Coronary revascularisation in patients with ischaemic cardiomyopathy

Heart ◽  
2021 ◽  
pp. heartjnl-2020-316856
Author(s):  
Matthew Ryan ◽  
Holly Morgan ◽  
Mark C Petrie ◽  
Divaka Perera
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Ischaemic Cardiomyopathy ◽  
Artery Disease ◽  
Stich Trial ◽  
Randomised Controlled

Heart failure resulting from ischaemic heart disease is associated with a poor prognosis despite optimal medical treatment. Despite this, patients with ischaemic cardiomyopathy have been largely excluded from randomised trials of revascularisation in stable coronary artery disease. Revascularisation has multiple potential mechanisms of benefit, including the reversal of myocardial hibernation, suppression of ventricular arrhythmias and prevention of spontaneous myocardial infarction. Coronary artery bypass grafting is considered the first-line mode of revascularisation in these patients; however, evidence from the Surgical Treatment of Ischaemic Heart Failure (STICH) trial showed a reduction in mortality, though this only became apparent with extended follow-up due to an excess of early adverse events in the surgical arm. There is currently no randomised controlled trial evidence for percutaneous coronary intervention in patients with ischaemic cardiomyopathy; however, the REVIVED-BCIS2 trial has recently completed recruitment and will address this gap in the evidence. Future directions include (1) clinical trials of revascularisation in patients hospitalised with heart failure, (2) defining the role of viability and ischaemia testing in heart failure, (3) studies to enhance the understanding of the mechanistic effects of revascularisation and (4) generating models to refine pre- and post-revascularisation risk prediction.

scholarly journals Complex Percutaneous Coronary Intervention Salvages a Patient with Recurrent Acute Coronary Syndrome and Ischaemic Heart Failure with Multiple Life Threatening Co-morbidities: A Case Report

2021 ◽  
Author(s):  
Brajesh Kunwar ◽  
Farah Ingle ◽  
Atul Ingle ◽  
Chandrasekhar Tulagseri
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Vascular Diseases ◽  
Coronary Intervention ◽  
Middle Income ◽  
Coronary Syndrome ◽  
Artery Disease

More than 422 million people are suffering from Diabetes Mellitus (DM) worldwide. Majority of the affected population resides in lower and middle income countries. This chronic, metabolic disease gradually does serious damage to heart, blood vessels, eyes, kidneys and nerves; eventually causing cardiovascular diseases, peripheral vascular diseases, retinopathy, nephropathy and neuropathy. Here, a rare case of a 58-year-old male was present who had history of uncontrolled DM with dry gangrene in right forefoot, acute kidney injury and Coronary Artery Disease (CAD) involving Left Main (LM) bifurcation presented with recurrent acute coronary syndrome with heart failure. Patient in view of multiple co-morbidities was unfit for Coronary Artery Bypass Grafting (CABG) was managed successfully with complex coronary intervention involving LM bifurcation.

The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions

Angiology ◽  
2015 ◽  
Vol 67 (5) ◽  
pp. 433-437 ◽  
Author(s):  
Onur Sinan Deveci ◽  
Aziz Inan Celik ◽  
Firat Ikikardes ◽  
Caglar Ozmen ◽  
Caglar Emre Caglıyan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Cerebral Infarction ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Major Complication ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Percutaneous Coronary ◽  
Artery Disease

Silent embolic cerebral infarction (SECI) is a major complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients with stable coronary artery disease (CAD) who underwent CAG with or without PCI were recruited. Cerebral diffusion-weighted magnetic resonance imaging was performed for SECI within 24 hours. Clinical and angiographic characteristics were compared between patients with and without SECI. Silent embolic cerebral infarction occurred in 12 (12%) of the 101 patients. Age, total cholesterol, SYNTAX score (SS), and coronary artery bypass history were greater in the SECI(+) group (65 ± 10 vs 58 ± 11 years, P = .037; 223 ± 85 vs 173 ± 80 mg/dL, P = .048; 30.1 ± 2 vs 15 ± 3, P < .001; 4 [33.3%] vs 3 [3.3%], P = .005). The SECI was more common in the PCI group (8/24 vs 4/77, P = .01). On subanalysis, the SS was significantly higher in the SECI(+) patients in both the CAG and the PCI groups (29.3 ± 1.9 vs 15 ± 3, P < .01; 30.5 ± 1.9 vs 15.1 ± 3.2, P < .001, respectively). The risk of SECI after CAG and PCI increases with the complexity of CAD (represented by the SS). The SS is a predictor of the risk of SECI, a complication that should be considered more often after CAG.

