scholarly journals Effect of risk enhancers versus technical aspects of high thrombotic risk criteria on adverse clinical events after PCI: insights from 2020 ESC NSTE-ACS Guidelines

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Y Wang ◽  
B Xu ◽  
R Zhang ◽  
C D Guan ◽  
K F Dou
Keyword(s):  
Continuous Variable ◽  
Prognostic Impact ◽  
Medication History ◽  
Total Occlusion ◽  
Thrombotic Risk ◽  
Technical Aspects ◽  
Funding Sources ◽  
Clinical Events ◽  
Stent Length

Abstract Background The long-term clinical outcome after PCI is affected by various clinical and angiographic risk features. The present study was designed to investigate the long-term prognostic impact of risk enhancers and technical aspects as defined by 2020 ESC NSTE-ACS Guidelines for high thrombotic risk (HTR) criteria on the risk of adverse events after PCI. Methods A total of 10,167 patients were enrolled from the Fuwai PCI registry. Risk enhancers and technical aspects were retrospectively assessed according to 2020 ESC NSTE-ACS Guidelines. Risk enhancers were defined as having at least one of the following characteristics: diabetes mellitus requiring medication, history of recurrent MI, any multivessel CAD, peripheral artery disease, premature (<45 years) CAD, and chronic kidney disease. Technical aspects were defined as having at least one of the following characteristics: ≥3 stents implanted, ≥3 lesions treated, total stent length >60 mm, left main PCI, bifurcation stenting with ≥2 stents implanted, and chronic total occlusion. The primary endpoint was 30-month major adverse cardiac and cerebrovascular events (MACCE, a composite of cardiac death, myocardial infarction [MI], stent thrombosis, any revascularization, and ischemic stroke). Results MACCE occurred in 1188 (11.7%) patients during the follow-up period (median duration: 881 days). Risk enhancers were present in 8,437 patients (83.0%) and was associated with increased 30-month risk for the MACCE (adjusted hazard ratio [adjHR]: 2.11; 95% CI: 1.72–2.60). Technical aspects were present in 3,335 patients (32.8%) and was an independent predictor of MACCE at 30 months (adjHR: 1.32; 95% CI: 1.17–1.49). The risk of MACCE associated with risk enhancers was significantly higher than for technical aspects (2.11 vs. 1.32; relative risk [RR]: 1.60; 95% CI: 1.47–1.75). Results were consistent when risk enhancers and technical aspects were modeled as a continuous variable. Adjusted HRs of MACCE within the 12 months for patients with risk enhancers and technical aspects were 2.35 (95% CI: 1.80–3.07) and 1.50 (95% CI: 1.30–1.73), respectively. Risk enhancers significantly influenced MACCE beyond 12 months (adjHR: 1.78; 95% CI: 1.29–2.46), whereas technical aspects were not associated with very late (12-month to 30-month) MACCE (adjHR: 1.01; 95% CI: 0.82–1.25). Both risk enhancers and technical aspects were not significantly associated with BARC type 2, 3, or 5 bleeding within 12 months and between 12 and 30 months. Conclusions Both risk enhancers and technical aspects of HTR criteria significantly affected long-term ischemic clinical events but not major bleeding in patients undergoing PCI. Risk enhancers appeared to have a greater and more prolonged effect on poor prognosis than technical aspects, suggesting the importance of compliance with guideline-directed medical therapy. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Beijing Municipal Health Commission (Grant No. 2020-1-4032)Chinese College of Cardiovascular Physicians, CS Optimizing Antithrombotic Research Fund (Grant number: BJUHFCSOARF201801-01)

scholarly journals The impact of bifurcation lesion in infarct-related artery of NSTE-ACS patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Boukerche ◽  
L Zouli ◽  
N Laredj
Keyword(s):  
Lesion Group ◽  
Prognostic Impact ◽  
Success Rates ◽  
Funding Sources ◽  
Bifurcation Lesion ◽  
Infarct Related Artery ◽  
Bifurcation Lesions ◽  
Few Data ◽  
The Impact

