Effect of coronary revascularization on long‐term clinical outcomes in patients with ischemic cardiomyopathy and recurrent ventricular arrhythmia

2018 ◽  
Vol 41 (7) ◽  
pp. 775-779 ◽  
Author(s):  
Ihab Elsokkari ◽  
Ratika Parkash ◽  
Chris J. Gray ◽  
Martin J. Gardner ◽  
Amir M. AbdelWahab ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Clinical Outcomes ◽  
Ischemic Cardiomyopathy ◽  
Coronary Revascularization

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P<0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

scholarly journals Long-Term Clinical Outcomes of Fractional Flow Reserve-Guided Coronary Artery Revascularization in Chronic Kidney Disease

2022 ◽  
Vol 12 (1) ◽  
pp. 21
Author(s):  
Chien-Boon Jong ◽  
Tsui-Shan Lu ◽  
Patrick Yan-Tyng Liu ◽  
Jeng-Wei Chen ◽  
Ching-Chang Huang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Fractional Flow Reserve ◽  
Primary Endpoint ◽  
Coronary Revascularization ◽  
Fractional Flow ◽  
Flow Reserve

Fractional flow reserve (FFR)-guided percutaneous coronary intervention has shown favorable long-term clinical outcomes. However, limited data exist evaluating the FFR assessment among the chronic kidney disease (CKD) population. The aim of this study was to evaluate the long-term clinical outcomes of FFR-guided coronary revascularization in patients with CKD. A total of 242 CKD patients who underwent FFR assessment were retrospectively analyzed. Patients were divided into two groups: revascularization (FFR ≤ 0.80) and non-revascularization (FFR > 0.80). The primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, and target vessel failure (TVF). The key secondary endpoint was TVF. The Cox regression model was used for risk evaluation. With 91% of the ischemic vessels revascularized, the revascularization group had higher risks for both the primary endpoint (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI], 1.07–3.97; p = 0.030) and key secondary endpoint (aHR: 2.19, 95% CI: 1.10–4.37; p = 0.026), during a median follow-up of 2.9 years. This result was consistent among different CKD severities. In patients with CKD, functional ischemia in coronary artery stenosis was associated with poor clinical outcomes despite coronary revascularization.

scholarly journals Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy

2017 ◽  
Vol 126 (5) ◽  
pp. 1560-1565 ◽  
Author(s):  
Hyunwook Kwon ◽  
Dae Hyuk Moon ◽  
Youngjin Han ◽  
Jong-Young Lee ◽  
Sun U Kwon ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Coronary Revascularization ◽  
Perioperative Period ◽  
Long Term Outcomes ◽  
Cardiac Damage ◽  
Artery Disease

OBJECTIVEControversy persists regarding the optimal management of subclinical coronary artery disease (CAD) prior to carotid endarterectomy (CEA) and the impact of CAD on clinical outcomes after CEA. This study aimed to evaluate the short-term surgical risks and long-term outcomes of patients with subclinical CAD who underwent CEA.METHODSThe authors performed a retrospective study of data from a prospective CEA registry. They analyzed a total of 702 cases involving patients without a history of CAD who received preoperative cardiac risk assessment by radionuclide myocardial perfusion imaging (MPI) and underwent CEA over a 10-year period. The management strategy (the necessity, sequence, and treatment modality of coronary revascularization and optimal perioperative medical treatment) was determined according to the presence, severity, and extent of CAD as determined by preoperative MPI and additional coronary computed tomography angiography and/or coronary angiography. Perioperative cardiac damage was defined on the basis of postoperative elevation of the blood level of cardiac troponin I (0.05–0.5 ng/ml) in the absence of myocardial ischemia. The primary endpoint was the composite of any stroke, myocardial infarction, or death during the perioperative period and all-cause mortality within 4 years of CEA. The associations between clinical outcomes after CEA and subclinical CAD were analyzed.RESULTSConcomitant subclinical CAD was observed in 81 patients (11.5%). These patients did have a higher incidence of perioperative cardiac damage (13.6% vs 0.5%, p < 0.01), but they had similar primary endpoint incidences during the perioperative period (2.5% vs.1.8%, p = 0.65) and similar estimated 4-year primary endpoint rates (13.6% vs 12.4%, p = 0.76) as the patients without subclinical CAD. Kaplan-Meier survival analysis showed that the 2 groups had similar rates of overall survival (p = 0.75).CONCLUSIONSPatients with subclinical CAD can undergo CEA with acceptable short- and long-term outcomes provided they receive selective coronary revascularization and optimal perioperative medical treatment.

