Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance

Numerous studies have demonstrated the negative prognostic value of tachycardia, both in the general population and in specific subgroups, including patients with coronary artery disease (CAD), arterial hypertension (HTN) and heart failure with preserved ejection fraction (HFpEF). In the latest edition of the European guidlines for the treatment of HTN the level of heart rate (HR) exceeding 80 beats per minute is highlighted as a separate independent predictor of adverse outcomes. However, the feasibility of pharmacological reduction of HR in patients with sinus rhythm is unclear. Unlike patients with reduced ejection fraction, in whom the positive effects of HR reduction are well established, the data on the effect of pharmacological HR reduction on the prognosis of patients with HTN, CAD and/or HFpEF are not so unambiguous. Some adverse effects of pharmacological correction of HR in such patients, which may be caused by a change in the aortic pressure waveform with its increase in late systole in the presence of left ventricular diastolic dysfunction, are discussed. The reviewed data underline the complexity of the problem of clinical and prognostic significance of increased HR and its correction in patients with HTN, stable CAD and/or HFpEF.

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Prediction of Coronary Artery Disease by Erectile Function Status: Evidence‐Based Data

Sexual Medicine Reviews ◽

10.1002/smrj.12 ◽

2013 ◽

Vol 1 (2) ◽

pp. 104-107 ◽

Cited By ~ 2

Author(s):

Graham Jackson

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Erectile Function ◽

Evidence Based ◽

Artery Disease

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Abstract 101: Gender Has Differential Effects on Non-Hemorrhagic Stroke Outcomes

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.101 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Justin Pieper ◽

Michael Ashamalla ◽

Daniel Sedhom ◽

Neil Yager ◽

Ketan Ghate ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Renal Insufficiency ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Hemorrhagic Stroke ◽

Peripheral Vascular ◽

Stroke Outcomes ◽

History Of ◽

Artery Disease

Background: We sought to examine the relationship between gender, age, co-morbidities, and outcomes in patients with non-hemorrhagic stroke. Materials and methods: Retrospective chart review was performed on 517 consecutive non-hemorrhagic stroke patients (48% women, 20% with diabetes, 26.8% with CAD, 38% with dyslipidemia, 62.2% with HTN, 4.2% with peripheral vascular disease, 4.7% with renal insufficiency) treated at a single academic medical center. Results: Younger patients were more likely to be men (age<50 55%, 51-60 58.3%, 61-70 59.6%; p<0.05) while older patients were likely to be women (age 71-80 54.9%, >80 56.6; p<0.05). Accordingly, the subsequent analysis stratified the cohort into two groups, <70 and >70 years old. Regardless of age, men had a higher prevalence of CAD (age <70, 25.2% vs 18.8% in women, and age >70, 43.7% vs. 23.1% in women; p<0.05) and dyslipidemia (age <70, 43.4% vs 32.5% in women and age >70, 44.8% vs. 30.6% in women; p=.05). There were no significant gender based differences in BMI, prevalence of diabetes, hypertension, peripheral vascular disease, or chronic renal insufficiency. The mean follow up duration was 47.3+/-0.9 months. Gender did not affect mortality in patients younger than 70 years old (15.5% men vs. 15.6% women.) However in patients of age >70 mortality was significantly increased in men (50.5% in men vs. 41.7% in women; chi-squared p<0.001, log-rank p<0.0001, Figure). In logistic regression analysis, when compared to women younger than 70 years old, men of the same age had similar mortality (HR 1.0; 95%CI 0.5-1.9, p=0.980); while age greater than 70 conferred 4-5 fold increased risk of mortality (HR 3.9; 95%CI 2.1-7.0, p<0.0001 in women, and HR 5.5; 95%CI 3.0-10.3, p<0.0001 in men). When gender and age were accounted for, history of coronary artery disease and/or dyslipidemia did not affect the outcomes. Conclusion: Men with non-hemorrhagic stroke were more likely to have dyslipidemia and history of coronary artery disease. This, however, did not translate into increased mortality in younger men. Gender appears to have a differential effect on non-hemorrhagic stroke outcomes which warrants future investigation.

