Stable coronary artery disease: medical therapy versus percutaneous coronary intervention versus surgery

2010 ◽  
pp. 220-234
Author(s):  
Scot Garg ◽  
Joanna J. Wykrzykowska ◽  
Patrick W. Serruys
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Interventional Procedure ◽  
Coronary Intervention ◽  
Vessel Disease ◽  
Triple Vessel Disease ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Stable Cad

Coronary artery disease (CAD) represents a wide spectrum of underlying anatomical disease ranging from near normal, minor single-vessel disease (SVD), to extensive triple-vessel disease. Its presentation is similarly variable, from a single episode of chest pain to acute coronary syndrome (ACS) or even death. The aim of treatment in CAD is to relieve symptoms and improve quality of life, reduce cardiovascular (CV) events, and prolong survival. There have been vast improvements in management over the years, following a greater understanding of the underlying pathophysiology, the identification and appropriate management of risk factors, development of new medication, and advances in revascularization techniques, both percutaneous and surgical. These developments have resulted in a move towards an anatomic treatment for CAD even though it is the minor lesion, so-called vulnerable plaque, which is suggested as the most likely culprit for mortality. Nevertheless, in those patients presenting with ACS or ST-elevation myocardial infarction the long-term benefits of percutaneous coronary intervention (PCI) have been confirmed in multiple randomized trials; however, debate surrounds the ideal management of the majority of patients who have angina, and who have not experienced any previous CV events or had an interventional procedure, so-called stable CAD.

scholarly journals Factors for In-hospital Mortality after Percutaneous Coronary Intervention in Patients with ACS

2021 ◽  
Vol 15 (7) ◽  
pp. 1600-1602
Author(s):  
Muhammad Asif Farooqi ◽  
Bilal Rafique Malik ◽  
Aneeqa Ilyas
Keyword(s):  
Coronary Artery Disease ◽  
Renal Failure ◽  
Percutaneous Coronary Intervention ◽  
Acute Renal Failure ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Intervention ◽  
Vessel Disease ◽  
Percutaneous Coronary ◽  
Artery Disease

Background: Percutaneous coronary intervention (PCI) is a nonsurgical technique for treating obstructive coronary artery disease. Aim: To assess the causes / factors leading to mortality after percutaneous coronary intervention Study design: Cross sectional study Setting: Department of Cardiology, Punjab institute of cardiology, Lahore. Duration: Six months i.e. from1stJuly 2020 to 31stDecember 2020. Methods: Medical records of 100 cases who dies after PCI for acute coronary syndrome were taken from record center. Medical record of patients aged 40 to 70 years, both genders underwent PCI and did not survived after PCI were included. Location of lesion, and severity of vessel disease, type of procedure and acute renal failure were considered as factors of mortality and were noted on proforma while analyzed in SPSS 20. Results: The mean age of the patients was 54.20 ± 8.84 years. There were 42(42%) males and 58(58%) females. History of smoking was positive in 48 (48%) cases, diabetes in 51(51%) and hypertension in 55(55%) cases. Among the factors, old age (≥50 years) was observed in 64(64%) patients while 36(36%) had age <50 years. There were 39(39%) patients who underwent PCI under emergency situation and 61(61%) patients had PCI under elective circumstances. Acute renal failure was noticed in 37(37%) patients. There were more patients of right coronary artery disease i.e. 54(54%) who underwent PCI. Conclusion: Out of all factors leading to mortality after PCI, older age at the time of PCI is the most common factor, followed by right coronary artery disease and multi-vessel disease. Keywords: Mortality, PCI, angiography, cardiovascular complications

scholarly journals Peripheral Artery Disease on The Prognosis Value of Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Retrospective, Single-Center Cohort Study

2021 ◽  
Vol 24 (5) ◽  
pp. E887-E892
Author(s):  
Zeyi Cheng ◽  
Miaomiao Qi ◽  
Zekun Lang ◽  
Tingting Fang ◽  
Mahboob Alam ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Peripheral Artery ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Stable Cad