Abstract 16009: Sex Differences in Patients With Suspected Cardiac Sarcoidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rajat Kalra ◽  
Ko-hsuan Chen ◽  
Pratik Velangi ◽  
Osama Okasha ◽  
Jeremy Markowitz ◽  
...  
Keyword(s):  
Sex Differences ◽  
Chest Pain ◽  
Ventricular Arrhythmia ◽  
Clinical Outcomes ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Composite Endpoint ◽  
All Cause Mortality ◽  
Secondary Endpoints

Introduction: Cardiac sarcoidosis is increasingly recognized as a cause of cardiomyopathy and mortality. However, there are no data on sex differences in patients with suspected cardiac sarcoidosis. Hypothesis: We hypothesized that sex differences exist in the clinical presentation, cardiac involvement, and long-term clinical outcomes of patients with suspected cardiac sarcoidosis. Methods: We performed a retrospective cohort study to examine sex differences in presenting features, CMR findings, and the long-term incidence of adverse clinical outcomes among consecutive patients with histologically proven sarcoidosis and suspected cardiac involvement investigated by cardiovascular magnetic resonance imaging (CMR). The primary composite clinical endpoint was all-cause mortality or significant ventricular arrhythmia. The secondary endpoints were all-cause mortality and significant ventricular arrhythmia. Results: Among 324 patients, 163 (50.3%) were women and 161 (49.7%) were men. Women reported a greater prevalence of chest pain and palpitations than men, but not dyspnea, presyncope, or syncope. Women were less likely to have LGE or meet the criteria for a clinical diagnosis of cardiac sarcoidosis, indicating lesser cardiac involvement. The long-term incidence of the primary composite endpoint (hazard ratio for women 1.36; 95% confidence interval 0.77-2.43; p = 0.29; Figure 1 ) or the cause of death between women and men (p = 0.62). However, women had a significantly lower cumulative incidence of significant ventricular arrhythmia compared with men (4.3% vs. 13.0%; log-rank p = 0.022). Conclusions: There were distinct sex differences in patients with histologically proven sarcoidosis and suspected cardiac involvement. A paradox was noted wherein women had a greater prevalence of chest pain and palpitations than men, but had lesser cardiac involvement, and a similar long-term incidence of all-cause death or significant ventricular arrhythmia.

scholarly journals Guideline-Based Critical Care Pathway Improves Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jo-Jo Hai ◽  
Chun-Ka Wong ◽  
Ka-Chun Un ◽  
Ka-Lam Wong ◽  
Zhe-Yu Zhang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Critical Care ◽  
Clinical Outcomes ◽  
Standard Care ◽  
Cox Regression ◽  
Care Pathway ◽  
Coronary Revascularization ◽  
Coronary Syndrome ◽  
Before And After

AbstractImplementation of a critical care pathway (CCP) for acute coronary syndrome (ACS) has been shown to improve early compliance to guideline-directed therapies and reduce early mortality. Nevertheless its long-term impact on the compliance with medications or clinical outcomes remains unknown. Between 2004 and 2015, 2023 consecutive patients were admitted to our coronary care unit with ACS. We retrospectively compared the outcomes of 628 versus 1059 patients (mean age 66.1 ± 13.3 years, 74% male) managed before and after full implementation of a CCP. Compared with standard care, implementation of the CCP significantly increased coronary revascularization and long-term compliance with guideline-directed medical therapy (both P < 0.01). After a mean follow-up of 66.5 ± 44.0 months, 46.7% and 22.2% patients admitted before and after implementation of the CCP, respectively, died. Kaplan-Meier analyses showed that patients managed by CCP had better overall survival (P = 0.03) than those managed with standard care. After adjustment for clinical covariates and coronary anatomy, CCP remained independently predictive of better survival from all-cause mortality [hazard ratio (HR): 0.75, 95%confidence intervals (CI): 0.62–0.92, P < 0.01]. Stepwise multivariate cox regression model showed that both revascularization (HR: 0.55, 95%CI: 0.45–0.68, P < 0.01) and compliance to statin (HR: 0.70, 95%CI: 0.58–0.85, P < 0.01) were accountable for the improved outcome.

scholarly journals Major Predictors of Long-Term Clinical Outcomes After Coronary Revascularization in Patients With Unprotected Left Main Coronary Disease

