Abstract 9658: Generation Differences in Long-Term Clinical Outcomes in Diabetic Patients After PCI Across POBA-, BMS- and DES-Era

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ryo Naito ◽  
Katsumi Miyauchi ◽  
Hirokazu Konishi ◽  
Shuta Tsuboi ◽  
Manabu Ogita ◽  
...  

Introduction: PCI has evolved with technological advance, improvement of operators’ techniques and medical therapy for secondary prevention. Despite these improvements, diabetes remains a negative predictor. To date, little is known regarding improvement of clinical outcomes in diabetic patients with PCI. We examined a temporal trend of long-term clinical outcomes in diabetic cohort across the different generations. Hypothesis: We hypothesized that clinical outcomes would improve with advances of PCI. Methods: We analyzed data of diabetic patients with PCI in Juntendo University from 1984 to 2010. The patients were divided into three groups according to the procedure data (POBA-era; January 1984 - December 1997, BMS-era; January 1998 - July 2004 and DES-era; August 2004 - February 2010). Primary endpoint was a composite of major adverse cardiovascular events including all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and revascularization. Results: A total of 1544 patients were examined (POBA-era; 374, BMS-era; 494 and DES-era; 676). The mean age was higher in DES-era. A higher prevalence of hypertension and dyslipidemia was observed in DES-era. The success rate of PCI was lower among the patients in POBA-era. Kaplan-Meier estimation for 3-year MACE was significantly different among the eras (Figure 1). Multivariable Cox regression analysis showed that DES-era was a predictor for long-term MACE (DES- vs BMS era; HR 0.50, 95%, CI 0.38 - 0.66, P < 0.001, DES- vs POBA-era; HR 1.60, 95% CI 0.34-27.9, P = 0.6). Conclusions: Long-term clinical outcomes in diabetic patients who underwent PCI were more favorable in DES-era, despite the higher risk profiles.

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052094197
Author(s):  
Chi Zhang ◽  
Meiji Chen ◽  
Weiguang Yu ◽  
Xiulan Han ◽  
Junxing Ye ◽  
...  

Objective To compare the long-term survivorship and Harris hip scores (HHSs) between cemented total hip arthroplasty (CTHA) and uncemented total hip arthroplasty (UTHA) for treatment of acute femoral neck fractures (FNFs). Methods Data of 224 hips (CTHA, n = 112; UTHA, n = 112) that underwent primary surgery in our medical institution from 2005 to 2017 were retrospectively analysed. The primary endpoint was the risk of all-cause revision. The difference in the risk of all-cause revision between the two groups was assessed by Kaplan–Meier survival analysis with a log-rank test and Cox regression analysis. Results The mean postoperative follow-up was 10 years (range, 3–13 years). The Kaplan–Meier estimated 10-year implant survival rate was significantly higher in the CTHA than UTHA group (98.1% vs. 96.2%, respectively). The adjusted Cox regression analysis demonstrated a significantly lower risk of revision in the CTHA than UTHA group. At the final follow-up, the mean HHS was significantly higher in the CTHA than UTHA group (85.10 vs. 79.11, respectively). Conclusion This retrospective analysis demonstrated that CTHA provided higher survival, lower revision risk, and higher functional outcome scores than UTHA. Further follow-up is necessary to verify whether these advantages of CTHA persist over time.


2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Chi-Feng Pan ◽  
Chih-Kuang Chuang ◽  
Fang-Ju Sun ◽  
Duen-Jen Wang ◽  
...  

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.


2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.


Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tetsuo Horimatsu ◽  
Kenichi Fujii ◽  
Masashi Fukunaga ◽  
Machiko Nishimura ◽  
Ten Saita ◽  
...  

