Residual Dyslipidemia Leads to Unfavorable Outcomes in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

Background. The present study aimed to evaluate the prevalence and prognosis of residual lipid abnormalities in statin-treated acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI).Subjects and Methods. A total of 3,047 ACS patients who underwent PCI and received statin therapy were included. Plasma concentrations of LDL-C, HDL-C, and TG were measured. For the follow-up study, major adverse cardiovascular cerebrovascular events (MACCE; including total death, cardiovascular death, myocardial infarction, and revascularization) were documented.Results. A total of 93.14% of all individuals were followed up for 18.1 months (range, 0–29.3 months). Of all 3,047 patients, those with a suboptimal goal were 67.75%, 85.85%, and 33.64% for LDL-C, HDL-C, and TG levels, respectively. Multiple Cox regression analysis revealed there were significant increases in cumulative MACCE of 41% (HR = 1.41, 95% CI [1.09–1.82],p=0.008), and revascularization of 48% (HR = 1.48, 95% CI [1.10–1.99],p=0.01) in low HDL-C patients with ACS after PCI, but not the high TG group at the end of study.Conclusions. Our results showed there is high rate of dyslipidemia in Chinese ACS patients after PCI. Importantly, low HDL-C but not high TG levels are associated with higher MACCE and revascularization rates in ACS patients after PCI.

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Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention - analysis from the Acute Coronary Syndrome Israeli Survey (ACSIS)

Cardiology ◽

10.1159/000521042 ◽

2021 ◽

Author(s):

Ran Eliaz ◽

Bethlehem Mengesha ◽

Tal Ovdat ◽

Zaza Iakobishvili ◽

David Hasdai ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Cox Regression ◽

Coronary Intervention ◽

Complication Rates ◽

Cox Regression Analysis ◽

Entire Cohort ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

St Elevation

Introduction: We aimed to compare the outcomes of ACS (acute coronary syndrome) patients undergoing in-hospital PCI (percutaneous coronary intervention) treated with prasugrel versus ticagrelor. Methods: Among 7,233 patients enrolled to the ACSIS (Acute Coronary Syndrome Israeli Survey) between 2010 and 2018, we identified 1126 eligible patients treated with prasugrel and 817 with ticagrelor. Comparison between the groups was preformed separately in ST-elevation myocardial infarction (STEMI) patients, propensity score matched (PSM) STEMI patients, and non-ST-elevation ACS (NSTE-ACS) patients. Results: In-hospital complication rates, including rates of stent thrombosis, were not significantly different between groups. In PSM STEMI patients, 30-day re-hospitalization rate (p <0.05), 30-day MACE (the composite of death, MI, stroke and urgent revascularization; p=0.006), and 1-year mortality rates (p = 0.08) were higher in the ticagrelor group compared to the prasugrel group; In NSTE-ACS patients, outcomes were not associated with drug choice. In cox regression analysis applied on the entire cohort, prasugrel was associated with lower 1-year mortality in STEMI patient but not in NSTE-ACS patients (p for interaction 0.03). Conclusions: Compared to ticagrelor, prasugrel was associated with superior clinical outcomes in STEMI patients, but not in NSTE-ACS patients.

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Does Baseline On-treatment Platelet Reactivity Impact Long-term Prognosis in Patients with Acute Coronary Syndrome and Thrombocytopenia Who Underwent Percutaneous Coronary Intervention?

10.21203/rs.3.rs-236763/v1 ◽

2021 ◽

Author(s):

Ru Liu ◽

Tianyu Li ◽

Deshan Yuan ◽

Yan Chen ◽

Xiaofang Tang ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Real World ◽

Cox Regression ◽

Platelet Reactivity ◽

Coronary Intervention ◽

The Real ◽

Coronary Syndrome ◽

Percutaneous Coronary

Abstract Objectives: This study analyzed the association between on-treatment platelet reactivity and long-term outcomes of patients with acute coronary syndrome (ACS) and thrombocytopenia (TP) in the real world. Methods: A total of 10724 consecutive cases with coronary artery disease who underwent percutaneous coronary intervention (PCI) were collected from January to December 2013. Cases with ACS and TP under dual anti-platelet therapy were enrolled from the total cohort. 5-year clinical outcomes were evaluated among cases with high on-treatment platelet reactivity (HTPR), low on-treatment platelet reactivity (LTPR) and normal on-treatment platelet reactivity (NTPR), tested by thromboelastogram (TEG) at baseline. Results: Cases with HTPR, LTPR and NTPR accounted for 26.2%, 34.4% and 39.5%, respectively. Cases with HTPR were presented with the most male sex, lowest hemoglobin level, highest erythrocyte sedimentation rate and most LM or three-vessel disease, compared with the other two groups. The rates of 5-year all-cause death, major adverse cardiovascular and cerebrovascular events (MACCE), cardiac death, myocardial infarction (MI), revascularization, stroke and bleeding were all not significantly different among three groups. Multivariable Cox regression indicated that, compared with cases with NTPR, cases with HTPR were not independently associated with all endpoints, as well as cases with LTPR (all P>0.05). Conclusions: In patients with ACS and TP undergoing PCI, 5-year all-cause death, MACCE, MI, revascularization, stroke and bleeding risk were all similar between cases with HTPR and cases with NTPR, tested by TEG at baseline, in the real world. The comparison result was the same between cases with LTPR and NTPR.

