Myocardial revascularization: symptomatic and prognostic indications

ESC CardioMed ◽  
2018 ◽  
pp. 1393-1395
Author(s):  
Jean-Claude Tardif ◽  
Philippe L. L’Allier ◽  
Fabien Picard
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Coronary Revascularization ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Optimal Medical Therapy ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Large Area ◽  
Artery Disease

The primary goal of therapy in patients with chronic ischaemic heart disease is to relieve symptoms, delay or prevent progression of coronary artery disease, and decrease the risk of major adverse cardiovascular events. This is primarily achieved with optimal medical therapy. When coronary revascularization is considered, symptomatic and prognostic indications must be differentiated. For symptomatic indications, revascularization is justified if there is a large area of inducible ischaemia or if there is persistent limiting angina despite optimal medical therapy. The key prognostic indications for revascularization are left main disease with stenosis greater than 50%, any proximal left anterior descending artery stenosis greater than 50%, two-vessel or three-vessel disease with stenosis greater than 50% with impaired left ventricular function (left ventricular ejection fraction <40%), a large area of ischaemia (>10% of the left ventricle), or a single remaining patent coronary artery with stenosis greater than 50%.

scholarly journals Results of 1-year follow-up of patients with comorbidity of coronary artery disease and respiratory disease underwent scheduled myocardial revascularization

2019 ◽  
Vol 29 (2) ◽  
pp. 189-198
Author(s):  
Evgeniy D. Bazdyrev ◽  
Nadezhda A. Kalichenko ◽  
Ol’ga M. Polikutina ◽  
Yuliya S. Slepynina ◽  
Ol’ga L. Barbarash
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Respiratory Disease ◽  
Cardiovascular Events ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chronic Obstructive ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

The first goal of this study was to analyze a relationship between 1-year outcomes and respiratory comorbidity in patients with coronary artery disease (CAD) underwent scheduled coronary artery bypass grafting (CABG); the second goal of the study was to determine the most significant predictors of fatal outcome in these patients. Methods. The study involved 251 patients underwent CABG. They were stratified according to having comorbid chronic obstructive (n = 62; 24.7%) or non-obstructive lung disease (n = 65; 25.9%) or not having chronic respiratory disease (n = 124; 49.4%). Cardiovascular events during 1 year were registered. Results. An expected decrease in functional classes of CAD and chronic heart failure (CHF) was noted over 1 year. Number of non-fatal significant cardiovascular events didn’t differ in patients with or without chronic obstructive pulmonary disease (COPD). Seven patients (2.78%) died during the year; the cause of death was cardiovascular disease in all cases. Factors predicting poor outcomes included age, occupational exposure to chemicals > 3 years, incomplete myocardial revascularization, FEV1/FVC ratio, and left ventricular ejection fraction < 40%. Conclusion. COPD is a predictor of poor outcome of myocardial revascularization in patients with CAD.

scholarly journals The independent reduction in mortality associated with guideline-directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction

2020 ◽  
Author(s):  
Natasha K Wolfe ◽  
Joshua D Mitchell ◽  
David L Brown
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Antiplatelet Drug ◽  
Reduced Ejection Fraction ◽  
Artery Disease

Abstract Aims Guideline-directed medical therapy (GDMT) is underutilized in patients with coronary artery disease (CAD). However, there are no studies evaluating the impact of GDMT adherence on mortality among patients with CAD and heart failure with reduced ejection fraction (HFrEF). We sought to investigate the association of GDMT adherence with long-term mortality in patients with CAD and HFrEF. Methods and results Surgical Treatment for Ischaemic Heart Failure (STICH) was a trial of patients with an left ventricular ejection fraction ≤35% and CAD amenable to coronary artery bypass graft surgery (CABG) who were randomized to CABG plus medical therapy (N = 610) or medical therapy alone (N = 602). Median follow-up time was 9.8 years. We defined GDMT for the treatment of CAD and HFrEF as the combination of at least one antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The primary outcome was all-cause mortality. Assessment of the independent association between GDMT and mortality was performed using multivariable Cox regression with GDMT as a time-dependent covariate. In the CABG arm, 63.6% of patients were on GDMT throughout the study period compared to 66.5% of patients in the medical therapy arm (P = 0.3). GDMT was independently associated with a significant reduction in mortality (hazard ratio 0.65, 95% confidence interval 0.56–0.76; P &lt; 0.001). Conclusion GDMT is associated with reduced mortality in patients with CAD and HFrEF independent of revascularization with CABG. Strategies to improve GDMT adherence in this population are needed to maximize survival.