Introduction: We have recently reported the cause of microcirculatory damage after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients can be evaluated by analyzing the thermodilution-derived coronary blood flow pattern (CBFP), and only the capillary destruction pattern was associated with poor mid-term clinical outcomes. In this study, we extend our research on the contribution of acute hyperglycemia on microcirculatory damage and long-term clinical outcomes in STEMI patient. Methods: Ninety-seven consecutive STEMI patients undergoing primary PCI were prospectively enrolled. Using a pressure sensor/thermistor-tipped guidewire, CBFP was assessed from the thermodilution-curves immediately after successful PCI. All patients were classified into 3 groups according to the shape of thermodilution curve: no microvascular damaged group (n=47), arteriole microemboli group (n=33), or capillary destruction group (n=17). Blood glucose levels were measured on admission. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, myocardial infarction, and heart failure rehospitalization within 3 years. Results: Mean admission glucose level was significantly higher in the capillary destruction group than in the microemboli and no microvascular damaged groups (259±134, 162±66, and 153±60 mg/dL, respectively, p<0.0001). These findings were similar when the analysis was limited to non-diabetic patients. The incidence of MACE was also higher in the capillary destruction group compared with the microemboli and no microvascular damaged groups (71, 19, and 16%, respectively, p<0.0001). On multivariate Cox regression analysis, the capillary destruction pattern was the independent predictor of MACE (hazard ratio, 9.41; 95%CI 2.28-38.8; p=0.001). In the multivariate logistic regression analysis, higher glucose level on admission remained as an independent risk factor of the capillary destruction pattern (per 10mg/dL increase, odds ratio, 1.10; 95%CI 1.10-1.22; p=0.002). Conclusions: Hyperglycemia on admission increases the risk of microvascular damage secondary to the capillary destruction and subsequent poor long-term clinical outcomes in STEMI patients.


2020 ◽  
Vol 13 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Iisa Lindström ◽  
Sara Protto ◽  
Niina Khan ◽  
Jussi Hernesniemi ◽  
Niko Sillanpää ◽  
...  

BackgroundMasseter area (MA), a surrogate for sarcopenia, appears to be useful when estimating postoperative survival, but there is lack of consensus regarding the potential predictive value of sarcopenia in acute ischemic stroke (AIS) patients. We hypothesized that MA and density (MD) evaluated from pre-interventional CT angiography scans predict postinterventional survival in patients undergoing mechanical thrombectomy (MT).Materials and methods312 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1-MCA) between 2013 and 2018. Median follow-up was 27.4 months (range 0–70.4). Binary logistic (alive at 3 months, OR <1) and Cox regression analyses were used to study the effect of MA and MD averages (MAavg and MDavg) on survival.ResultsIn Kaplan–Meier analysis, there was a significant inverse relationship with both MDavg and MAavg and mortality (MDavg P<0.001, MAavg P=0.002). Long-term mortality was 19.6% (n=61) and 3-month mortality 12.2% (n=38). In multivariable logistic regression analysis at 3 months, per 1-SD increase MDavg (OR 0.61, 95% CI 0.41 to 0.92, P=0.018:) and MAavg (OR 0.57, 95% CI 0.35 to 0.91, P=0.019) were the independent predictors associated with lower mortality. In Cox regression analysis, MDavg and MAavg were not associated with long-term survival.ConclusionsIn acute ischemic stroke patients, MDavg and MAavg are independent predictors of 3-month survival after MT of the ICA or M1-MCA. A 1-SD increase in MDavg and MAavg was associated with a 39%–43% decrease in the probability of death during the first 3 months after MT.


2009 ◽  
Vol 110 (2) ◽  
pp. 319-326 ◽  
Author(s):  
Behzad Eftekhar ◽  
Mohammad Ali Sahraian ◽  
Banafsheh Nouralishahi ◽  
Ali Khaji ◽  
Zahra Vahabi ◽  
...  

Object The goal of this paper was to investigate the long-term outcome and the possible prognostic factors that might have influenced the persistence of posttraumatic epilepsy after penetrating head injuries sustained during the Iraq–Iran war (1980–1988). Methods In this retrospective study, the authors evaluated 189 patients who sustained penetrating head injury and suffered posttraumatic epilepsy during the Iraq–Iran war (mean 18.6 ± 4.7 years after injury). The probabilities of persistent seizures (seizure occurrence in the past 2 years) in different periods after injury were estimated using the Kaplan-Meier method. The possible prognostic factors (patients and injury characteristics, clinical findings, and seizure characteristics) were studied using log-rank and Cox regression analysis. Results The probability of persistent seizures was 86.4% after 16 years and 74.7% after 21 years. In patients with < 3 pieces of shrapnel or no sphincter disturbances during seizure attacks, the probability of being seizure free after these 16 and 21 years was significantly higher. Conclusions Early seizures, prophylactic antiepileptics drugs, and surgical intervention did not significantly affect long-term outcome in regard to persistence of seizures.


