Abstract 10954: Clinical and Angiographic Predictors of Adverse Outcomes After Percutaneous Coronary Intervention in Patients With Radiation Associated Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Grant W Reed ◽  
Ahmad Masri ◽  
Brian P Griffin ◽  
Samir R Kapadia ◽  
Stephen G Ellis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Nyha Class ◽  
Coronary Intervention ◽  
Vessel Diameter ◽  
Syntax Score ◽  
Target Vessel ◽  
Percutaneous Coronary ◽  
Artery Disease

Background: The clinical and angiographic predictors of outcomes after percutaneous coronary intervention (PCI) in patients with cancer and radiation associated coronary artery disease (CAD) are not well established. Methods: In this retrospective cohort study, 157 patients with thoracic malignancy and external beam radiation therapy (XRT) prior to PCI were identified. The rates of major adverse cardiovascular and cerebrovascular events (MACCE; all-cause mortality, myocardial infarction, repeat revascularization, or stroke) were compared across patient characteristics. Results: During follow-up of 5.4±4.5 years, 91 (58%) patients had MACCE; 59 (38%) died, of which 23 (39%) were cardiac deaths, 23 (39%) due to cancer or other causes, and 13 (22%) unknown. By Kaplan-Meier analysis, MACCE were more frequent with coronary artery calcification (p=0.023), ostial stenosis (p=0.049), target vessel diameter ≥ 3.0 mm (p=0.018), a SYNTAX score ≥ the median of 11 (p=0.014), or bare metal stenting (BMS) compared to drug-eluting stenting (DES) (p=0.006) (Figure). Cardiac death was more frequent in patients with SYNTAX score ≥ 11 (p=0.028) or BMS (p=0.043). After multivariable adjustment, independent predictors of MACCE were chronic kidney disease (CKD) (p=0.006), New York Heart Association (NYHA) class ≥ 3 (p=0.024), and BMS (p=0.008) (Table). Conclusions: In patients with radiation associated CAD treated with PCI, MACCE is more frequent in those with target vessel calcification, ostial stenosis, large vessel diameter, or SYNTAX score ≥ 11. BMS placement is independently associated with greater MACCE than DES, and other risk factors for MACCE include CKD and NYHA class ≥ 3.

scholarly journals Identify Unsuitable Patients with Left Main Coronary Artery Disease in Intermediate SYNTAX Scores Treated by Percutaneous Coronary Intervention

2017 ◽  
Vol 20 (6) ◽  
pp. 258 ◽  
Author(s):  
Chunxiao Zhang ◽  
Yaguang Zheng ◽  
Xinbin Liu ◽  
Yutong Cheng ◽  
Yang Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Repeated Revascularization

Background: With the follow-up extending to 5 years, the outcomes of SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) trial were comparable between coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in left-main (LM) patients with intermediate SYNTAX scores of 23–32. A subdivision depending on SYNTAX score will help to identify unsuitable LM patients with intermediate SYNTAX scores to receive PCI treatment.Methods: Between January 2011 and June 2013, 104 patients with LM Coronary Artery Disease (CAD) undergoing PCI were selected retrospectively. We compared clinical outcomes in patients with SYNTAX score <27 and ≥27. The follow-up time was 25.23 ± 7.92 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to compare various outcomes between two groups.Results: Higher rates of repeated revascularization (18.2% versus 4.2%, P = .027) and major adverse cerebro-cardiovascular events (MACCE) (24.2% versus 7.0%, P = .014) were shown in patients with SYNTAX score ≥ 27. After multivariate adjustment, a significant higher risk of repeated revascularization (hazard ratio: 6.25, 95% confidence interval: 1.48 to 26.37, P = .013) and MACCE (hazard ratio: 4.49, 95% confidence interval: 1.41 to 14.35, P = .011) were also found in patients with SYNTAX score ≥ 27.Conclusions: Based on the higher rate of repeated revascularization and MACCE, patients with LM CAD and intermediate SYNTAX scores will need a subdivision to identity the one not benefit from PCI. CABG is still the standard treatment method for patients of LM CAD with a SYNTAX score of ≥ 27.

