P256 Clinical outcomes following coronary artery bifurcation intervention after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
KAREEM Abdelshafi ◽  
SEUNG Woon Rha ◽  
BYOUNG Geol Choi ◽  
S E Yeon Choi ◽  
DONG Kyeong Byun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Cardiac Death ◽  
Chronic Stable Angina ◽  
Target Vessel ◽  
Total Death

Abstract Background Bifurcation coronary artery disease (CAD) represents 15-20% in PCI patients, however, limited data concerning the short and long term clinical outcome in AMI.  Methods A total of 1402 patients underwent bifurcation lesions PCI were enrolled. Patients were divided into two groups: 1) chronic stable angina group (CSA, N = 954) and 2) acute myocardial infarction group (AMI, N = 448) (241 NSTEMI and 207 STEMI). Major adverse cardiac events (MACE), the composite of death, myocardial infarction (MI), stroke and revascularization and stent thrombosis were compared between the two groups at up to 5 years. Results At 30 days follow up, the AMI group had significantly higher incidence of total death  (HR: 5.901, 95% CI : 1.879 to 18.532; p = 0.002), cardiac death (HR: 6.438, 95% CI 1.743 to 23.781; p = 0.005), MI (HR: 4.736  , 95% CI :1.646 to 13.632; p = 0.004), TLR (HR: 4.300  , 95% CI :1.295 to 14.279; p = 0.017), Stroke (HR: 5.901  , 95% CI :1.879 to 18.532; p = 0.002)  and MACE (HR: 4.318, 95% CI : 1.940 to 9.611; p = 0.000)  than the CSA group moreover, at 5 years follow up the AMI group had significantly higher incidence of  MI , TLR , Stent Thrombosis and MACE than the CSA group.Using Multivariate logistic regression, and after adjusting for potential confounding factors, the AMI  patients had higher incidence of total MACE at 30 days (HR: 3.668, 95% CI 1.572 to 8.558 ; p = 0.003) and at 5 years MACE (HR: 1.693, 95% CI 1.206 to 2.377 ; p = 0.002) Conclusion In this study, bifurcation lesion PCI in AMI setting was associated with a higher incidence of adverse clinical outcomes at 30 days and up to 5 years. Clinical Outcomes at 5 Years The incidence of Event (%) at 5 years Outcomes CSA (n = 954) AMI(n = 448) Log Rank Hazard ratio (95% Confidence interval ) P value Total death 21 (2.2) 14 (3.1) 0.285 1.443 (0.734-2838) 0.288 Cardiac death 10 (1.0) 10 (2.2) 0.078 2.160 (0.899-5.190) 0.085 Myocardial infarction 22 (2.3) 23 (5.1) 0.004 2.302 (1.283-4.130) 0.005 Revascularization 65 (6.8) 50 (11.2) 0.003 1.749 (1.210-2.529) 0.003 Target lesion 36 (3.7) 45 (6.4) 0.000 2.854 (1.831-4.448) 0.000 Target vessel 42 (4.4) 47 (10.5) 0.000 2.548 (1.680-3.863) 0.000 Non-target vessel 26 (2.7) 8 (1.8) 0.320 0.671 (0.304-1.482) 0.324 Stroke 131 (13.7) 66 (14.7) 0.555 1.093 (0.813-1.469) 0.556 Stent thrombosis 8 (0.8) 11 (2.5) 0.013 2.997 (1.205-7.451) 0.018 Total MACE 87 (9.1) 60 (13.4) 0.006 1.579 (1.135-2.196) 0.007

Sirolimus-Eluting Magnesium Resorbable Scaffold Implantation in Patients with Acute Myocardial Infarction

Cardiology ◽  
2019 ◽  
Vol 142 (2) ◽  
pp. 93-96 ◽  
Author(s):  
Alfonso Ielasi ◽  
Enrico Cerrato ◽  
Salvatore Geraci ◽  
Gianluca Campo ◽  
Nadia Garro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Cohort Analysis ◽  
Target Lesion ◽  
Target Vessel ◽  
Multicenter Cohort ◽  
Potential Benefits ◽  
Procedural Success