scholarly journals Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP

2017 ◽  
Vol 50 (6) ◽  
pp. 1700749 ◽  
Author(s):  
Yüksel Peker ◽  
Erik Thunström ◽  
Helena Glantz ◽  
Karl Wegscheider ◽  
Christine Eulenburg
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Sleep Apnoea ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Artery Disease ◽  
Randomised Controlled

Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA) have increased risk for major adverse cardiovascular and cerebrovascular events (MACCEs) compared with CAD patients without OSA. We aimed to address if the risk is similar in both groups when OSA patients are treated.This study was a parallel observational arm of the RICCADSA randomised controlled trial, conducted in Sweden between 2005 and 2013. Patients with revascularised CAD and OSA (apnoea–hypopnoea index (AHI) ≥15 events·h−1) with daytime sleepiness (Epworth Sleepiness Scale score ≥10) were offered continuous positive airway pressure (CPAP) (n=155); CAD patients with no OSA (AHI <5 events·h−1) acted as controls (n=112), as a randomisation of sleepy OSA patients to no treatment would not be ethically feasible. The primary end-point was the first event of MACCEs. Median follow-up was 57 months.The incidence of MACCEs was 23.2% in OSA patientsversus16.1% in those with no OSA (adjusted hazard ratio 0.96, 95% CI 0.40–2.31; p=0.923). Age and previous revascularisation were associated with increased risk for MACCEs, whereas coronary artery bypass grafting at baseline was associated with reduced risk.We conclude that the risk for MACCEs was not increased in CAD patients with sleepy OSA on CPAP compared with patients without OSA.

scholarly journals CORONARY ARTERY STENOSIS: IS REVASCULARIZATION ALWAYS REASONABLE?

2019 ◽  
Vol 8 (1) ◽  
pp. 42-51 ◽  
Author(s):  
A. S. Korotin ◽  
O. M. Posnenkova ◽  
A. R. Kiselev ◽  
Yu. V. Popova ◽  
V. I. Gridnev
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Artery Stenosis ◽  
Asymptomatic Patients ◽  
Artery Disease ◽  
Stable Cad

Aim.To determine factors associated with percutaneous coronary intervention (PCI) and/ or coronary artery bypass grafting (CABG) in patients with stable coronary artery disease (CAD), who have no indications for myocardial revascularization.Methods.The data were collected using the Federal CAD Registry. Medical data of 1522 patients with CAD were reviewed. Of them, 326 patients (median age – 54.7±8.7 years; 73.0% – males) who had no indications for PCI and CABG according to 2013 ESC guidelines on stable CAD (ESC 2014) were analyzed.Results.216 patients out of 326 (66%) patients received medical treatment. The rest 110 patients (34%) without any recommended indications underwent myocardial revascularization. Discriminate analysis determined coronary artery stenosis of >70% was the only factor reliably associated with the decision to perform myocardial revascularization in the absence of any indications (р<0.001). Almost 93% of the interventions were performed in asymptomatic patients or patients with mild angina.Conclusion. Patients with stable CAD without any objective indications for coronary intervention may be unreasonably referred to myocardial revascularization (commonly PCI) due to coronary artery stenosis >70% regardless of whether they have or do not have angina symptoms. 

Percutaneous Unprotected Left Main Coronary Artery Interventions – Updated Results and Current Recommendations

2011 ◽  
Vol 6 (1) ◽  
pp. 44
Author(s):  
Alfonso Ielasi ◽  
Alaide Chieffo ◽  
◽  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Current Evidence ◽  
Drug Eluting Stent ◽  
Left Main ◽  
European Guidelines ◽  
Artery Disease ◽  
Randomised Controlled

Current guidelines recommend coronary artery bypass grafting (CABG) as the treatment of choice for patients who have unprotected left main coronary artery disease (ULMCA). Several registries and two randomised controlled clinical trials have shown that hard end-points such as cardiac death, myocardial infarctions and cerebrovascular events are similar following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation compared with CABG. However, current American and European guidelines do not endorse PCI as an appropriate alternative to CABG for patients with ULMCA. In this article we review the current evidence on PCI with DES for ULMCA stenosis treatment and propose future directions in this evolving topic of great interest.

Sign in / Sign up

Export Citation Format

Share Document