scholarly journals Very long-term benefits of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Padilla Escamez ◽  
M J Romero Reyes ◽  
C Otte Alba ◽  
S Rufian Andujar ◽  
F J Molano Casimiro
Keyword(s):  
Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Heart Failure Hospitalization ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Background Short and medium-term benefits of cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) have been well studied. However, studies on long-term benefits of such programs after percutaneous coronary intervention (PCI) are scarce. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) on very long-term mortality and morbidity after PCI. Methods We conducted a retrospective cohort study of 701 patients who underwent PCI at our hospital between 2004 and 2011. Patients were classified into two cohorts based on whether or not they participated in a CR program phase II. A follow-up was performed in May 2020. We collected the events occurring during a median follow-up of 11 years. Results 701 patients were included in our study: 291 (41.5%) participated in the CR program, whereas 410 (58.4%) refused to do it. AMI was the most frequent indication for PCI (51.9%), followed by unstable angina (42.8%). The characteristics of the cohort based on participation in the CR program are shown in the table below. Patients who participated in the CR program were younger and mostly male. However, those who refused to do it had a higher cardiovascular risk due to a higher percentage of multivessel disease, diabetes mellitus, kidney failure and history of cerebrovascular accident. Using multivariate logistic regression, CR participation was found to be associated with significantly reduced all-cause mortality (19.5 vs 48.4%; OR 0.455; IC95% 0.295–0.701; p<0.001) and cardiac mortality (4.5% vs 18.0%; OR 0.361; IC95% 0.181–0.721; p 0.004). CR is also associated with a substantial decrease in heart failure hospitalization (10.0% vs 24.8%; OR 0.557; IC95% 0.331–0.937; p 0.027) and incidence of stroke (5.5% vs 10.6%; OR 0.491; IC95% 0.271–0.890; p<0.017) during the follow-up. No significant differences were observed in re-AMI (20.6% vs 24.1%, p=NS). Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality, heart failure hospitalization rates and morbidity during long-term follow-up. FUNDunding Acknowledgement Type of funding sources: None.

P632Long-term benefits of cardiac rehabilitation in patients with diabetes mellitus after percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M J Romero Reyes ◽  
R Rodriguez Delgado ◽  
I Esteve Ruiz ◽  
C Otte Alba ◽  
J A Mora Pardo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Heart Failure Hospitalization ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Patients With Diabetes

Abstract Introduction After percutaneous coronary intervention (PCI), patients with diabetes have a worse prognosis than non-diabetics and are at increased risk of recurrent cardiovascular events, hospitalization and higher mortality. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) in this high-risk group of patients. Methods We performed a retrospective cohort study of 318 consecutive patients with type 2 diabetes mellitus (DM2) who underwent PCI in our hospital between 2004 and 2011. We classified the patients in two cohorts according to their participation (n=154) or not (n=164) in a CR programme. We collected the events ocurring during a median follow-up of 9 years. Results Using multivariate logistic regression, we found that CR participation was associated with significantly reduced all-cause mortality (53% vs 23%, OR 2.10; IC 95%; 1.16–3.82; p 0.014) and cardiac mortality (3.9% vs 23.8%, OR 8.69; IC95% 2.80–26.99; p<0.0005). CR aslo associated with a singnificant decrease in a heart failure hospitalization (26.6% vs 10.6%, OR 2.4; IC 95% 1.06–5.52; p<0.035). No significant differences were observed in non fatal myocardial infarction, stent restenosis and non fatal stroke. Basal characteristics Rehabilitation (n=153) No Rehabilitation (n=164) P vaule Male sex 138 (86.4%) 100 (61.0%) <0.0005 Age (years) 59 (38–74) 65 (47–74) <0.0005 Hypertension 113 (73.9%) 111 (67.7%) NS Hypercholesterolemia 112 (73.7%) 115 (70.1%) NS HbA1c ≥7% 88 (66.2%) 73 (64.6%) NS Prior myocardial infarction 24 (15.6%) 32 (19.5%) NS Chronic kidney disease 6 (3.9%) 19 (11.6%) 0.012 FEVI <50% 30 (20%) 39 (25%) NS Three vessel disease 53 (34.4%) 58 (35.4%) NS Incomplete revascularization 80 (51.9%) 81 (49.4%) NS Drug-eluting stent 110 (78.6%) 127 (80.4%) NS Stent length 22.4±11.9 24.6±14.8 NS Stent diameter 2.7±0.3 2.8±0.4 NS Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality and heart failure hospitalization rates in patients with DM2 during long-term follow-up.

