scholarly journals Long term outcomes of single versus multi-vessel coronary artery disease in patient with diabetes undergoing PCI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Omair ◽  
D.D Dinh ◽  
A.B Brennan ◽  
O.F Farouque ◽  
S.D Duffy ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
Ventricular Ejection Fraction ◽  
Kaplan Meier ◽  
Insulin Dependence ◽  
Patients With Diabetes ◽  
Artery Disease ◽  
Long Term Mortality

Abstract Background Long-term outcomes of PCI in diabetics with single vessel disease (SVD) are less well known. We aimed to assess the long-term mortality of patients with diabetes with SVD compared to MVD undergoing PCI. Methods We included 7,506 consecutive patients with DM undergoing PCI from 34,784 patients in the Melbourne Interventional Group registry (2005–2018). Results 4,889 (65%) of DM had MVD. Compared to SVD, MVD were older (67±11 vs. 64±11 years), with higher rates of hypertension, insulin dependence, renal impairment, left ventricular ejection fraction <45% and cardiogenic shock (all p<0.001). Patients with MVD had significantly higher rates of stent thrombosis, unplanned CABG and major bleeding (all p<0.001). Unadjusted mortality rates in hospital, at 30 days and long-term (mean 5.4±3 years) were higher in MVD (4.1 vs 1.4%, 4.9% vs 1.9%, 26% vs 16.4%; all p<0.001). Cox proportional hazard modelling found MVD as an independent predictor of long-term mortality (HR 1.7, 95% CI 1.5–1.9, p<0.001). Long term mortality was similar for SVD diabetes and MVD non-diabetes (HR 1.29, 95% CI 1.13–1.48 vs 1.26, 95% 1.16–1.37), which was also evident on Kaplan-Meier curve. Conclusion DM with SVD undergoing PCI had a lower long-term mortality. However, the mortality beyond 5 years in SVD increases, mandating aggressive risk factor control and close clinical follow-up. Kaplan-Meier curve Funding Acknowledgement Type of funding source: None

Sex differences in pharmacotherapy and long-term outcomes in patients with ischaemic heart disease and left ventricular dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Dagan ◽  
D Dinh ◽  
J Stehli ◽  
C Tan ◽  
A Brennan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Medical Therapy ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Kaplan Meier ◽  
Long Term Mortality

Abstract Background Left ventricular dysfunction and ischaemic heart disease are common amongst women, however, women tend to present later and are less likely to receive guideline-directed medical therapy compared to their male counterparts. Purpose To investigate if a sex discrepancy exists for optimal medical therapy (OMT) and long-term mortality in a cohort of patients with known ischaemic heart disease (IHD) and left ventricular dysfunction. Methods We analysed prospectively collected data from a multicentre registry database collected between 2005–2018 on pharmacotherapy 30-days post percutaneous coronary intervention (PCI) in 13,015 patients with left ventricular ejection fraction (LVEF) <50%. OMT at 30-days was defined as beta-blocker (BB), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) ± mineralocorticoid receptor antagonist (MRA). Long-term mortality was determined by linkage with the National Death Index, with median follow up of 4.7 (IQR 2.0–8.6) years. Results Mean age was 65±12 years; women represented 20.2% (2,634) of the cohort. Women were on average 5 years older, had higher average BMI, higher rates of hypertension, diabetes, renal dysfunction, prior stroke and rheumatoid arthritis. Men were more likely to have sleep apnoea, be current/ex-smokers and to have had prior myocardial infarction, PCI and bypass surgery. Overall, 72.3% (9,411) of patients were on OMT, which was similar between sexes (72.7% in women vs. 72.2% in men, p=0.58). Rates of BB therapy were similar between sexes (85.2% vs. 84.5%, p=0.38), while women were less likely to be on an ACEi/ARB (80.4% vs. 82.4%, p=0.02) and more likely to be on a MRA (12.1% vs. 10.0%, p=0.003). Amongst those with LVEF ≤35% (n=1,652), BB (88.7% vs. 87.3%, p=0.46), ACEi/ARB (83.3% vs. 82.1%, p=0.59) and MRA use (32.5% vs. 33.3%, p=0.78) was comparable. Aspirin use was similar between sexes (95.3% vs. 95.9%, p=0.12), while women were less likely to be on statin therapy (93.5% vs. 95.3%, p<0.001) and a second antiplatelet agent (94.4% vs. 95.6%, p=0.007). On unadjusted analysis women had significantly higher long-term mortality of 25.4% compared to 19.0% for men (p<0.001). Kaplan-Meier analysis out to 14 years demonstrated that men on OMT have the best long-term survival overall and women on sub-OMT have significantly poorer outcomes compared to men on sub-OMT. However, after adjusting for OMT and other comorbidities there was no difference in long-term mortality between sexes (HR 0.99, 95% CI 0.87–1.14, p=0.94). Conclusion From this large multicentre registry, we found similar rates of guideline-directed pharmacotherapy for left ventricular dysfunction between sexes, however women were less likely to be on appropriate IHD secondary prevention. The increased unadjusted long-term mortality amongst women is likely due to differing baseline risk, given that adjusted mortality was similar between sexes. Kaplan-Meier Survival Analysis Funding Acknowledgement Type of funding source: None

Very long-term prognosis in patients with right ventricular apical pacing for sick sinus syndrome

Heart ◽  
2019 ◽  
Vol 105 (19) ◽  
pp. 1493-1499
Author(s):  
Kosuke Nakasuka ◽  
Kohei Ishibashi ◽  
Ayako Kamijima ◽  
Tsukasa Kamakura ◽  
Mitsuru Wada ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Sick Sinus Syndrome ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Explanatory Variables ◽  
Kaplan Meier ◽  
The Impact

ObjectiveThe impact of right ventricular (RV) apical pacing on very long-term cardiac prognosis is little known. In this study, we retrospectively evaluated the relationship between RV apical pacing and cardiovascular events (CEs) in patients with sick sinus syndrome (SSS) and left ventricular ejection fraction (LVEF) >35%.MethodsTotal of 532 consecutive pacemaker recipients with SSS and LVEF >35% were divided into two groups according to the mean cumulative per cent RV apical ventricular pacing (mean %VP) (<50%; non-VP group vs ≥50%; VP group) and occurrence of CE was compared using Kaplan-Meier analysis between two groups. Cox hazard model was used to assess predictors of CE after adjusting explanatory variables such as age, atrial fibrillation (AF) and structural heart disease (SHD).ResultsMean %VP was 86.0% and 8.2% in VP and non-VP groups, respectively (p<0.001). During mean follow-up of 13.4±7.0 years, CE occurred in 131 patients and more frequently in VP than non-VP group (p<0.001). However, the VP group was no longer associated with CE after taking into account other variables in multivariate analysis, which revealed AF (HR (HR)=2.08), SHD (HR=4.97), low LVEF (HR=0.98 for every 1% increase) and high age (HR=1.03 for every year of age) were independent predictors for CE. Regarding patients with SHD and/or AF and those aged ≥75 years, Kaplan-Meier curves showed both groups had similar prognosis.ConclusionsCardiac prognosis of patients with RV apical pacing was poor, but after adjusting for other predictors of CE, RV apical pacing was not a prognostic factor in patients with SSS with LVEF >35%.

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