scholarly journals 377 Optimal timing for percutaneous coronary interventions in patients undergoing TAVI

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gabriele Venturi ◽  
Mattia Lunardi ◽  
Paolo Alberto Del Sole ◽  
Michele Pighi ◽  
Roberto Scarsini ◽  
...  
Keyword(s):  
High Risk ◽  
Primary Endpoint ◽  
University Hospital ◽  
Optimal Timing ◽  
Left Main ◽  
Free Survival ◽  
Percutaneous Coronary ◽  
Procedural Complication ◽  
Angiographic Result

Abstract Aims PCI timing in patients undergoing TAVI is still controversial, with most cases treated before TAVI, because of concerns about potential ischaemic complications during valve replacement. This study aims to compare procedural and in-hospital outcomes in patients undergoing PCI before or after TAVI. Methods and results Patients undergoing TAVI and PCI from 2010 to 2021 at Verona University Hospital were included. High-risk PCI were defined when performed in unprotected left main, proximal left anterior descending, proximal dominant right coronary artery or in 3-vessel disease. The primary endpoint was the cumulative incidence of any TAVI procedural complication and in-hospital adverse events (VARC-3 criteria). 129/940 TAVI patients underwent PCI was performed before TAVI in 33.4% of cases. Most patients (76.4%) were at high-risk. The primary endpoint occurred in 30.2% PCI pre-TAVI vs. 23.3% post-TAVI (HR: 0.72; 95% CI: 0.26–2.86; P = 0.671); and in 37.9% vs. 18.5% respectively, among high-risk PCI (HR: 1.62; 95% CI: 0.86–3.76; P = 0.102). At 24 months, MACCE-free survival was comparable (PCI pre-TAVI 91.7% vs. post-TAVI 97.5%, HR: 0.88, 95% CI: 0.13–4.77, P = 0.765). Conclusions PCI performed after TAVI does not expose patients to higher risks of peri-procedural or long-term complications when compared with pre-TAVI procedures, even in presence of high-risk lesions. 377 FigureAn example of post-TAVI high risk PCI. Pre-TAVI coronary angiography showed ostial left main critical lesion (A). After Symetis Aortic valve deployment, balloon angioplasty and stent implantation were performed (B and C) with good final angiographic result (D).

scholarly journals Long‐Term Clinical Outcomes Following Revascularization in High‐Risk Coronary Anatomy Patients With Stable Ischemic Heart Disease

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kevin R. Bainey ◽  
Wendimagegn Alemayehu ◽  
Robert C. Welsh ◽  
Arnav Kumar ◽  
Spencer B. King ◽  
...  
Keyword(s):  
High Risk ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Left Main ◽  
Left Main Disease ◽  
Coronary Anatomy ◽  
Percutaneous Coronary ◽  
Selection For

Background The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial failed to show a reduction in hard clinical end points with an early invasive strategy in stable ischemic heart disease (SIHD). However, the influence of left main disease and high‐risk coronary anatomy was left unaddressed. In a large angiographic disease‐based registry, we examined the modulating effect of revascularization on long‐term outcomes in anatomically high‐risk SIHD. Methods and Results 9016 patients with SIHD with high‐risk coronary anatomy (3 vessel disease with ≥70% stenosis in all 3 epicardial vessels or left main disease ≥50% stenosis [isolated or in combination with other disease]) were selected for study from April 1, 2002 to March 31, 2016. The primary composite of all‐cause death or myocardial infarction (MI) was compared between revascularization versus conservative management. A total of 5487 (61.0%) patients received revascularization with either coronary artery bypass graft surgery (n=3312) or percutaneous coronary intervention (n=2175), while 3529 (39.0%) patients were managed conservatively. Selection for coronary revascularization was associated with improved all‐cause death/MI as well as longer survival compared with selection for conservative management (Inverse Probability Weighted hazard ratio [IPW‐HR] 0.62; 95% CI 0.58 to 0.66; P <0.001; IPW‐HR 0.57; 95% CI 0.53–0.61; P <0.001, respectively). Similar risk reduction was noted with percutaneous coronary intervention (IPW‐HR 0.64, 95% CI 0.59–0.70, P <0.001) and coronary artery bypass graft surgery (IPW‐HR 0.61; 95% CI 0.57–0.66; P <0.001). Conclusions Revascularization in patients with SIHD with high‐risk coronary anatomy was associated with improved long‐term outcome compared with conservative therapy. As such, coronary anatomical profile should be considered when contemplating treatment for SIHD.

