P2688A novel risk factor of stent restenosis after drug-eluting stent implantation; Involvement of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Nakano ◽  
M Suzuki ◽  
K Waseda ◽  
T Niwa ◽  
H Ando ◽  
...  
Keyword(s):  
Risk Factor ◽  
Coronary Angiography ◽  
Drug Eluting Stent ◽  
Control Group ◽  
Multivariable Logistic Regression Analysis ◽  
Luminal Diameter ◽  
2Nd Generation ◽  
Increased Risk ◽  
Late Loss ◽  
Drug Eluting

Abstract Background Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel disease concept characterized by the excessive accumulation of triglyceride in cardiomyocytes and vascular smooth muscle cells, leading to coronary artery disease (CAD), heart failure, and arrhythmia. However, it is rarely known whether TGCV contributes to the increased risk of vascular failure after drug eluting stent (DES) implantation. Purpose The aim of this study was to evaluate vascular failure after 2nd generation DES implantation in patients with TGCV. Methods Among 637 consecutive patients suspected of having CAD who underwent both coronary angiography and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy between 2010 and 2018, we analyzed the data from 92 patients who met the inclusion criteria (shown in Table and Figure). Ninety-two patients were allocated to the presence (TGCV group, 11 patients) or absence (control group, 81 patients) of TGCV. All of 92 patients were implanted 2nd generation DES and underwent planned follow up coronary angiography. Control patients were diagnosed of diabetes mellitus. Binary restenosis (ISR), defined as angiographic luminal diameter ≥50% by quantitative coronary angiography, target lesion revascularization (TLR), In-stent late loss and restenosis morphology were assessed in 23 stents of TGCV group and 120 stents of control group. Results There were no significant differences in baseline characteristics between the two groups except for the prevalence of hypertension. In-stent late loss was greater in TGCV than in control (0.45 (−0.04 to 3.33) vs. 0.15 (−0.18 to 2.75), p=0.ehz748.10067), resulting in greater incidence of ISR and TLR in TGCV than in control (34.8% vs. 10.0%, p=0.0017; 21.7% vs. 6.7%, p=0.021, respectively). On multivariable logistic regression analysis, TGCV was found to be a significant and independent predictor for ISR after 2nd generation DES implantation. Regarding restenosis morphology, diffuse and occlusive pattern of ISR, were more frequently observed in TGCV than control (87.5% and 33.3%, Fisher's exact test p=0.028). Table 1.The 4th edition diagnostic criteria for TGCV Items Clinical findings 2 points I) BMIPP scintigraphy Wash-Out Rare <10% II) Diffuse narrowng coronary arteries 1 point III) Jordans anomaly in peripheral blood smear IV) Diabetes Decision 4 points or more → Definite TGCV Figure 1 Conclusion Patients with TGCV showed the greater incidence of vascular failure even after 2nd generation DES implantation, contributing to the novel risk factor for coronary intervention even in the 2nd DES era.

Relocation of minimal luminal diameter after bare metal and drug-eluting stent implantation: Incidence and impact on angiographic late loss

2007 ◽  
Vol 69 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Marco A. Costa ◽  
Manel Sabaté ◽  
Dominick J. Angiolillo ◽  
Paula Hu ◽  
Pilar Jimenez-Quevedo ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Luminal Diameter ◽  
Late Loss ◽  
Drug Eluting ◽  
Minimal Luminal Diameter

scholarly journals Association ofHelicobacter pyloriInfection with Coronary Artery Disease: IsHelicobacter pyloria Risk Factor?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Jamshid Vafaeimanesh ◽  
Seyyed Fakhroldin Hejazi ◽  
Vahid Damanpak ◽  
Mostafa Vahedian ◽  
Mohammadamin Sattari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Control Group ◽  
Igg Antibody ◽  
Luminal Diameter ◽  
The World ◽  
Artery Disease ◽  
Common Infection