To date, very little is known about the performance of a sirolimus-eluting bioresorbable magnesium scaffold (Mg-BRS) in patients with acute myocardial infarction (AMI). A multicenter cohort analysis was performed on 69 consecutive AMI subjects treated with Mg-BRS. Procedural success was obtained in all cases, and no in-hospital events were reported. At 9-month follow-up, no cardiac death, target-vessel myocardial infarction, ischemia-driven target lesion revascularization, or Mg-BRS thrombosis was reported. Although our analysis showed encouraging results, larger studies and longer-term follow-up are needed to better understand the potential benefits associated with the use of a Mg-BRS in AMI patients.

scholarly journals Clinical outcomes of an ultrathin-strut sirolimus-eluting stent in all-comers population: Thailand Orsiro registry

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pannipa Suwannasom ◽  
Siriporn Athiksakul ◽  
Tasalak Thonghong ◽  
Vorarit Lertsuwunseri ◽  
Jarkarpun Chaipromprasit ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Target Lesion ◽  
Target Vessel ◽  
Chronic Total Occlusions ◽  
Small Vessels ◽  
Sirolimus Eluting Stent

Abstract Background Despite numerous studies supporting the outperformance of ultrathin-strut bioresorbable polymer sirolimus-eluting stent (Orsiro SES, Biotronik AG), the generalizability of the study results remains unclear in the Asian population. We sought to evaluate the clinical outcomes of the Orsiro SES in unselected Thai population. Methods The Thailand Orsiro registry was a prospective, open-label clinical study evaluating all patients with obstructive coronary artery disease implanted with Orsiro SES. The primary endpoint was target lesion failure (TLF) at 12 months. TLF is defined as a composite of cardiac death, target vessel myocardial infarction (TVMI), emergent coronary artery bypass graft (CABG), and clinically driven target lesion revascularization (CD-TLR). Patients with diabetes, small vessels (≤ 2.75 mm), chronic total occlusions (CTOs), and acute myocardial infarction (AMI) were pre-specified subgroups for statistical analysis. Result A total of 150 patients with 235 lesions were included in the analysis. Half of the patients (53.3%) presented with AMI, and 24% had diabetes. Among 235 lesions, 93(39.4%) were small vessels, and 24(10.2%) were chronic total occlusions. The primary endpoint, TLF at 12 months, occurred in eight patients (5.3%), predominately caused by cardiac death. By contrast, the incidences of TVMI and CD-TLR were null. The outcomes in pre-specified subgroup were not different from the overall population (all p > 0.05). One definite late stent thrombosis(0.7%) was incidentally observed during primary percutaneous coronary intervention to the non-target vessel. Conclusion The safety and efficacy of the ultrathin strut sirolimus-eluting stent in unselected cases are confirmed in the Thailand Orsiro registry. Despite the high proportion of pre-specified high-risk subgroups, the excellent stent performance was consistent with the overall population. Trial Registration TCTR20190325001.

Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS)

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Whady A. Hueb ◽  
Paulo Rogério Soares ◽  
Sérgio Almeida de Oliveira ◽  
Shiguemituzo Ariê ◽  
Rita Helena A. Cardoso ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Angioplasty ◽  
Bypass Surgery ◽  
Random Assignment