2020 ◽  
Author(s):  
Pin Li ◽  
Huixia Zhou ◽  
Hualin Cao ◽  
Tao Guo ◽  
Weiwei Zhu ◽  
...  

Abstract Background To elucidate the bladder rhabdomyosarcoma clinicopathological characteristics and reveal the prognostic factors. Methods We screened data from SEER database (1975-2016) stratified by age group, evaluated the differences between groups with Chi-square and Fisher’s test, conducted the Kaplan-Meier survival analysis and plotted the survival curve. The significant factors were brought into Cox regression analysis and calculated the HR(95%CI). Results About half of the patients who develop bladder RMS will be younger than 2 years of age. Embryonal RMS account for 76% of all histopathology types. Age at diagnosis more than 16-y (HR=6.595,95%CI:3.62-12.01, p=7.04e-10), NOT embryonal rhabdomyosarcoma (HR=3.61, 95%CI:1.99-6.549, p =4.1e-06), without radiotherapy combined or surgery alone (HR=4.382, 95%CI:1.99-6.549, p =2.4e-05) and not performed the surgery (HR=2.982,95%CI:1.263-7.039, p =0.0126) were negatively correlated with 5-year survival time, while race( p =0.341), whether performed the lymphadenectomy( p =0.722) showed no influence on survival time. Cox regression results show that age, histology, SEER stage, treatment combined or alone influence the clinical outcomes. Conclusions We demonstrated the demographic and characteristic of bladder rhabdomyosarcoma, identified and excluded the prognostic factors for the 5-year overall survival and clinical outcomes.


2020 ◽  
Author(s):  
Xiulan Han ◽  
Weiguang Yu ◽  
Jinluan Lin ◽  
Mingdong Zhao ◽  
Guowei Han ◽  
...  

Abstract Background Despite the increased use of uncemented total hip arthroplasty (UTHA), there is little evidence of its superiority over cemented total hip arthroplasty (CTHA). The purpose of this retrospective study was to compare the long-term survivorship and Harris Hip Scores (HHSs) of CTHA versus UTHA in the treatment of acute femoral neck fractures (FNFs). Methods Data involving 224 hips (CTHA, n= 112; UTHA, n=112) that underwent primary surgery in our medical institutions during 2005-2017 were analysed retrospectively. The primary endpoint was the risk of all-cause revision. The difference in the risk of all-cause revision between groups was assessed by Kaplan-Meier survival analysis with a log-rank test and Cox regression analysis. Results The mean follow-up from surgery was 10 years (range, 3 - 13 years). Kaplan-Meier estimated that the 10-year implant survival was 98.1% (CI: 96.1–98.5) in the CTHA group and 96.2% (CI: 95.2–97.3) in the UTHA group (p = 0.030). The adjusted Cox regression analysis demonstrated a lower risk of revision in CTHA than in UTHA (hazard ratio [HR] = 1.4, 95% confidence interval [CI] = 1.1-2.6, p = 0.000). At the final follow-up, significant differences were detected in HHS (85.10[±12.21] for CTHA vs. 79.11[±13.19] for UTHA). Conclusion This retrospective analysis demonstrates that CTHA has superior survival to UTHA, with a significantly reduced revision risk and higher functional outcome scores. Further follow-up is necessary to verify whether the CTHA advantage persists over time.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V L Malavasi ◽  
M Vitolo ◽  
M Proietti ◽  
L Fauchier ◽  
F Marin ◽  
...  