Background.Helicobacter pylori(HP) infection is the most common infection in the world and coronary artery disease (CAD) is probably associated with it. The aim of this prospective study was to evaluate the association between HP infection and CAD in suspected patients referred for coronary angiography. The coronary angiography was performed using Judkins method and patients were assigned to participate in CAD positive (>50% luminal diameter stenosis) and negative groups. The serum HP IgG antibody was checked.Results. Positive and negative CAD groups consisted of 62 and 58 patients, respectively. HP was more prevalent among CAD+ patients, and with increasing the number of coronary arteries with stenosis, the HP seropositivity increased so that 76.3% of patients with multiple vessel diseases (MVD) and 70% of patients with single vessel diseases (SVD) were HP seropositive versus 50% in control group (P=0.006). Positive CAD was significantly associated with HDL level (P=0.01) and ESR level (P=0.006). Also, CAD+ patients had higher CRP levels than controls and it was statistically different between SVD group and controls (P<0.05).Conclusion.HP infection is more prevalent in CAD positive patients and, in case of proving causal relationship, it can be considered as a reversible risk factor for CAD.

What Would Be the Ideal Drug-eluting Stent for Managing Patients with Long Lesions?

2009 ◽  
Vol 4 (1) ◽  
pp. 44
Author(s):  
Rhidian J Shelton ◽  
Daniel J Blackman ◽  
◽  
Keyword(s):  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Specific Design ◽  
Diffuse Disease ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Late Loss ◽  
Drug Eluting ◽  
Design Characteristics ◽  
The Ideal

Drug-eluting stents (DES) substantially reduce the risk of restenosis, particularly in complex coronary disease. Their use is now standard in demanding anatomy, including in long lesions, which represent an increasing proportion of percutaneous coronary intervention (PCI) cases. However, long lesions pose a number of procedural and clinical challenges for DES, specifically stent deliverability, stent overlap and an increased risk of restenosis, peri-procedural myocardial infarction, geographical miss and stent thrombosis. The ideal DES for long lesions would incorporate a number of specific design characteristics to meet these challenges, including low late loss to minimise restenosis risk, thin struts to enhance deliverability and minimise risk of peri-procedural infarction and the availability of long lengths to minimise overlap and avoid geographical miss. It is clear from a knowledge of their properties, and from available data on DES performance in long lesions, that some currently available DES have superior design characteristics and clinical outcomes in the setting of diffuse disease. An awareness of these issues is essential for the practising interventional cardiologist in treating long lesions in routine clinical practice.

Comparative Efficacy and Safety of Duration of Dual Antiplatelet Therapy in Patients with CAD Undergoing Drug-eluting Stent Implantation: A Systematic Review and Network Meta-analysis

2020 ◽  
Vol 26 (44) ◽  
pp. 5739-5745
Author(s):  
Jieqiong Guan ◽  
Wenjing Song ◽  
Pan He ◽  
Siyu Fan ◽  
Hong Zhi ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Drug Eluting Stent ◽  
Efficacy And Safety ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Drug Eluting