2010 ◽  
Vol 3 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Sun-Yang Min ◽  
Duk-Woo Park ◽  
Sung-Cheol Yun ◽  
Young-Hak Kim ◽  
Jong-Young Lee ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Coronary Disease ◽  
Coronary Revascularization ◽  
Left Main

Impact of smoking status and smoking cessation after coronary revascularization on long-term clinical outcomes: from a nationwide population-based study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.J Ki ◽  
J.K Han ◽  
H.S Lee ◽  
M.O Chang ◽  
J.H Kang ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Clinical Outcomes ◽  
Smoking Status ◽  
Coronary Revascularization ◽  
Population Based ◽  
Health Check ◽  
National Health Insurance System ◽  
Population Based Study ◽  
The Impact

Abstract Background There are many studies on emphasizing the importance of quitting smoking, but the smoking status was based on baseline status without subsequent status. Since a significant percentage of patients who have received coronary revascularization change their smoking status, it is necessary to confirm the clinical consequences of smoking status after revascularization. Purpose In this study, we aimed to investigate the impact of smoking status after revascularization on long-term clinical outcomes, using large population based study from the Korean National Health Insurance System. Methods Among 74,004 patients who received coronary revascularization (PCI or CABG) from 1 January 2007 to 21 December 2013 and underwent regular health check-up within 2 years after index PCI, examined for death, MI, revascularization and stroke. Results Within patients who underwent revascularization, 33,800 (45.7%) of patients were self-reported non-smoker, 28,603 (38.7%) were ex-smoker, 11601 (15.6%) were current smokers at first regular health check-up after revascularization. Current smokers were associated with higher risks for death (HR: 1.497; 95% CI: 1.366–1.641), MI (HR: 1.498; 95% CI: 1.302–1.723) and revascularization (HR: 1.088; 95% CI: 1.018–1.164) than non-smokers. Compared with non-smokers, more than 30PY ex-smokers and current smokers showed higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of death, MI, revascularization and stroke. Regarding smoking tendency, maintaining non-smokers were lower risk for MACCE than maintaining smokers (Figure 1). Quitters tended to lower MACCE compared to patients who continued to smoke (HR: 0.823; 95% CI: 0.762–0.888). Especially, maintaining non-smokers and quitters significantly showed lower mortality than patients who continued to smoke. Conclusion Smoking is associated with poor clinical outcomes after coronary revascularization especially more than 30PY ex-smokers and current smokers. These results also emphasized that smoking cessation after revascularization also important for mortality benefit. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study

2020 ◽  
Vol 41 (37) ◽  
pp. 3521-3529 ◽  
Author(s):  
Jihoon Kim ◽  
Danbee Kang ◽  
Hyejeong Park ◽  
Minwoong Kang ◽  
Taek Kyu Park ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Coronary Revascularization ◽  
Blocker Therapy ◽  
Β Blocker ◽  
Insurance Data

Abstract Aims To investigate the association between long-term β-blocker therapy and clinical outcomes in patients without heart failure (HF) after acute myocardial infarction (AMI). Method and results Between 2010 and 2015, a total of 28 970 patients who underwent coronary revascularization for AMI with β-blocker prescription at hospital discharge and were event-free from death, recurrent myocardial infarction (MI), or HF for 1 year were enrolled from Korean nationwide medical insurance data. The primary outcome was all-cause death. The secondary outcomes were recurrent MI, hospitalization for new HF, and a composite of all-cause death, recurrent MI, or hospitalization for new HF. Outcomes were compared between β-blocker therapy for ≥1 year (N = 22 707) and β-blocker therapy for &lt;1 year (N = 6263) using landmark analysis at 1 year after index MI. Compared with patients receiving β-blocker therapy for &lt;1 year, those receiving β-blocker therapy for ≥1 year had significantly lower risks of all-cause death [adjusted hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.72–0.91] and composite of all-cause death, recurrent MI, or hospitalization for new HF (adjusted HR 0.82; 95% CI 0.75–0.89), but not the risks of recurrent MI or hospitalization for new HF. The lower risk of all-cause death associated with persistent β-blocker therapy was observed beyond 2 years (adjusted HR 0.86; 95% CI 0.75–0.99) but not beyond 3 years (adjusted HR 0.87; 95% CI 0.73–1.03) after MI. Conclusion In this nationwide cohort, β-blocker therapy for ≥1 year after MI was associated with reduced all-cause death among patients with AMI without HF.

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