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Abstract 1803: Catheterization without In-hospital Revascularization is Associated with Increased Long-term Mortality in Patients with Non-ST Elevation Myocardial Infarction and Significant Coronary Artery Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_384 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Mark Y Chan ◽

Kenneth W Mahaffey ◽

Jie-Lena Sun ◽

Karen S Pieper ◽

Harvey D White ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Clinical Features ◽

Medical Management ◽

Significant Coronary Artery Disease ◽

Evidence Based ◽

St Elevation ◽

Artery Disease

Background: Despite guidelines recommendations for early invasive management in non-ST-elevation myocardial infarction (NSTEMI), some patients (pts) with significant coronary artery disease (CAD) found on early angiography do not undergo revascularization. The prevalence, clinical features, and long-term prognosis of this population have not been well-characterized. Methods: We evaluated 8225 NSTEMI pts from the SYNERGY trial (2002–2004) with >50% stenosis in at least 1 epicardial artery who received in-hospital percutaneous coronary intervention (PCI), in-hospital coronary artery bypass grafting (CABG), or no revascularization before discharge (medical management). A propensity-adjusted Cox proportional hazards model was used to compare death/MI rates at 6 months and mortality rates at 1 year among the 3 subgroups starting from the time of hospital discharge. Results: A total of 2633 of 8255 pts (32%) were medically managed, 4294 (52%) underwent PCI, and 1298 (16%) underwent CABG. Clinical features and unadjusted outcomes are shown below. Guidelines-recommended discharge medications were used in a large proportion of patients, but those undergoing PCI most commonly received evidence-based therapies. The adjusted risk of 6-month death or MI was 2.19 (95% CI: 1.79–2.67) for medical management compared with PCI, and 3.07 (95% CI: 2.18 – 4.34) for medical management compared with CABG. The adjusted risks of 1-year mortality for medical management were 1.52 (95% CI: 1.07–2.17) and 1.70 (95% CI: 0.96–3.03), respectively. Conclusion: A substantial proportion of NSTEMI pts with significant CAD are managed medically without in-hospital revascularization. These pts have higher-risk clinical characteristics and worse outcomes compared with those who undergo PCI or CABG, despite fairly good use of evidence-based medications. Therefore, innovative treatment strategies are needed to mitigate the increased risk of adverse outcomes in this population. Baseline Characteristics, Discharge Medications, and Unadjusted Clinical Outcomes for the 3 Groups

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Abstract 15487: Combined Effects of Lipoprotein(a) and Hypertension in Predicting Cardiovascular Outcomes in Patients With Coronary Artery Disease

Circulation ◽

10.1161/circ.142.suppl_3.15487 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Huihui Liu ◽