Abstract 2875: Long-Term Outcomes Following Vascular Surgery in Patients With Multivessel Coronary Artery Disease: Analysis of Randomized and Excluded Patients from the Coronary Artery Revascularization Prophylaxis (CARP) Trial

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Santiago Garcia ◽  
Herbert B Ward ◽  
Thomas Moritz ◽  
Fred Littooy ◽  
Steve Goldman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Coronary Angiography ◽  
Vascular Surgery ◽  
Left Main ◽  
Term Survival ◽  
Coronary Artery Revascularization ◽  
Probability Of Survival ◽  
Artery Disease

Background: The Coronary Artery Revascularization Prophylaxis (CARP) Trial was a multicenter randomized study that showed no long-term survival benefit with revascularization prior to elective vascular surgery in patients with stable coronary artery disease (CAD). To determine whether subsets with high-risk anatomy benefited from preoperative revascularization, survival was determined in randomized and registry patients who underwent coronary angiography within 6 months of vascular surgery. Methods: Over a 4-year enrollment period, 4,876 patients were screened prior to vascular surgery and 1,048 (21.5%) had preoperative coronary angiography for either multiple cardiac risks or an abnormal preoperative stress test. The cohort included 462 randomized and 586 excluded patients and the probability of survival was determined at 2.5 years following vascular surgery. Results: Of 1,048 patients with preoperative coronary angiography, non-obstructive disease (< 70%) was present in 192 (18.3%) and 1 vessel disease (VD) was present in 244 (23.3%), with a combined survival of 0.84. Previous bypass surgery (CABG) was present in 225 (21.5%), with a survival of 0.78. High risk coronary anatomy in patients without prior CABG included 2-VD in 204 (19.5%), 3-VD in 130 (12.4%) and an unprotected left main stenosis > 50% in 48 (4.6%) patients. Their long-term survival according to the preoperative revascularization status is shown in the Table . Conclusions: The results demonstrate that an unprotected left main stenosis was present in 4.6% of high-risk patients presenting for vascular surgery and was the only anatomical subset that demonstrated a survival benefit with preoperative revascularization prior to vascular surgery. These data may warrant additional strategies to identify patients with unprotected left main disease either prior to or immediately following vascular surgery. Long-Term Probability of Survival at 2.5 Years Following Vascular Surgery

scholarly journals Effect of Chemotherapy With Docetaxel With Androgen Suppression and Radiotherapy for Localized High-Risk Prostate Cancer: The Randomized Phase III NRG Oncology RTOG 0521 Trial

2019 ◽  
Vol 37 (14) ◽  
pp. 1159-1168 ◽  
Author(s):  
Seth A. Rosenthal ◽  
Chen Hu ◽  
Oliver Sartor ◽  
Leonard G. Gomella ◽  
Mahul B. Amin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Distant Metastasis ◽  
Disease Free Survival ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Androgen Suppression ◽  
Disease Free