Abstract Introduction Angioplasty of bifurcation lesions remains challenging. In most studies, long-term outcomes were less favourable compared to non-bifurcation lesions. Patients with bifurcation lesions were excluded from most of the randomised studies of AMI. Purpose The aim of this study was to determine the prognostic impact of bifurcation lesion on three-year outcome in a prospective cohort of NSTE-ACS patients. Bifurcation lesions (BFLs) remain a challenging lesion subset, often associated with lower success rates than less complex lesions. There are few data regarding the impact of BFLs in the setting of NSTE-ACS. Methods Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether infarct-related-artery lesions were vs. were not a bifurcation lesion. Major outcomes were assessed at 3 years. Results A total of 296 patients were evaluated: mean age was 62±12 years and 58% were male. The three-year mortality was 12.2% (36 patients) and the three-year MACCE was 26.4% (78 patients). The bifurcation lesion group included 62 patients (20.9%).The three-year mortality and MACCE in the patients of the bifurcation lesion group was significantly higher (19.4% vs. 10.3%; p=0.046) and (45.2% vs. 21.4%; p≤10–3) respectively. Conclusion In NSTE-ACS, bifurcation lesions portend worse prognosis. This may guide prognostication and decision making in treatment. FUNDunding Acknowledgement Type of funding sources: None. MACCE occurrence: Bifurcation impact

scholarly journals Prognostic impact of CTO lesion in NSE-ACS patients: three-year outcome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Boukerche ◽  
N Laredj
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Observational Study ◽  
Chronic Total Occlusion ◽  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Total Occlusion ◽  
Funding Sources ◽  
Percutaneous Coronary

Abstract Introduction CTO represents the most advanced form of CAD and affects adverse clinical outcomes in patients with AMI due to several pathophysiological mechanisms Purpose The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on two-year outcome in a prospective cohort of NSTE-ACS patients. CTO is present in many patients with NSTE-ACS and is difficult to treat with percutaneous coronary intervention. Methods Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether CTO lesions were vs. were not present. Major outcomes were assessed at 3 years. Results A total of 296 patients were evaluated: mean age was 62±12 years and 58% were male. The three-year mortality was 12.2% (36 patients) and the three-year MACCE was 26.4% (78 patients). The CTO group included 38 patients (12.2%). The three-year mortality and MACCE in the patients of CTO group was significantly higher (26.3% vs. 10.1%; p=0.013) and (50.0% vs. 22.9%; p=0.001) respectively. Conclusion In this prospective observational study of patients with NSTE-ACS, CTO was associated with a worst three-year outcome. FUNDunding Acknowledgement Type of funding sources: None. MACCE: CTO Vs No CTO lesion

scholarly journals Flavonoids Ameliorate Stress-Induced Depression by Preventing NLRP3 Inflammasome Priming

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1231-1231
Author(s):  
Giulio Pasinetti
Keyword(s):  
Mrna Expression ◽  
Chronic Stress ◽  
Nlrp3 Inflammasome ◽  
Signaling Cascades ◽  
Dietary Polyphenols ◽  
Funding Sources ◽  
Glycation End Products ◽  
Molecular Patterns

Abstract Objectives Chronic stress activates danger-associated molecular patterns (DAMPs), stimulating the NLRP3 inflammasome. NLRP3 activation triggers the release of pro-inflammatory cytokine IL-1β. The activity of the NLRP3 inflammasome propagates pro-inflammatory signaling cascades implicated in the onset of depression. Our previous studies show that polyphenolic compounds were found to ameliorate stress induced depression in mouse models. However, the relevant mechanism has not been identified. This study examined the effect of administering polyphenols on DAMP signaling in enriched mice microglia. Methods This study examined the effect of administering polyphenols on DAMP signaling in mice microglia. To recapitulate stress-induced depression, mice underwent chronic unpredictable stress (CUS). Microglia were isolated at various time points throughout the CUS protocol. We also assessed long-term persistent changes after CUS and susceptibility to subthreshold unpredictable stress (US) re-exposure. Results Interestingly, the development of US – induced depression and anxiety depended upon a previous exposure to CUS. We found that CUS caused robust upregulation of IL-1β mRNA in enriched microglia, an effect that persists for up to 4 weeks following CUS exposure. Following the subthreshold US re-exposure, we observed the upregulation of pro- IL-1β as well as pro-receptor for advanced glycation end products (RAGE). Toll-like receptor 4 (TLR-4) was not. We also observed an increase in RAGE mRNA expression when mice were exposed to US prior to the start of the CUS paradigm. Importantly, a primary exposure to US, was sufficient to increase RAGE mRNA expression. We found that polyphenol administration significantly improved CUS-induced depressive-like phenotypes and also reversed neuroinflammation in mice. Treatment with dietary flavonoids prevented upregulation of IL-1β, RAGE mRNA, which reflects the ability of polyphenols that may have begun following the primary exposure to US. Conclusions Taken all together, the results provide evidence of the role of dietary polyphenols in preventing persistent microglial activation, which has been shown to result in reduced long term vulnerability to depressive-like behaviors following expose to chronic stress. Funding Sources This study was supported by a P50 CARBON Center grant from the NCCIH/ODS.