scholarly journals Association of C1q/TNF-related protein-9 (CTRP9) level with obstructive sleep apnea in patients with coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X Wang ◽  
Z Li ◽  
Y Du ◽  
L Jia ◽  
J Fan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Obstructive Sleep Apnea ◽  
Coronary Artery ◽  
Sleep Apnea ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Related Protein ◽  
Obstructive Sleep ◽  
Artery Disease

Abstract Background Obstructive sleep apnea (OSA) is closely related to the incidence and progression of coronary artery disease (CAD), but the mechanisms linking OSA and CAD are unclear. C1q/TNF-related protein-9 (CTRP9) is a novel adipokine that protects the heart against ischemic injury and ameliorates cardiac remodeling. Purpose We aimed to ascertain the clinical relevance of CTRP9 with OSA prevalence in patients with CAD. Methods From August 2016 to March 2019, consecutive eligible patients with CAD (n=154; angina pectoris, n=88; acute myocardial infarction [AMI], n=66) underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events h–1. Plasma CTRP9 concentrations were measured by ELISA method. Results OSA was present in 89 patients (57.8%). CTRP9 levels were significantly decreased in the OSA group than in the non-OSA group (4.7 [4.1–5.2] ng/mL vs. 4.9 [4.4–6.0] ng/mL, P=0.003). The difference between groups was only observed in patients with AMI (3.0 [2.3–4.9] vs. 4.5 [3.2–7.9], P=0.009), but not in patients with AP (5.0 [4.7–5.3] ng/mL vs. 5.1 [4.7–5.9] ng/mL, P=0.571) (Figure 1). Correlation analysis showed that CTRP9 levels were negatively correlated with AHI (r=−0.238, P=0.003) and oxygen desaturation index (r=−0.234, P=0.004), and positively correlated with left ventricular ejection fraction (r=0.251, P=0.004) in all subjects. Multivariate analysis showed that male gender (OR 3.099, 95% CI 1.029–9.330, P=0.044), body mass index (OR 1.148, 95% CI 1.040–1.268, P=0.006), and CTRP9 levels (OR 0.726, 95% CI 0.592–0.890, P=0.002) were independently associated with the prevalence of OSA. Conclusions Plasma CTRP9 levels were independently related to the prevalence of OSA in patients with CAD, suggesting that CTRP9 might play a role in the pathogenesis of CAD exacerbated by OSA. Figure 1. CTRP9 levels in OSA and non-OAS groups Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242367
Author(s):  
Hari Vivekanantham ◽  
Martin Scoglio ◽  
Philipp Suter ◽  
Stephane Cook ◽  
Yann Roux ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Left Main ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

Formation of platelet microaggregates correlates with adverse clinical outcome in patients with coronary artery disease

2003 ◽  
Vol 89 (04) ◽  
pp. 681-686 ◽  
Author(s):  
Shinzo Miyamoto ◽  
Hiroaki Kawano ◽  
Tomohiro Sakamoto ◽  
Hirofumi Soejima ◽  
Ichiro Kajiwara ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Relative Risk ◽  
Confidence Interval ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Platelet Aggregates ◽  
Artery Disease ◽  
Small Platelet

SummaryPlatelet activation plays a pivotal role in the pathogenesis of acute coronary syndromes. Laser-light scattering in a platelet aggregometer was used to evaluate aggregate size and number quantitatively. Small platelet aggregates ultimately develop into medium and then large platelet aggregates. Thus the measurement of small platelet aggregates is important in the evaluation of thrombus formation.We examined the relationship between small platelet aggregates and the occurrence of subsequent cardiovascular events. We followed-up 204 patients (149 men and 55 women, mean age 68 ± 9 years) with coronary artery disease (CAD) for 48 months. Blood sampling to determine platelet aggregation was performed on the day of hospital discharge.The degree of small platelet aggregates [relative risk 4.34, 95% confidence interval (1.62-11.7), p = 0.004] and low left-ventricular ejection fraction [relative risk 2.88, 95% confidence interval (1.23-6.73), p = 0.015] were independent predictors of the occurrence of cardiovascular events in multivariate Cox hazard analysis. In Kaplan-Meier analysis, the degree of small platelet aggregates correlated with the probability of cardiovascular event occurrence.In patients with CAD, an increase in small platelet aggregates is closely correlated with the future occurrence of cardiovascular events

Sign in / Sign up

Export Citation Format

Share Document