PURPOSE Radiotherapy (RT) plus long-term androgen suppression (AS) are a standard treatment option for patients with high-risk localized prostate cancer. We hypothesized that docetaxel chemotherapy (CT) could improve overall survival (OS) and clinical outcomes among patients with high-risk prostate cancer. PATIENTS AND METHODS The multicenter randomized NRG Oncology RTOG 0521 study enrolled patients with high-risk nonmetastatic disease between 2005 and 2009. Patients were randomly assigned to receive standard long-term AS plus RT with or without adjuvant CT. RESULTS A total of 612 patients were enrolled; 563 were evaluable. Median prostate-specific antigen was 15.1 ng/mL; 53% had a Gleason score 9 to 10 cancer; 27% had cT3 to cT4 disease. Median follow-up was 5.7 years. Treatment was well tolerated in both arms. Four-year OS rate was 89% (95% CI, 84% to 92%) for AS + RT and 93% (95% CI, 90% to 96%) for AS + RT + CT (hazard ratio [HR], 0.69; 90% CI, 0.49 to 0.97; one-sided P = .034). There were 59 deaths in the AS + RT arm and 43 in the AS + RT + CT arm, with fewer deaths resulting from prostate cancer in the AS + RT + CT arm versus AS + RT (23 v 16 deaths, respectively). Six-year rate of distant metastasis was 14% for AS + RT and 9.1% for AS + RT + CT, (HR, 0.60; 95% CI, 0.37 to 0.99; two-sided P = .044). Six-year disease-free survival rate was 55% for AS + RT and 65% for AS + RT + CT (HR, 0.76; 95% CI, 0.58 to 0.99; two-sided P = .043). CONCLUSION For patients with high-risk nonmetastatic prostate cancer, CT with docetaxel improved OS from 89% to 93% at 4 years, with improved disease-free survival and reduction in the rate of distant metastasis. The trial suggests that docetaxel CT may be an option to be discussed with selected men with high-risk prostate cancer.

scholarly journals Long-Term Clinical Outcomes for Non-ST Elevation Acute Coronary Syndrome Patients with High-Risk Angiographic Findings Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Sida Jia ◽  
Ce Zhang ◽  
Yue Liu ◽  
Deshan Yuan ◽  
Xueyan Zhao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Coronary Intervention ◽  
Coronary Anatomy ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Angiographic Findings

Objective. We aim to evaluate the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with high-risk coronary anatomy (HRCA). Background. Coronary disease severity is important for therapeutic decision-making and prognostication among patients presenting with NSTE-ACS. However, long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with HRCA is still unknown. Method. NSTE-ACS patients undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and subsequently divided into HRCA and low-risk coronary anatomy (LRCA) groups according to whether angiography complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal LAD lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year and 5-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to the HRCA group, while 1,232 patients belonged to the LRCA group. Compared with the LRCA group, patients in the HRCA group had worse baseline characteristics including higher age, more comorbidities, and worse angiographic findings. Patients in the HRCA group had higher incidence of unplanned revascularization (2 years: 9.7% vs. 5.1%, p<0.001; 5 years: 15.4% vs. 10.3%, p<0.001), 2-year MACCE (13.1% vs. 8.8%, p<0.001), and 5-year death/MI/revascularization/stroke (23.0% vs. 18.4%, p=0.001). Kaplan–Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of revascularization (2 years: HR = 1.636, 95% CI: 1.225–2.186; 5 years: HR = 1.460, 95% CI: 1.186–1.798), 2-year MACCE (HR = 1.275, 95% CI = 1.019–1.596) and 5-year death/MI/revascularization/stroke (HR = 1.183, 95% CI: 1.010–1.385). Conclusion. In our large cohort of Chinese patients, HRCA is an independent risk factor for long-term unplanned revascularization and MACCE.

scholarly journals Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial

2019 ◽  
Vol 6 (4) ◽  
pp. 222-230
Author(s):  
Mariusz Tomaniak ◽  
Ply Chichareon ◽  
Kuniaki Takahashi ◽  
Norihiro Kogame ◽  
Rodrigo Modolo ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Aims To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence. Methods and results This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm. Conclusion In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected. Clinical trial registration unique identifier NCT01813435.

Sign in / Sign up

Export Citation Format

Share Document