Background —Although coronary angioplasty and myocardial bypass surgery are routinely used, there is no conclusive evidence that these interventional methods offer greater benefit than medical therapy alone. This study is intended to evaluate, in a prospective, randomized, and comparative analysis, the benefit of the 3 current therapeutic strategies for patients with stable angina and single proximal left anterior descending coronary artery stenosis. Methods and Results —In a single institution, 214 patients with stable angina, normal ventricular function, and severe proximal stenosis (>80%) on the left anterior descending artery were selected for the study. After random assignment, 70 patients were referred to surgical treatment, 72 to angioplasty, and 72 to medical treatment. The primary end points were the occurrence of acute myocardial infarction or death and presence of refractory angina. After a 5-year follow-up, these combined events were reported in only 6 patients referred to surgery as compared with 29 patients treated with angioplasty and 17 patients who only received medical treatment ( P =0.001). However, no differences were noted in relation to the occurrence of cardiac-related death in the 3 treatment groups ( P =0.622). No patient assigned to surgery needed repeat operation, whereas 8 patients assigned to angioplasty and 8 patients assigned to medical treatment required surgical bypass after the initial random assignment. Surgery and angioplasty reduced anginal symptoms and stress-induced ischemia considerably. However, all 3 treatments effectively improved limiting angina. Conclusions —Bypass surgery for single-vessel coronary artery disease is associated with a lower incidence of medium-term and long-term events as well as fewer anginal symptoms than that found in the patients who underwent angioplasty or medical therapy. In this study, coronary angioplasty was only superior to medical strategies in relation to the anginal status. However, the 3 treatment regimens yielded a similar incidence of acute myocardial infarction and death. Such information should be useful when choosing the best therapeutic option for similar patients.

Screening for Coronary Artery Disease After Mediastinal Irradiation for Hodgkin's Disease

2007 ◽  
Vol 26 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Paul A. Heidenreich ◽  
Ingela Schnittger ◽  
H. William Strauss ◽  
Randall H. Vagelos ◽  
Byron K. Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Hodgkin's Disease ◽  
Cardiac Death ◽  
Stress Testing ◽  
Hodgkin’S Disease ◽  
Mediastinal Irradiation ◽  
Artery Disease

Purpose Incidental cardiac irradiation during treatment of thoracic neoplasms has increased risks for subsequent acute myocardial infarction or sudden cardiac death. Identifying patients who have a high risk for a coronary event may decrease morbidity and mortality. The objective of this study was to evaluate whether stress imaging can identify severe, unsuspected coronary stenoses in patients who had prior mediastinal irradiation for Hodgkin's disease. Patients and Methods We enrolled 294 outpatients observed at a tertiary care cancer treatment center after mediastinal irradiation doses ≥ 35 Gy for Hodgkin's disease who had no known ischemic cardiac disease. Patients underwent stress echocardiography and radionuclide perfusion imaging at one stress session. Coronary angiography was performed at the discretion of the physician. Results Among the 294 participants, 63 (21.4%) had abnormal ventricular images at rest, suggesting prior myocardial injury. During stress testing, 42 patients (14%) developed perfusion defects (n = 26), impaired wall motion (n = 8), or both abnormalities (n = 8). Coronary angiography showed stenosis ≥ 50% in 22 patients (55%), less than 50% in nine patients (22.5%), and no stenosis in nine patients (22.5%). Screening led to bypass graft surgery in seven patients. Twenty-three patients developed coronary events during a median of 6.5 years of follow-up, with 10 acute myocardial infarctions (two fatal). Conclusion Stress-induced signs of ischemia and significant coronary artery disease are highly prevalent after mediastinal irradiation in young patients. Stress testing identifies asymptomatic individuals at high risk for acute myocardial infarction or sudden cardiac death.

P833Two-year clinical outcomes between statin with ACE inhibitor or ARB in patients with ST-segment elevation myocardial infarction after successful PCI with DES

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y H Kim ◽  
A.-Y Her ◽  
M.-H Jeong ◽  
B.-K Kim ◽  
S.-Y Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Clinical Outcomes ◽  
Cardiac Death ◽  
Hazard Ratio ◽  
P Value ◽  
Target Vessel ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Repeat Revascularization