CLINICAL OUTCOMES OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG CARDIAC REHABILITATION AND NON CARDIAC REHABILITATION GROUPS-A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 25-27
Author(s):  
Saroj Mandal ◽  
Vignesh. R ◽  
Sidnath Singh
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Observational Study ◽  
Cardiac Rehabilitation ◽  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Percutaneous Coronary ◽  
All Cause Mortality

OBJECTIVES To determine clinical outcome and to nd out the association between participation of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in cardiac rehabilitation programme. DESIGN A Prospective observational study. STUDY AREA : Department of Cardiology, Institute of Postgraduate Medical Education and Research,Kolkata. PARTICIPANTS: Patients aged ≥18 years who underwent PCI due to AMI. OUTCOME MEASURES The outcomes were subsequent myocardial infarction, revascularisation, all-cause readmission, cardiac readmission, all-cause mortality and cardiac mortality. RESULT: The data of 1107 patients were included and 60.07%% of them participated in CR program. The risks of revascularisation, all cause readmission and cardiac readmission among CR participants were compared. The results of those analysis were consistent and showed that the CR participants had lower allcause mortality ,cardiac mortality,all cause readmission, cardiac admission. However no effect was observed for subsequent myocardial infarction or revascularisation. CONCLUSIONS: It was suggested CR participation may reduce the risk of all-cause mortality ,cardiac mortality, all cause readmission and cardiac admission.

scholarly journals Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001319
Author(s):  
Line Davidsen ◽  
Kristian Hay Kragholm ◽  
Mette Aldahl ◽  
Christoffer Polcwiartek ◽  
Christian Torp-Pedersen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
The Impact

BackgroundIn patients with stable angina (SA), the clinical benefits of percutaneous coronary intervention (PCI) reside almost exclusively within the realm of symptomatic improvement rather than improvement in hard clinical endpoints. The benefits of PCI should always be balanced against its potential short-term and long-term risks. Common among these risks is the presence of anaemia and its interaction with poor clinical outcomes and increased morbidity; this study aims to elucidate the impact of anaemia on long-term clinical outcomes of this patient group.MethodsFrom Danish national registries, we identified patients with SA treated with PCI who had a haemoglobin measurement maximum of 90 days prior to PCI procedure. Anaemia was defined as haemoglobin <130 and <120 g/L in men and women, respectively. Follow-up was up to 3 years after PCI, and Cox regression was used to estimate HRs with 95% CIs of hospitalisation due to bleeding, acute coronary syndrome (ACS) and all-cause mortality in patients with anaemia compared with patients without anaemia.ResultsOf 2837 included patients, 14.6% had anaemia prior to PCI. During follow-up, 93 patients (3.3%) had a bleeding episode, which was higher in patients with anaemia (5.8%) compared with patients without anaemia (2.8%). A total of 213 patients (7.5%) developed ACS, which was higher in patients with anaemia (10.6%) compared with patients without anaemia (7.0%). Furthermore, 185 patients (6.5%) died, with a mortality rate of 18.1% in patients with anaemia compared with 4.5% in patients without anaemia. In multivariable analyses, anaemia was associated with a significantly increased risk of bleeding (HR 1.69; 95% CI 1.04 to 2.73; P 0.033), ACS (HR 1.47; 95% CI 1.04 to 2.10; P 0.031) and all-cause mortality (HR 2.41; 95% CI 1.73 to 3.30; P <0.001).ConclusionAnaemia in patients with SA was significantly associated with bleeding, ACS and all-cause mortality following PCI.