Objective: The purpose of this investigation aimed to clarify the impact of peripheral artery disease (PAD) on the prognosis value of patients with stable coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). Methods: The SPSS 16 software was used for secondary analysis of DRYAD database data. A total of 204 patients were enrolled from Shinonoi General Hospital for newly diagnosed stable CAD and received PCI performance between October 2014 and October 2017. Patients with old myocardial infarction (MI) were excluded. We divided patients into two groups with PAD and without PAD. The primary endpoints were major adverse cardiac events (MACE, defined as all-cause death, non-fatal MI, and non-fatal stroke) and cardiovascular events (defined as cardiovascular death, non-fatal MI, and non-fatal stroke). The secondary outcomes were the individual components of the composite primary outcomes. The median follow-up time was 783 days. Results: No statistical difference was found between PAD and non-PAD patients of lesional characteristics. Spearman’s rank correlations indicate diabetes mellitus (DM) (P = 0.019) and HbA1c (P = 0.009) are positively correlated with PAD. In Kaplan-Meier analysis, patients with PAD predicted poor prognosis in MACE (P < 0.05) and cardiovascular events (P < 0.05). In Multivariable Cox proportional hazards analysis, patients with PAD independently predicted MACE and cardiovascular events. Conclusions: PAD is a significant mediator for the prognosis of patients with stable CAD who underwent PCI treatment.

Genetic predictors for symptoms recurrenсe in coronary artery disease after percutaneous coronary intervention

2017 ◽  
pp. 81-86
Author(s):  
Г.А. Березовская ◽  
Е.С. Клокова ◽  
Н.Н. Петрищев
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Folate Metabolism ◽  
Genotype Distribution ◽  
Polymorphic Markers ◽  
Percutaneous Coronary ◽  
Artery Disease

Гены тромбообразования и фолатного обмена играют важную роль в развитии и прогрессии ишемической болезни сердца (ИБС). Однако о возможной роли полиморфных маркеров в рецидиве ИБС после чрескожного коронарного вмешательства (ЧКВ) известно недостаточно. Цель исследования: Оценить роль генетических факторов системы тромбообразования и фолатного обмена (полиморфных маркеров генов F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB ), в возобновление клиники ИБС после ЧКВ. Методика: Исследование проводили с использованием выборки из 90 больных ИБС в возрасте от 40 до 75 лет: 75 пациентов после планового ЧКВ (60 мужчин и 15 женщин) и 15 лиц после экстренного ЧКВ (12 мужчин и 3 женщины). Молекулярно-генетическое исследование было выполнено с помощью комплекта реагентов «Сердечно-сосудистые заболевания СтрипМетод»® (ViennaLab Diagnostics GmbH, Австрия), выявляющие следующие варианты: F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB . Результаты: В результате исследования была показана ассоциация полиморфного маркера G103T ( Val34Leu ) гена F13A1 (фактор свертываемости крови 13, субъединица A1) с развитием рецидивирующего состояния ИБС после ЧКВ. Выявлены статистически значимые различия в распределении частот генотипов полиморфного маркера Val34Leu гена F13A1 . Показано, что частота генотипа Val/Val у пациентов с осложнениями была выше, чем у пациентов без таковых: 0,700 и 0,400 соответственно (c = 7,78; p = 0,020), при этом генотип Val/Val проявил себя как фактор риска развития осложнений: ОШ = 3,50 (95%ДИ 1,37-8,93). При сравнении аллелей выявили, что частота аллеля L у больных с осложнениями была ниже, чем у лиц без таковых: 0,167 и 0,375 соответственно (p = 0,004), и носительство аллеля L уменьшало вероятность развития осложнений: ОШ = 0,33 (95%ДИ 0,15-0,72). Заключение: Носительство варианта 34V гена F13A1 , кодирующего A-субъединицу фактора свёртывания 13, предрасполагает к возобновлению клинических проявлений ИБС после ЧКВ. Genes of thrombosis and folate metabolism play an important role in development and progression of coronary artery disease (CAD). However, a possible role of polymorphic markers in CAD relapse following percutaneous coronary intervention (PCI) is not sufficiently understood. Background. Reports have indicated an association of genetic factors generally related with thrombophilia and recurrence of symptoms for coronary artery disease (CAD) following a percutaneous coronary intervention (PCI) due to restenosis and in-stent thrombosis. However, the relapse can also be caused by progression of atherosclerosis and endothelial dysfunction in unoperated blood vessels. Aim: To assess the role of genetic risk factors involved in thrombosis and folate metabolism (polymorphic markers of F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB genes) in recurrence of CAD symptoms after PCI. Methods: The study included 90 patients with CAD aged 40-75; 75 of these patients had undergone elective PCI (60 men and 15 women) and 15 patients - emergency PCI (12 men and 3 women). Molecular genetic tests were performed using a CVD StripAssays® reagent kit (ViennaLab Diagnostics GmbH, Austria) to identify the following genetic variations: F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB . Results: The study results showed a significant association of the G103T ( Val34Leu ) polymorphism in the F13A1 gene with relapses of IHD after PCI. Significant differences were found in genotype distribution frequencies of the Val34Leu polymorphism in the F13A1 gene. The frequency of Val / Val genotype was higher in patients with complications than without complications, 0.700 and 0.400, respectively (c = 7.78, p = 0.020). Furthermore, the Val/Val genotype can be classified as a risk factor for complications (OR = 3.50; 95% CI, 1.37-8.93). The L allele frequency was lower in patients with complications than in those without complications (0.167 and 0.375, respectively, p = 0.004), and carriage of the L allele reduced the likelihood of complications (OR = 0.33; 95% CI 0.15-0.72). Conclusion: Carriage of the 34V variant in the F13A1 gene that encodes the coagulation factor XIII A subunit predisposes to a relapse of CAD symptoms after PCI.