Abstract Background Limited comparative data are available. Purpose We decided to compare 2-year major clinical outcomes between statin with ACEI and statin ARB therapy in patients with STEMI after PCI with drug-eluting stents (DES). Methods A total 11706 STEMI patients who underwent PCI with DES and who prescribed statin were enrolled and they were divided into two groups, the statin with ACEI group (n=8705) and the statin with ARB group (n=3001). The primary endpoint was the major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR. The secondary endpoints were the cumulative incidences of individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR. Results Two PSM groups (2835 pairs, n=5670, C-statistic = 0.680) were generated. The relative risk of MACE was higher in the statin with ARB group compared to statin with ACEI groups after propensity score-matched (PSM) analysis (hazard ratio [HR]: 1.323, 95% confidence interval [CI]: 1.085–1.613, p=0.006). The relative risks of cardiac death (HR: 1.831, 95% CI: 1.199–2.740, p=0.005), total repeat revascularization (HR: 1.487, 95% CI: 1.133–1.950, p=0.004), and non-TVR (HR: 1.696, 95% CI: 1.122–2.564, p=0.012) were also higher in the statin with ARB group after PSM. Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Statin + ACEI Statin + ARB Log-rank Propensity score matched Patients MACE 173 (6.5) 225 (8.5) 0.006 1.323 (1.085–1.613) 0.006 All-cause death 58 (2.2) 80 (3.0) 0.054 1.391 (0.992–1.950) 0.056 Cardiac death 35 (1.3) 63 (2.3) 0.004 1.831 (1.199–2.740) 0.005 Re-MI 39 (1.5) 44 (1.7) 0.548 1.141 (0.742–1.756) 0.548 Total repeat revascularization 88 (3.4) 128 (4.9) 0.004 1.487 (1.133–1.950) 0.004 TLR 26 (1.0) 40 (1.5) 0.075 1.561 (0.953–2.558) 0.077 TVR 53 (2.0) 71 (2.8) 0.086 1.364 (0.955–1.946) 0.088 Non-TVR 36 (1.4) 60 (2.3) 0.011 1.696 (1.122–2.564) 0.012 TVF 140 (5.3) 173 (6.6) 0.050 1.249 (1.000–1.561) 0.050 Conclusions In this study, we suggest that the combination of statin with ACEI may be beneficial for reducing the cumulative incidences of MACE, total repeat revascularization rate, and non-TVR rather than the statin with ARB after PCI with DES in STEMI patients.

scholarly journals The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

2020 ◽  
Vol 26 ◽  
pp. 107602962094329
Author(s):  
Xiang Wang ◽  
Meng Guan ◽  
Xiuhang Zhang ◽  
Taiyuan Ma ◽  
Muli Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Stent Thrombosis ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
Serum Levels ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Hs Crp

Very late stent thrombosis (VLST) is a rare but serious complication following percutaneous coronary intervention (PCI). S100A8/A9 plays an important role in thrombosis through modulating the inflammatory response. This observational study aimed to reveal the association between S100A8/A9 and VLST. Continuous blood samples were collected from patients at both the time of index PCI for acute myocardial infarction (AMI) and the time of PCI for VLST (VLST group) or follow-up coronary angiography (AMI group). In all, 56 patients were selected in each group from a cohort of 8476 patients and other 112 individuals who underwent health checkups (normal control [NC] group) were selected as controls. Serum levels of S100A8/A9 and high sensitivity C-reactive protein (hs-CRP) were tested and compared. The mean level of S100A8/A9 was 3754.4 ± 1688.9 ng/mL during index PCI and increased to 5517.8 ± 2650.9 ng/mL at the time of VLST; in the AMI group, S100A8/A9 level was 2434.9 ± 1243.4 ng/mL during index PCI and decreased to 1568.2 ± 772.1 ng/mL during follow-up, similar to that detected in the NC group (1618.2 ± 641.4 ng/mL). Of note, S100A8/A9 levels showed significant increases during VLST when compared to its own levels during index PCI, which was different from the changes of hs-CRP. Higher serum levels of S100A8/A9 are associated with the development of VLST.

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