Prognostic Value of Admission Blood Urea Nitrogen/Creatinine Ratio in Patients with STEMI Undergoing Late Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Caijuan Dong ◽  
Yanbo Xue ◽  
Yan Fan ◽  
Ruochen Zhang ◽  
Yunfei Feng ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Blood Urea Nitrogen ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Creatinine Ratio ◽  
Cardiac Mortality ◽  
Urea Nitrogen ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Objective: Numerous patients with ST-segment elevation myocardial infarction (STEMI), especially in developing countries, undergo late percutaneous coronary intervention (PCI), defined as time of PCI > 24 hours from symptom onset. This study is aimed to identify the predictive value of admission blood urea nitrogen/creatinine ratio (BUN/Cr) on long-term all-cause mortality and cardiac mortality in STEMI patients receiving late PCI. Methods: Eligible STEMI patients who received late PCI between 2009 and 2011 were consecutively enrolled. They were classified into two groups based on the median BUN/Cr: low BUN/Cr group and high BUN/Cr group. Patients were followed up by phone or face to face interviews and medical records review. The primary endpoint was defined as all-cause mortality and cardiac mortality. Results: 780 STEMI patients were enrolled finally. The median BUN/Cr was 14.29. The median follow-up period was 41 months, with 37 all-cause deaths and 25 cardiac deaths. Compared to the low BUN/Cr group, high BUN/Cr group had higher all-cause mortality (6.4% vs. 3.1%, P=0.029), and cardiac mortality (6.3% vs. 1.5%, P<0.001). The Cox proportional hazard analysis revealed that high BUN/Cr at admission was an independent predictor of long-term cardiac mortality (P=0.003), but not of all-cause mortality (P=0.077). Conclusions: High BUN/Cr ratio at admission was an independent predictor of cardiac mortality in STEMI patients receiving late PCI. Brief Summary: In a retrospective study of STEMI patients receiving late PCI, we found that high BUN/Cr ratio (BUN/Cr>14.29) at admission was an independent predictor of long-term cardiac mortality, but not of all-cause mortality. The study showed that BUN/Cr ratio could be a potential indicator of risk stratification models for STEMI patients undergoing late PCI.

scholarly journals In-hospital cardiac rehabilitation and clinical outcomes in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039096
Author(s):  
Natsuko Kanazawa ◽  
Hiroaki Iijima ◽  
Kiyohide Fushimi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Percutaneous Coronary ◽  
All Cause Mortality

ObjectivesTo verify the associations between participation in an in-hospital cardiac rehabilitation (CR) programme and clinical outcomes among patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).DesignA retrospective cohort study using the Japanese administrative claims database.SettingJapanese acute-care hospitals.ParticipantsPatients aged ≥18 years who underwent PCI due to AMI and survived to discharge.Primary and secondary outcome measureThe primary outcomes were revascularisation, all-cause readmission and cardiac readmission (median follow-up period: 324 days, 236 days and 263 days, respectively). The secondary outcomes were all-cause mortality and cardiac mortality (median follow-up period: both were 460 days).ResultThe data of 13 697 patients were extracted from the database, and 65.4% of them participated in an in-hospital CR. The risks of revascularisation, all-cause readmission and cardiac readmission among CR participants were compared with those of non-participants using two statistical techniques: matched-pair analysis based on propensity score and a 30-day landmark analysis. The results of those analysis were consistent and showed that the CR participants had lower risk of revascularisation (adjusted HR: 0.74; 95% CI: 0.65 to 0.84), all-cause readmission (HR: 0.81; 95% CI: 0.74 to 0.88) and cardiac readmission (HR: 0.77; 95% CI: 0.70 to 0.85). However, all-cause mortality and cardiac mortality were not associated with participation in the CR.ConclusionsIt was suggested that in-hospital CR participation may reduce the risk of revascularisation, all-cause readmission and cardiac readmission among patients with AMI after PCI. In-hospital CR may expand the potential benefits of CR in addition to outpatient CR.