Should Percutaneous Coronary intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?.

2020 ◽  
Vol 16 ◽  
Author(s):  
George Kassimis ◽  
Grigoris V. Karamasis ◽  
Athanasios Katsikis ◽  
Joanna Abramik ◽  
Nestoras Kontogiannis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Symptom Relief ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of the optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.

scholarly journals Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

2021 ◽  
Author(s):  
Simone Biscaglia ◽  
Barry F. Uretsky ◽  
Matteo Tebaldi ◽  
Andrea Erriquez ◽  
Salvatore Brugaletta ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Qualitative Method ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Diffuse Disease ◽  
Percutaneous Coronary ◽  
Functional Patterns ◽  
Artery Disease

Abstract Purpose Wire-based coronary physiology pullback performed before percutaneous coronary intervention (PCI) discriminates coronary artery disease (CAD) distribution and extent, and is able to predict functional PCI result. No research investigated if quantitative flow ratio (QFR)–based physiology assessment is able to provide similar information. Methods In 111 patients (120 vessels) treated with PCI, QFR was measured both before and after PCI. Pre-PCI QFR trace was used to discriminate functional patterns of CAD (focal, serial lesions, diffuse disease, combination). Functional CAD patterns were identified analyzing changes in the QFR virtual pullback trace (qualitative method) or after computation of the QFR virtual pullback index (QVPindex) (quantitative method). QVPindex calculation was based on the maximal QFR drop over 20 mm and the length of epicardial coronary segment with QFR most relevant drop. Then, the ability of the different functional patterns of CAD to predict post-PCI QFR value was tested. Results By qualitative method, 51 (43%), 20 (17%), 15 (12%), and 34 (28%) vessels were classified as focal, serial focal lesions, diffuse disease, and combination, respectively. QVPindex values >0.71 and ≤0.51 predicted focal and diffuse patterns, respectively. Suboptimal PCI result (post-PCI QFR value ≤0.89) was present in 22 (18%) vessels. Its occurrence differed across functional patterns of CAD (focal 8% vs. serial lesions 15% vs. diffuse disease 33% vs. combination 29%, p=0.03). Similarly, QVPindex was correlated with post-PCI QFR value (r=0.62, 95% CI 0.50–0.72). Conclusion Our results suggest that functional patterns of CAD based on pre-PCI QFR trace can predict the functional outcome after PCI. Clinical Trial Registration ClinicalTrials.gov, number NCT02811796. Date of registration: June 23, 2016.

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