Child Money and Food Stamps: A comparative analysis of Mongolian welfare programmes in the Ger Districts of Ulaanbaatar

2020 ◽  
Vol 66 (4) ◽  
pp. 499-524
Author(s):  
Elizabeth Fox
Keyword(s):  
Participant Observation ◽  
Food Stamps ◽  
Means Testing ◽  
Economic Cycles ◽  
Funding Sources ◽  
Urban Migrants ◽  
Multi Level ◽  
Welfare Model ◽  
Level Analysis

Abstract Until recently, the Mongolian welfare system was entirely category based. However, a new food stamps programme funded by loans from the Asian Development Bank, which targets aid according to proxy means testing, has been introduced as part of the bank’s aim to push Mongolia towards a fiscally sustainable welfare model. The food stamps programme is presented as efficient and responsible in contrast to Mongolia’s universal child money programme. Based on long-term participant observation research in the ger districts of Ulaanbaatar, areas inhabited by many rural-urban migrants living in poverty, this paper compares the two programmes, interweaving street-level accounts of the experiences of residents and bureaucrats alike with the respective histories and funding sources of the two programmes. Doing so provides a multi-level analysis of the emergent welfare state in Mongolia, unpicking the ‘system’ that ger district residents encounter, linking the relative influence of international financial institutions to democratic and economic cycles, and offering a critique of the supposed efficiency of targeted welfare programmes.

Impact of Baseline Neutrophil-to-Lymphocyte Ratio on Long-Term Prognosis in Patients With Atrial Fibrillation

Angiology ◽  
2021 ◽  
pp. 000331972110004
Author(s):  
Shuang Wu ◽  
Yan-min Yang ◽  
Jun Zhu ◽  
Jia-meng Ren ◽  
Juan Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Neutrophil To Lymphocyte Ratio ◽  
Long Term Outcomes ◽  
Lymphocyte Ratio ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
All Cause Mortality

We performed a retrospective analysis involving 1269 patients with atrial fibrillation (AF) to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on long-term outcomes. The primary outcomes were all-cause mortality and combined end point events (CEEs). Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis were performed. During a median follow-up of 3.32 years, 285 deaths and 376 CEEs occurred. With the elevation of the NLR, the incidence of all-cause mortality (2.77, 4.14, 6.12, and 12.18/100 person-years) and CEEs (4.19, 7.40, 8.03, and 15.22/100 person-years) significantly increased. Multivariate Cox analysis indicated that the highest NLR quartile was independently associated with the incidence of all-cause mortality (hazard ratio [HR] = 1.77, 95% CI: 1.19-2.65) and CEEs (HR = 1.66, 95% CI: 1.18-2.33). When the NLR was analyzed as a continuous variable, a 1-unit increment in log NLR was related to 134% increased risk of all-cause mortality and 119% increased risk of CEEs. Net reclassification improvement analysis revealed that NLR significantly improved risk stratification for all-cause death and CEEs by 15.0% and 9.6%, respectively. Neutrophil-to-lymphocyte ratio could be an independent predictor of long-term outcomes in patients with AF.