scholarly journals Outcomes of DES in Diabetic and Nondiabetic Patients with Complex Coronary Artery Disease after Risk Stratification by the SYNTAX Score

2016 ◽  
Vol 10 ◽  
pp. CMC.S37239 ◽  
Author(s):  
Mohamed Loutfi ◽  
Mohamed A. Sadaka ◽  
Mohamed Sobhy
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Repeat Revascularization ◽  
Percutaneous Coronary ◽  
Artery Disease

Diabetes mellitus (DM) increases the risk of adverse outcomes after coronary revascularization. Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD). Aim The aim of this study was to assess the outcomes of drug-eluting stent (DES) insertion in DM and non-DM patients with complex coronary artery disease (CAD) after risk stratification by the percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Methods and Results We performed multivessel percutaneous coronary intervention (PCI) for 601 lesions in 243 DM patients and 1,029 lesions in 401 non-DM patients. All included patients had MVD and one or more lesions of type B2/C. The two-year outcomes and event rates were estimated in the DM and non-DM patients using Kaplan–Meier analyses. The baseline SYNTAX score was ≤22 in 84.8% vs. 84%, P = 0.804, and 23-32 in 15.2% vs. 16%, P = 0.804, of the DM and non-DM patients, respectively. The number of diseased segments treated (2.57 ± 0.75 vs. 2.47 ± 0.72; P = 0.066) and stents implanted per patient (2.41 ± 0.63 vs. 2.32 ± 0.54; P = 0.134) were similar in both groups. After a mean follow-up of 642 ± 175 days, there were no differences in the major adverse cardiac and cerebrovascular events (MACCE; 26.7% vs. 20.9%; P = 0.091), composite end point of all-cause death/myocardial infarction (MI)/stroke (12.3% vs. 9%; P = 0.172), individual MACCE components of death (3.7% vs. 3.2%; P = 0.754), MI (6.6% vs. 4%; P = 0.142), and absence of stroke in the DM and non-DM patients. An increased need for repeat revascularization was observed in DM patients (18.5% vs. 10.2%; P = 0.003). In the multivariate analysis, DM was an independent predictor of repeat revascularization (hazard ratio: 1.818; 95% confidence interval: 1.162-2.843; P = 0.009). Conclusions DES implantation provides favorable early and mid-term results in both DM and non-DM patients undergoing PCI for complex lesions. After a mean follow-up of two years, DM and non-DM patients with complex CAD treated by PCI using new-generation DES showed no differences with regard to MACCE and other secondary end points. However, higher rates of ischemia-driven repeat revascularization were observed in DM patients.

scholarly journals The relationship between IL-6 levels and the angiographic severity of coronary artery disease following percutaneous coronary intervention in acute coronary syndrome patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Ling ◽  
Hairong Weng ◽  
Shengxing Tang
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Area Under The Curve ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Background The present investigation was developed for the exploration of the association between IL-6 levels and acute coronary syndrome (ACS) findings upon angiographic evaluation. Methods A retrospective review of 346 patients suffering from chest discomfort that underwent coronary angiography was performed. The SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and SS II were used to gauge ACS severity, with ACS patients being stratified into two groups based on an SS value of 22 and the median SS II value. Associations between IL-6 levels and SS or SS II values were assessed through Spearman's correlation analyses, and independent predictors of intermediate-high SS or high SS II were identified via a multivariate logistic regression approach. A receiver operating characteristic (ROC) curve was employed to explore of the predictive value of IL-6 levels. Results IL-6 was positively correlated with both SS (r = 0.479, P < 0.001) and SS II (r = 0.305, P < 0.001). Moreover, IL-6 levels were independently predictive of intermediate-high SS and high SS II values. ROC curves further demonstrated that IL-6 was able to predict intermediate-high SS and high SS II, with area under the curve (AUC) values of 0.806 and 0.624, respectively. Conclusion IL-6 levels are closely linked to the extent of coronary artery disease in ACS patients undergoing percutaneous coronary intervention. IL-6 levels may thus serve as a valuable and non-invasive biomarker of high-risk ACS patients.

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