scholarly journals Impact of gender on the long-term prognosis in acute STEMI patients undergoing primary percutaneous coronary intervention: analysis of 10-year all-comers registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.B Cid Alvarez ◽  
M Juskova ◽  
P Tasende Rey ◽  
B Alvarez Alvarez ◽  
E Gonzalez Babarro ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Long Term Prognosis

Abstract Background Published data about the impact of female gender on the long-term prognosis in patients with ST–elevation -myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) have been incoherent. Much of the registries show that the gender effect diminishes after control for age and comorbidities Purpose We sought to investigate the gender dependent impact on the long-term prognosis in STEMI patients undergoing PPCI. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. Our primary objective was to assess its impact of gender in all-cause mortality and major adverse cardiovascular events (MACE; death, recurrent MI, target vessel revascularization, heart failure) during follow-up. Follow-up was performed through consultation of the electronic registries available in the autonomic community of Galicia (IANUS program); all medical evaluations and hospital registries were reviewed. Median follow-up was 3 years (interquartile range of 0.68–4.67 years). Results Of the 1965 patients with STEMI admitted for primary PCI, 464 (23,6%) were female. Women were on average 10 years older than men (71.5±13 vs. 61.5±12 yrs, p=0,000), with a higher prevalence of diabetes (25,2% vs 20,5% p=0,030) and hypertension (65,1% vs 44,5% p=0,000). With regard to system delays, the median time from first medical contact to PPCI were superior in women (116,3±83) than men (97,9±67) (p=0,000). Despite their older age women did not show differences in the extent of coronary disease (median SYNTAX score 13,60±8.0 vs. 14.33±8.7 in men, p=0,122). The GRACE score was higher for women (141.1±39 vs 120.8±35 p=0.07) and the incidence of cardiogenic shock at admission was 10.2% (7.1% in men, p=0,003). Furthermore, female patients received less guideline-directed medical therapy than men with less prescription of statins (93.6.5% vs 96.9%; p=0,003), and beta blockers (80.2% vs 85.1%; p=0.021), and having less radial access for PPCI (84.1% vs 90.1%; p=0.000). The cumulative incidence of all-cause mortality was 19.4% vs 12.6% (p=0,000), the incidence of MACE was 31.9% vs 23.4% (p=0.000) for women and men respectively (Image 1). Multivariate analysis revealed that, after correction for baseline differences, gender remained and independent predictor for all-cause mortality (HR IC 95%: 1.922 (1.396–2.696) p=0.000) Conclusions In our “real-world” registry of patients with STEMI undergoing pPCI women had longer ischemic times, higher risk profiles, and differing interventional approaches compared with men and gender results an independent predictor for all-cause mortality. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap. Image 1 Funding Acknowledgement Type of funding source: None

