D, Group III — 25 patients (47 eyes), mean SE 6.88 ± 0.72 D. All patients underwent femtolaser correction of myopia using the ReLEx® SMILE method with the VisuMax™ laser system (Carl Zeiss Meditec AG).Results. Uncorrected visual acuity of 09 — 1.0 was noted in 34 eyes (87.2 %) in group I, in II — in 43 eyes (84.3 %), in 37 eyes (78.7 %) in group III. The efficiency coefficient was 1.0 in groups I — II and 0.89 in group III. There was no decrease in corrected visual acuity (CVA) during the correction of mild and moderate myopia, in group III it was recorded by 0.1 in two cases (4 %), by 0.2 in one case (2 %), the safety factor in I — II groups 1.0, in III 0,89. Two years after ReLEx® SMILE, refraction of ± 0.5 D from planned in the study groups was achieved, respectively, in 94.9, 88.2, 76.6 % of cases, ± 1.0 D in 100 % of cases in I, II groups, in 97 % of cases in III group. The predictability coefficient was 0.95 in group I, 0.88 in group II, and 0.77 in group III. Refractive regression compared with the results 1 month postoperatively was 0.08 D in group I, 0.1 D in group II, and 0.16 D in group III. Analysis of the long-term results of ReLEx® SMILE allows us to conclude: the method is safe and effective, provides high predictability of refractive results in correcting various degrees of myopia. Further study of the long-term results of the operation, the creation and use of nomograms, taking into account the individual characteristics of the cornea, will improve the predictability and stability of refractive results in the correction of high myopia. 

scholarly journals Metabolic Syndrome: Its Association with Acute ST-Elevation Myocardial Infarction and Its Clinical Outcome – A Study Done in the Tertiary Level Hospital in Bangladesh

2020 ◽  
Vol 4 (3) ◽  
pp. 215
Author(s):  
Reaz Mahmud Huda ◽  
Miliva Mozaffor ◽  
Mohammad Ashraful Alam ◽  
Md Delwar Hossain
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Metabolic Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Acute Stemi ◽  
Group I ◽  
St Elevation ◽  
Group Ii ◽  
Artery Disease

Background:Metabolic syndrome is a matter of immense public health concern. Based on ethnicity, its associationand impact on ischemic heart diseases like myocardial infarction (MI) is a current topic of research.Objective: To evaluate the clinical impact of metabolic syndrome on patients with acute ST-elevation myocardial infarction (acute STEMI) in a Bangladeshi population.Methods: This prospective observational study was done in the Department of Cardiology of the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, from July to December of 2013.A total 233 patient were selected for data collection; 109 were in group I (acute STEMI patients with metabolic syndrome), while 124 werein group II (acute STEMI patients without metabolic syndrome). Initial evaluation of the patients done by history and clinical examination was recorded in the preformed data collection sheet.Baseline investigations like ECG, CK(MB), lipid profile, fasting blood sugar, serum creatinine andechocardiography were done. Coronary angiogram (CAG) was done in the Cardiac Cath-Lab facility of the same hospital.The patients’ outcomes were observed until they were discharged from the hospital.Results: Heart failure was significantly more in patients of group I than group II (46.79% vs. 20.97%; p<0.001). Among the patients who underwent coronary angiogram (CAG), the mean Friesinger score was 9.7±2.5 in group I and 7.1±3.3 in group II, which was statistically significant (p<0.05), and indicated more chances of severe coronary artery disease in group I patients. However, mortality rate was not statistically significant in between group I and group II (16.51% vs 12.09%; p=0.415). Both in heart failure and coronary artery disease, among all the components of metabolic syndrome, hyperglycemia had the strongest association followed by low HDL and high triglyceride (TG). However, raised BP had much less significant association with development of heart failure or coronary artery disease.Conclusion:Our data suggest that the acute ST-elevation myocardial infarction patients with metabolic syndrome have poor disease prognosis and in-hospital outcome than those without metabolic syndrome.However, the use of a simple risk score based on those biomarkers may identify a high-risk group to initiate preventive measures for cardiovascular health of the country’s population.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 215-221

scholarly journals Angiographic Comparison of Coronary Artery Disease between Diabetic Men and Women

2013 ◽  
Vol 6 (1) ◽  
pp. 3-9
Author(s):  
Md. Sk. Mamun ◽  
AAS Majumder ◽  
M Ullah ◽  
S Alam
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Diabetic Patients ◽  
Study Group ◽  
Coronary Artery Lesions ◽  
Group I ◽  
Group Ii ◽  
Artery Disease

Background: Cardiovascular diseases are the leading cause of death and morbidity in diabetic patients and this group is two to four times as likely to develop cardiovascular disease than the nondiabetic group, women being specially involved in this situation. In women , diabetes appear to be a stronger risk factor for the development of coronary heart disease than in men regardless of age ,menopausal status and whether or not the patient is insulin or non-insulin dependent. Objective of this study was to compare the angiographic extent of coronary artery disease between diabetic men and diabetic women. Method: This observational study was undertaken on 100 diabetic patients ( 50 women and 50 men) admitted inNational Institute of Cardiovascular disease (NICVD) during the period of July, 2006 to April ,2007.Diabetic women with coronary artery disease constitute the study group-I and diabetic men with coronary artery disease matched for age (±5 years) and risk factors , the study group-II . Coronary angiography was done in all patients & findings were analyzed. Segmental distribution method for coronary artery lesions was used to describe the distribution of atherosclerotis in coronary artery. Results: The mean age of group I was 51.02 ±8.93 years and that of the group II was 50.99± 9.83 years. In this study it was found that Diabetic women with coronary artery disease (CAD) had a higher coronary artery score, CAS (11.02±5.034) as compared to the diabetic men with CAD ( 8.04±4.866) (p<0.001). Diabetic women had also higher number of diseased vessels ( 78.67% vs 67.34%; p<0.01) and higher number of vessel score 3 ( 58% vs 34%; p<0.001). As compared to the diabetic men, diabetic women had a higher total number of coronary artery lesions (183 vs 136; p<0.001), a higher number of lesions per patient (3.66/ patients vs 2.72/patients; p<0.001) and a higher number of diffuse vessels (13.56% vs 8.91%;p<0.05). Conclusion: Diabetic women with coronary artery disease have more severe disease on coronary angiography as compared to diabetic men with coronary artery disease. The diffuse coronary artery involvement was also significantly higher in diabetic women than men. Cardiovascular Journal Volume 6, No. 1, 2013, Page 3-9 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16108

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