scholarly journals Adiponectin and its receptors in patients with cardiovascular disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Belik ◽  
OV Gruzdeva ◽  
YUA Dyleva ◽  
EG Uchasova ◽  
MYU Sinitsky ◽  
...  
Keyword(s):  
Heart Defects ◽  
Post Translational Modification ◽  
Fat Depots ◽  
Funding Sources ◽  
Adiponectin Mrna ◽  
Fat Stores ◽  
Group 2 ◽  
High Level ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Aim to determine the features of adiponectin expression, secretion of adiponectin and its receptors in local fat depots in CVD. Materials and methods The study included 90 patients with СAD (Group 1) and 60 patients with heart defects (Group 2). Adipocytes were isolated from samples of subcutaneous (SAT), epicardial (EAT) and perivascular (PVAT) adipose tissue obtained during CABG or heart valve replacement. The expression of adiponectin was determined by qPCR using TaqManTM Gene Expression Assays (Applied Biosystems, USA) in the ViiA 7 Real-Time PCR System (Applied Biosystems, USA), the levels of expression products was determined using enzyme immunoassay (Bender MedSystems GmbH, Vienna, Austria). The data were analyzed using the statistical software Statistica 9.0. Results EAT adipocytes were characterized by the lowest adiponectin expression relative to adipocytes of other localization both in Group 1 and Group 2. In patients Group 1 adiponectin expression in EAT was reduced relative in SAT and PVAT (by 1.2 and 1.5 times). In Group 2, the adiponectin mRNA in the EAT was lower than in the SAT and PVAT (1.4 and 1.5 times). The expression of adiponectin in EAT in Group 2 exceeded the same indicator in Group 1 by 1.2 times. The maximum expression of adiponectin was observed in the PVAT culture in patients of both groups. For Group 2, this indicator exceeded the values of Group 1 by 1.2 times. The content of adiponectin in the culture EAT was lower than in the SAT, both in Group 1 and Group 2 (by 1.3 and 1.13 times). The level of this indicator in Group 2 was 1.4 times higher than in Group 1. PVAT adipocytes of patients with CAD were characterized by the lowest level of adiponectin secretion in comparison with adipocytes of other localization. The adiponectin level in the PVAT of Group 2 exceeded that of fat stores of other localization and in Group 1 patients by 1.8 times. There were no statistically significant differences in the expression and concentration of adiponectin in the culture of adipocytes of the SAT between the groups of patients. In Group 1, the lowest level of AdipoR1 was found in the adipocyte culture of the PVAT. Noteworthy is the decrease in the level of AdipoR1 in Group 1 compared to the level of Group 2, observed in the SAT and PVAT: 1.3 and 1.5 times. There were no significant differences in the concentration of the AdipoR1 in the EAT, as well as AdipoR2 in all types of AT between the groups of patients. Conclusion: in CVD the EAT is characterized by minimal expression and secretion of adiponectin, regardless of nosology. In CAD despite the high level of expression of adiponectin, the adipocytes of the PVAT were found to have the lowest content in comparison with adipocytes of other localization. Dysregulation of the adiponectin/AdipoR axis is observed in PVAT, which may be due to low expression of adiponectin receptors and long-term processes of its post-translational modification and oligomerization in CAD.

scholarly journals Assessment of thrombotic risk during long-term treatment of immune thrombocytopenia with fostamatinib

2021 ◽  
Vol 12 ◽  
pp. 204062072110108
Author(s):  
Nichola Cooper ◽  
Ivy Altomare ◽  
Mark R. Thomas ◽  
Phillip L. R. Nicolson ◽  
Steve P. Watson ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Term Treatment ◽  
Phase Iii ◽  
Thromboembolic Events ◽  
Thrombotic Risk ◽  
Long Term Treatment ◽  
Heavily Pretreated ◽  
The Usa ◽  
Syk Inhibitor

Background: Patients with immune thrombocytopenia (ITP) are at risk of bleeding and, paradoxically, thromboembolic events (TEEs), irrespective of thrombocytopenia. The risk of thrombosis is increased by advanced age, obesity, and prothrombotic comorbidities: cancer, hyperlipidemia, diabetes, hypertension, coronary artery disease, and chronic kidney disease, among others. Certain ITP treatments further increase the risk of TEE, especially splenectomy and thrombopoietin receptor agonists. Spleen tyrosine kinase (SYK) is a key signaling molecule common to thromboembolic and hemostatic (in addition to inflammatory) pathways. Fostamatinib is an orally administered SYK inhibitor approved in the USA and Europe for treatment of chronic ITP in adults. Methods: The phase III and extension studies included heavily pretreated patients with long-standing ITP, many of whom had risk factors for thrombosis prior to initiating fostamatinib. This report describes long-term safety and efficacy of fostamatinib in 146 patients with up to 5 years of treatment, a total of 229 patient-years, and assesses the incidence of thromboembolic events (by standardized MedDRA query). Results: Platelet counts ⩾50,000/µL were achieved in 54% of patients and the safety profile was as described in the phase III clinical studies with no new toxicities observed over the 5 years of follow-up. The only TEE occurred in one patient (0.7%, or 0.44/100 patient-years), who experienced a mild transient ischemic attack. This is a much lower rate than might be expected in ITP patients. Conclusion: This report demonstrates durable efficacy and a very low incidence of TEE in patients receiving long-term treatment of ITP with the SYK inhibitor fostamatinib. identifiers: NCT02076399, NCT02076412, and NCT02077192.

scholarly journals Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Mohammad Abdallah Eltahlawi ◽  
Abdel-Aziz Fouad Abdel-Aziz ◽  
Abdel-Salam Sherif ◽  
Khalid Abdel-Azeem Shokry ◽  
Islam Elsayed Shehata
Keyword(s):  
Chronic Total Occlusion ◽  
Bioresorbable Vascular Scaffold ◽  
Total Occlusion ◽  
Intracoronary Imaging ◽  
Group I ◽  
Significant Difference ◽  
Vascular Scaffold ◽  
Long Term Follow Up

Abstract Background We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. Results At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. Conclusion This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. Trial registration ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: [email protected]

Sign in / Sign up

Export Citation Format

Share Document