Abstract Background Management of patients with atrial fibrillation (AF) and malignancy is a clinical challenge given the paucity of evidence supporting the appropriate clinical management. Purpose To evaluate the outcomes of patients with active or prior malignancy in a large contemporary cohort of European AF patients. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. We stratified the population into three categories (i) No Malignancy (NoM) (ii) Prior Malignancy (PriorM) and (iii) Active Malignancy (ActM). The primary outcome for this analysis was all-cause death among the three groups. The association between anticoagulant treatment, all-cause death and haemorrhagic events was also evaluated. Results Among the original 11 096 AF patients enrolled, 10 383 were included in this analysis (median age 71 years (interquartile range [IQR] 63–77, males 59.7%). Of these, 9 597 (92.4%) were NoM patients, 577 (5.6%) PriorM and 209 (2%) ActM. Patients with malignancy (prior or active) had a higher median age, median CHA2DS2-VASc and HAS-BLED scores, compared to patients without malignancy (p&lt;0.001). Lack of anticoagulation (AC) prescription occurred more commonly in ActM (21.5%) as compared with the other groups (PriorM 10.1% vs NoM 12.8%, p&lt;0.001). In case of AC treatment, patients with ActM were treated more frequently with heparins (ActM 8.1% vs PriorM 2.4% vs NoM 2%, p&lt;0.001). After a median follow-up of 730 days [IQR 692–749], 982 (9.5%) patients died. Among all deaths, the proportion of cardiovascular death was different according to the three groups (40.0% in NoM, 26.0% in PrioM and 22.2% in ActM, p=0.002). For all cause-death, Kaplan-Meier analysis showed a progressively higher cumulative risk in the PriorM and ActM groups compared to NoM patients (Figure 1). On multivariable Cox regression analysis, adjusted for CHA2DS2-VASc score, use of AC, type of AF and chronic kidney disease, ActM group was independently associated with a higher risk for all cause death (hazard ratio [HR] 2.90, 95% confidence interval [CI] 2.23–3.76) while PriorM group was not. Among PriorM and NoM patients, multivariable adjusted Cox regression analysis found that the use of any AC was independently associated with a lower risk for all-cause death (HR 0.36, 95% CI 0.19–0.66; HR 0.66, 95% CI 0.54–0.81). No significant association between AC and all-cause death was found for ActM patients. Conclusions In a large contemporary cohort of European AF patients, active malignancy was found to be independently associated with all-cause death. Use of any AC was associated with a lower risk for all-cause death in patients with no malignancies and with prior malignancies, but with no significant association amongst patients with active malignancies. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022). Figure 1. Kaplan-Meier for all-cause death


2021 ◽  
Vol 8 ◽  
Author(s):  
Side Gao ◽  
Wenjian Ma ◽  
Sizhuang Huang ◽  
Xuze Lin ◽  
Mengyue Yu

Background: Sex differences in clinical profiles and prognosis after acute myocardial infarction have been addressed for decades. However, the sex-based disparities among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remain largely unreported. Here, we investigated sex-specific characteristics and long-term outcomes in MINOCA population.Methods: A total of 1,179 MINOCA patients were enrolled, including 867 men and 312 women. The mean follow-up was 41.7 months. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal reinfarction, revascularization, non-fatal stroke, and hospitalization for unstable angina or heart failure. Baseline data and outcomes were compared. Kaplan-Meier curves and Cox regression analyses were used to identify association between sex and prognosis.Results: Female patients with MINOCA had more risk profiles with regard to older age and higher prevalence of hypertension and diabetes compared with men. The evidence-based medical treatment was similar in men and women. The incidence of MACE (men vs. women: 13.8 vs. 15.3%, p = 0.504) did not differ significantly between the sexes. The Kaplan-Meier analysis also indicated that women had a similar incidence of MACE compared to men (log rank p = 0.385). After multivariate adjustment, female sex was not associated with the risk of MACE in overall (adjusted hazard ratio 1.02, 95% confidence interval: 0.72–1.44, p = 0.916) and in subgroups of MINOCA patients.Conclusion: The long-term outcomes were similar for men and women presenting with MINOCA despite older age and more comorbidities in women. Future research should aim to improve in-hospital and post-discharge care for both sexes with MINOCA.


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