Objective: The aim was to evaluate the efficacy and safety of duration of dual antiplatelet therapy (DAPT) for patients who received percutaneous coronary intervention (PCI) with a drug-eluting stent. Background: The optimal duration of DAPT to balance the risk of ischemia and bleeding in CAD patients undergoing drug-eluting stent (DES) implantation remains controversial. Methods: PubMed, Cochrane Library, Web of Science, Clinicaltrials.gov, CNKI and Wanfang Databases were searched for randomized controlled trials of comparing different durations of DAPT after DES implantation. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), and major bleeding, and were pooled by Bayes network meta-analysis. Net adverse clinical and cerebral events were used to estimate the surface under the cumulative ranking (SUCRA) curves. The subgroup analysis based on clinical status, follow-up and area was conducted using traditional pairwise meta-analysis. Results: A total of nineteen trials (n=51,035) were included, involving six duration strategies. The network metaanalysis showed that T2 (<6-month DAPT followed by aspirin, HR:1.51, 95%CI:1.02-2.22), T3 (standard 6-month DAPT, HR:1.47, 95%CI:1.14-1.91), T4 (standard 12-month DAPT, HR:1.41, 95%CI:1.15-1.75) and T5 (18-24 months DAPT, HR:1.47, 95%CI:1.09-1.97) was associated with significantly increased risk of MACCE compared to T6 (>24-month DAPT). However, no significant difference was found in MACCE risk between T1 (<6-month DAPT followed by P2Y12 monotherapy) and T6. Moreover, T5 was associated with significantly increased risk of bleeding compared to T1(RR:3.94, 95%CI:1.66-10.60), T2(RR:3.65, 95%CI:1.32-9.97), T3(RR:1.93, 95%CI:1.21-3.50) and T4(RR:1.89, 95%CI:1.15-3.30). The cumulative probabilities showed that T6(85.0%), T1(78.3%) and T4(44.5%) were the most efficacious treatment compared to the other durations. In the ACS (<50%) subgroup, T1 was observed to significantly reduce the risk of major bleeding compared to T4, but not in the ACS (≥50%) subgroup. Conclusions: Compared with other durations, short DAPT followed by P2Y12 inhibitor monotherapy showed non-inferiority, with a lower risk of bleeding and not associated with an increased MACCE. In addition, the risk of major bleeding increased significantly, starting with DAPT for 18-month. Compared with the short-term treatment, patients with ACS with the standard 12-month treatment have a better prognosis, including lower bleeding rate and the decreased risk of MACCE. Due to study's limitations, the results should be verified in different risk populations.

scholarly journals TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

2021 ◽  
Vol 10 (13) ◽  
pp. 2907
Author(s):  
Alba Martínez-Escudé ◽  
Guillem Pera ◽  
Anna Costa-Garrido ◽  
Lluís Rodríguez ◽  
Ingrid Arteaga ◽  
...  
Keyword(s):  
Risk Factor ◽  
Liver Fibrosis ◽  
General Population ◽  
Transient Elastography ◽  
Atherogenic Dyslipidemia ◽  
Control Group ◽  
Cross Sectional ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Tsh Levels

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18–75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥ 8.0 kPa and ≥ 9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

2018 ◽  
Vol 118 (12) ◽  
pp. 2162-2170 ◽  
Author(s):  
Kamilla Steensig ◽  
Kevin Olesen ◽  
Troels Thim ◽  
Jens Nielsen ◽  
Svend Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Ischaemic Stroke ◽  
Independent Risk Factor ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Artery Disease

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

Abstract 40: Hospital Variation in Premature Clopidogrel Discontinuation following Drug Eluting Stent Placement and Adverse Cardiovascular Outcomes from the VA Clinical Assessment, Reporting, and Tracking System for Cath Labs (CART-CL)

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Rebecca Vigen ◽  
Thomas M Maddox ◽  
Colin O'Donnell ◽  
Deepak L Bhatt ◽  
Thomas T Tsai ◽  
...  
Keyword(s):  
Tracking System ◽  
Adverse Outcomes ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Hospital Level ◽  
Pharmacy Refill ◽  
Hospital Variation ◽  
Increased Risk ◽  
Drug Eluting ◽  
Clopidogrel Therapy