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Plasma Trimethylamine-N-Oxide Is an Independent Predictor of Long-Term Cardiovascular Mortality in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.728724 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ceren Eyileten ◽

Joanna Jarosz-Popek ◽

Daniel Jakubik ◽

Aleksandra Gasecka ◽

Marta Wolska ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Predictive Value ◽

Cox Regression ◽

Independent Predictor ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

All Cause Mortality

To investigate the association of liver metabolite trimethylamine N-oxide (TMAO) with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted seven yr in median. Adjusted Cox-regression analysis was used for prediction of mortality. ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p < 0.001). The cut-off value of >4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR = 11.62, 95% CI: 2.26–59.67; p = 0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3 vs. 2.6%; p = 0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low. High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS.

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Predictive value of cardiopulmonary fitness parameters in the prognosis of patients with acute coronary syndrome after percutaneous coronary intervention

Journal of International Medical Research ◽

10.1177/0300060520949081 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094908

Author(s):

Suping Niu ◽

Fei Wang ◽

Shenghua Yang ◽

Zongxue Jin ◽

Xuejie Han ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Predictive Value ◽

Cox Regression ◽

Multivariable Analysis ◽

Cardiopulmonary Exercise Testing ◽

Coronary Intervention ◽

Coronary Syndrome ◽

C Statistic ◽

Percutaneous Coronary

Objectives We aimed to determine the predictive value of cardiopulmonary exercise testing (CPX) in the prognosis of patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). Methods We conducted a retrospective study including patients who underwent CPX within 1 year of PCI between September 2012 and October 2017. Patients were followed-up until the occurrence of a major adverse cardiac event (MACE) or administrative censoring (September 2019). A Cox regression model was used to identify significant predictors of a MACE. Model performance was evaluated in terms of discrimination (C-statistic) and calibration (calibration-in-the-large). Results In total, 184 patients were included and followed-up for a median 51 months (interquartile range: 36–67 months) and 32 events occurred. Multivariable analysis revealed that body mass index and Gensini score were significant predictors of a MACE. Four CPX-related variables were found to be predictive of a MACE: premature CPX termination, peak oxygen uptake, heart rate reserve, and ventilatory equivalent for carbon dioxide slope. The final prediction model had a C-statistic of 0.92 and calibration-in-the-large 0.58%. Conclusion CPX-related parameters may have high predictive value for poor outcomes in patients with ACS who undergo PCI, indicating a need for appropriate treatment and timely management.

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External validation of the PRECISE-DAPT score in an Asian cohort of patients with acute coronary syndrome post-percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehab724.1424 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Y Fong ◽

A Lee ◽

W Huang ◽

K K Yeo ◽

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Cox Regression ◽

Bleeding Risk ◽

Coronary Intervention ◽

Assessment Tools ◽

Discriminative Performance ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Asian Cohort

Abstract Background Dual antiplatelet therapy (DAPT) is a key treatment in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI), and the PRECISE-DAPT score is one of the risk assessment tools developed to guide its optimal duration. However, the PRECISE-DAPT derivation cohorts were largely based on Western populations and it remains unclear whether the score is able to demonstrate good predictive value in Asian populations. Objective To validate the performance of the PRECISE-DAPT score in a nationwide Asian cohort of ACS patients who underwent PCI and with subsequent DAPT. Methods Patients admitted with ACS between January 2012 and December 2014 were extracted from the Singapore Cardiac Longitudinal Outcomes Database (SingCLOUD). The primary outcome was major adverse cardiovascular events (MACE), a composite of deaths, ischemic and hemorrhagic strokes, and recurrent myocardial infarction. The PRECISE-DAPT score was calculated for each patient and was used to stratify patients into low bleeding risk (LBR) (score <25) and high bleeding risk (HBR) (score ≥25) groups (Figure 1). The PRECISE-DAPT guidelines propose that patients with LBR follow a DAPT regimen of 12 months, while patients with HBR follow a DAPT regimen of 3 months followed by aspirin or clopidogrel monotherapy for the rest of the year. Medication adherence to the PRECISE-DAPT guidelines with a proportion of days covered (PDC) of 80% over the 1-year period post-PCI was taken as the cutoff to define adherence, i.e. patients with at least 80% of days covered were defined as adherent. Multivariate Cox regression analysis adjusted for age, gender, ethnicity, smoking status, prior MI, prior PCI and diabetes mellitus was applied to examine the association between the PRECISE-DAPT adherence and MACE. Score discrimination using c-statistic were calculated and calibration curves were visually assessed. Results A total of 1135 patients were analyzed. The PRECISE-DAPT score of the adherent group (n=486) was lower compared to the non-adherent group, that made up the majority (n=649) [16.8 (± 9.63) vs 30.37 (± 18.4), p<0.001]. The overall incidence rate of MACE in this cohort was 14.3% and bleeding rate was 1.5%. Non-adherence to PRECISE-DAPT guidelines was independently associated with MACE at 1 year [OR 1.48, 95% CI 1.03 – 2.13, p=0.033] (Figure 1). Receiver-operating characteristic (ROC) analysis demonstrated that the PRECISE-DAPT score in predicting MACE has an area under curve (AUC) of 0.644 [95% CI 0.603, 0.685] (Figure 2) with a sensitivity of 42.8% and specificity of 80.2%. Conclusion The PRECISE-DAPT score is able to predict MACE in Asian patients with ACS treated with PCI with high specificity but is not sensitive. The lower AUC value derived suggests that other important factors potentially contribute to the development of MACE in this cohort. Further research is warranted to identify factors that may improve its discriminative performance. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council (NMRC) Figure 1. Cox regression for MACE Figure 2. Histogram and AUC Curve

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