Yexuan Cao ◽

Jinglu Jin ◽

Hui-Wen Zhang ◽

Qi Hua ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cox Regression ◽

Reference Group ◽

Prognostic Significance ◽

Cardiovascular Death ◽

Hypertension Status ◽

Clinical Prognosis ◽

Lipoprotein A ◽

Artery Disease

Introduction: Although emerging data have suggested that circulating lipoprotein(a) [Lp(a)] could predict cardiovascular events (CVEs) in patients with cardiovascular disease, no study is currently available regarding the prognostic significance of Lp(a) in patients with hypertension. Hypothesis: We assessed the hypothesis that there is a prognostic linkage between hypertension and Lp(a) concentrations in patients with coronary artery disease (CAD). Methods: A total of 8668 patients with stable CAD were consecutively enrolled. Baseline Lp(a) concentrations of them were measured. All subjects were categorized according to Lp(a) levels of <10 (low), 10-30 (medium) and 30 mg/dL (high) and were further stratified by hypertension status. They were regularly followed-up for the occurrence of cardiovascular death, non-fatal myocardial infarction and stroke. Results: Over an average of 54.81±18.60 months follow-up, 584 (6.7%) CVEs occurred. Kaplan-Meier and multivariate Cox regression analyses showed that elevated Lp(a) levels had a significant association with CVEs in hypertensive patients, regardless of the control status of blood pressure, but not in normotensive subjects. Moreover, when subgrouping according to both Lp(a) categories and hypertension status, the risk for CVEs was only significantly elevated in high Lp(a) plus hypertension group compared with the reference group with low Lp(a) levels and normotension (hazard ratio: 1.85, 95% confidence interval: 1.19-2.85). Conclusions: In conclusion, elevated Lp(a) was associated with higher risk for CVEs in CAD patients with hypertension and the coexistence of high Lp(a) concentrations and hypertension greatly worsened the clinical prognosis. Our findings may present a prognostic linkage between hypertension and Lp(a) concentrations in patients with CAD.

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Prognostic significance of reticulated platelet levels in diabetic patients with stable coronary artery disease

Platelets ◽

10.1080/09537104.2019.1704712 ◽

2019 ◽

Vol 31 (8) ◽

pp. 1012-1018 ◽

Cited By ~ 2

Author(s):

Leor Perl ◽

Yuri Matatov ◽

Ran Koronowski ◽

Eli I. Lev ◽

Alejandro Solodky

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Prognostic Significance ◽

Diabetic Patients ◽

Artery Disease

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The Prognostic Significance of Quantitative Myocardial Perfusion: An Artificial Intelligence Based Approach Using Perfusion Mapping

Circulation ◽

10.1161/circulationaha.119.044666 ◽

2020 ◽

Cited By ~ 6

Author(s):

Kristopher D. Knott ◽

Andreas Seraphim ◽

Joao B. Augusto ◽

Hui Xue ◽

Liza Chacko ◽

...

Keyword(s):

Artificial Intelligence ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Perfusion ◽

Myocardial Perfusion Reserve ◽

Prognostic Significance ◽

Suspected Coronary Artery Disease ◽

Major Adverse Cardiovascular Events ◽

Co Morbidity ◽

Artery Disease

Background: Myocardial perfusion reflects the macro- and microvascular coronary circulation. Recent quantitation developments using cardiovascular magnetic resonance (CMR) perfusion permit automated measurement clinically. We explored the prognostic significance of stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR, the ratio of stress to rest MBF). Methods: A two center study of patients with both suspected and known coronary artery disease referred clinically for perfusion assessment. Image analysis was performed automatically using a novel artificial intelligence approach deriving global and regional stress and rest MBF and MPR. Cox proportional hazard models adjusting for co-morbidities and CMR parameters sought associations of stress MBF and MPR with death and major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure hospitalization, late (>90 day) revascularization and death. Results: 1049 patients were included with median follow-up 605 (interquartile range 464-814) days. There were 42 (4.0%) deaths and 188 MACE in 174 (16.6%) patients. Stress MBF and MPR were independently associated with both death and MACE. For each 1ml/g/min decrease in stress MBF the adjusted hazard ratio (HR) for death and MACE were 1.93 (95% CI 1.08-3.48, P=0.028) and 2.14 (95% CI 1.58-2.90, P<0.0001) respectively, even after adjusting for age and co-morbidity. For each 1 unit decrease in MPR the adjusted HR for death and MACE were 2.45 (95% CI 1.42-4.24, P=0.001) and 1.74 (95% CI 1.36-2.22, P<0.0001) respectively. In patients without regional perfusion defects on clinical read and no known macrovascular coronary artery disease (n=783), MPR remained independently associated with death and MACE, with stress MBF remaining associated with MACE only. Conclusions: In patients with known or suspected coronary artery disease, reduced MBF and MPR measured automatically inline using artificial intelligence quantification of CMR perfusion mapping provides a strong, independent predictor of adverse cardiovascular outcomes.

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