Background: Clopidogrel is recommended for 1 year following drug eluting stent (DES) placement and premature discontinuation has been associated with adverse outcomes. The extent of variation in premature discontinuation across hospitals within an integrated healthcare system is unknown. Accordingly, we assessed variation in premature clopidogrel discontinuation across all VA PCI sites and whether there was an association between hospitals with higher rates of premature discontinuation and adverse outcomes. Methods: We used the VA CART-CL registry which includes all PCIs with drug eluting stents performed between 10/01/08 and 09/30/09 at 55 VA cath labs that used CART. We evaluated the frequency of patients who prematurely discontinue clopidogrel at 6 and 9 months using pharmacy refill data. Multivariable regression assessed the association between premature discontinuation and all-cause mortality and/or myocardial infarction (MI). We then grouped sites into quartiles of premature discontinuation and evaluated the association between hospital level premature discontinuation and adverse outcomes. Results: Of the 7,022 patients who received a DES, 6.3% discontinued by 6 months, and 10.2% by 9 months. After risk adjustment, patients who discontinued clopidogrel prematurely had increased risk of adverse events with HR of 5.42 at 6 months (95% CI 4.22 – 6.99), and 6.24 at 9 months (95% CI 4.98 – 7.83). There was a significant trend in the unadjusted rates within quartiles toward increased risk of adverse outcomes among hospitals with greater rates of patients who discontinue prematurely by 6 months (p < 0.01 for trend, OR 1.65 CI 1.07 – 2.62 for comparison between quartile 1 and 4). Conclusion: Premature discontinuation of clopidogrel is associated with adverse outcomes among patients who receive drug eluting stents. Hospitals with higher rates of premature discontinuation of clopidogrel have higher rates of adverse outcomes. Hospital-level interventions to reduce early discontinuation of clopidogrel therapy have the potential to improve outcomes of patients who receive a DES.

Abstract 2355: A Randomized Comparison of Triple Antiplatelet Therapy with Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation: D rug- E luting Stenting Followed by C ilostazol treatment reduces LA te RE stenosis in Patients with DIABETES mellitus: DECLARE - DIABETES Trial

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Seong-Wook Park ◽  
Seung-Whan Lee ◽  
Young-Hak Kim ◽  
Sung-Cheol Yun ◽  
Duk-Woo Park ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Group Versus ◽  
Drug Eluting Stent ◽  
Standard Group ◽  
Triple Antiplatelet Therapy ◽  
Patients With Diabetes ◽  
Late Loss ◽  
Drug Eluting

Objectives: To determine whether cilostazol improves the efficacy of drug-eluting stent (DES) in patients with diabetes mellitus (DM). Background: Cilostazol has been reported to reduce neointimal hyperplasia and restenosis after bare-metal stent (BMS) implantation. But it is not known that its effect is extrapolated to drug eluting stent (DES) in patients with DM. Methods: This randomized, multicenter, prospective study compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol, triple group, n=200) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n=200) for 6 months in patients with DM receiving DES. The primary end point was in-stent late loss at 6-month angiography according to the intention-to-treat principle. Results: The both groups had similar baseline clinical and angiographic characteristics. The in-stent (0.25±0.53 mm vs. 0.38±0.54 mm, p=0.025) and in-segment (0.42±0.48 mm vs. 0.53±0.49 mm, p=0.031) late loss were significantly lower in the triple versus standard group. Six-month in-segment restenosis (8.0% vs. 15.6%, p=0.033) and 9-month target lesion revascularization (TLR) (2.5% vs. 7.0%, p=0.034) was significantly lower in triple group versus standard group. At 9 months, major adverse cardiac events (MACE) including death, myocardial infarction, and TLR had a lower tendency in triple group versus standard group (3.0% vs. 7.0%, p=0.066). Subgroup analysis showed that triple plus SES patients had significantly lower in-segment restenosis (0%, 0/88) than standard plus SES (8%, 7/88, p=0.014), triple plus PES (17.3% 13/75, p<0.001), and standard plus PES (24.1%, 19/79, p<0.001) patients. On the multivariate analysis, SES and the use cilostazol were strong predictors of restenosis and TLR. Conclusions: In patients with DM, compared with dual antiplatelet therapy, triple antiplatelet therapy after DES implantation is associated with a decrease in angiographic restenosis as well as the extent of late luminal loss, resulting in reduced risk of 9-monthTLR.

Sign in / Sign up

Export Citation Format

Share Document