Is female gender associated with worse outcomes after percutaneous coronary intervention of left main coronary artery?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W.J Skorupski ◽  
M Grygier ◽  
S Grajek ◽  
M Pyda ◽  
P Mitkowski ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Left Main Coronary Artery ◽  
Real Life ◽  
Female Gender ◽  
Coronary Intervention ◽  
Left Main ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Introduction Left main coronary artery (LM) disease is a life-threatening condition, so the invasive treatment is crucial for the survival of the patients. There is still controversy regarding whether female sex is associated with worse outcomes after percutaneous coronary intervention (PCI) of LM. Purpose Our aim was to examine gender-based differences in patients after LM PCI. Methods Consecutive 459 patients (mean age: 68.4±9.4 years) in whom PCI of LM was performed (between January 2015 and June 2018) were included in the study. The clinical and angiographic data of these patients including short and long-term outcomes has been analyzed. Results The whole group consisted of 112 (24.4%) women and 347 (75.6%) men. Compared with men, women were older (69.9±8.9 vs 67.9±9.5; p=0.04), had higher prevalence rates of diabetes (43.8% vs 33.4%; p=0.048) and hypertension (92% vs 79.1%; p&lt;0.01). Renal failure (42% vs 32.3%; p=0.061) was found insignificantly more often in women, frequency of other comorbidities did not differ statistically. Women were more often disqualified from bypass surgery (19.6% vs 11.8%; p=0.036) and more often required complex stenting techniques (29.2% vs 18.7%; p=0.028). SYNTAX Score and Euroscore II did not differ statistically between the genders. All periprocedural complications (8.9% vs 8.4%; p=0.85) and the frequency of periprocedural myocardial infarction (6.3% vs 4%; p=0.330) did not differ among the groups. We observed higher all-cause mortality in men group (19.1% vs 24.3%; p=0.041) at a median follow-up of 808 days (range 367 to 1616 days). Conclusion In our real-life cohort of patients, complex LM procedures and comorbidities were more frequent in women. There was no significant difference in short-term results between two genders, although in our real-life study we observed higher long-term all-cause mortality in men. Our results suggest that female gender in LM PCI is not a predictor of adverse outcomes. Further studies are required to determine the optimal revascularization modality in women. Long-term follow-up Funding Acknowledgement Type of funding source: None

Impact of Type 2 Diabetes on Five-year Clinical Outcomes Following Successful Percutaneous Coronary Intervention on Chronic Total Occlusions: a Propensity Matched Cohort Analysis

2021 ◽  
Author(s):  
Peizhi Wang ◽  
Deshan Yuan ◽  
Sida Jia ◽  
Pei Zhu ◽  
Ce Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Background: Despite substantial improvement in chronic total occlusions (CTO) revascularization technique, the long-term clinical outcomes in diabetic patients with revascularized CTO remain controversial. Our study aimed to investigate the five-year cardiovascular survival for patients with or without type 2 diabetes mellitus (DM) who underwent successful percutaneous coronary intervention (PCI) for CTO. Methods: Data of the current analysis derived from a large single-center, prospective and observational cohort study, including 10,724 patients who underwent PCI in 2013 at Fuwai Hospital. Baseline, angiographic and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which consisted of death, recurrent myocardial infarction (MI), stroke and target vessel revascularization (TVR). The secondary endpoint was all-cause mortality. Cox regression analysis and propensity-score matching was performed to balance the baseline confounders. Results: A total of 719 consecutive patients with ≥ 1 successful CTO-PCI were stratified into diabetic (n=316, 43.9%) and non-diabetic (n=403, 56.1%) group. During a median follow-up of 5 years, the risk of MACCE (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.08-2.00, P = 0.013) was significantly higher in the diabetic group than in the non-diabetic group, whereas the adjusted risk of all-cause mortality (HR 2.37, 95% CI 0.94-5.98, P = 0.068) was similar. In the propensity score matched population, there were no significant differences in the risk of MACCE (HR 1.27, 95% CI 0.92-1.75, P = 0.155) and all-cause mortality (HR 2.56, 95% CI 0.91-7.24, P = 0.076) between groups. Subgroup analysis revealed a consistent effect on five-year MACCE across various subgroups.Conclusions: In patients who received successful CTO-PCI, non-diabetic patients were related to better long-term survival benefit in terms of MACCE. Further randomized studies are warranted to confirm these findings.

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

2016 ◽  
Vol 11 (1) ◽  
pp. 33
Author(s):  
Yohei Sotomi ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Percutaneous Coronary ◽  
Orbital Atherectomy ◽  
Long Term Follow Up ◽  
Coronary Lesions ◽  
Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

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