scholarly journals Total Thrombus‐formation Analysis System Predicts Periprocedural Bleeding Events in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

2017 ◽  
Vol 6 (4) ◽  
Author(s):  
Yu Oimatsu ◽  
Koichi Kaikita ◽  
Masanobu Ishii ◽  
Tatsuro Mitsuse ◽  
Miwa Ito ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Analysis System

scholarly journals Antiplatelet Therapy for Patients with Hemophilia after Percutaneous Coronary Intervention

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5041-5041
Author(s):  
Peter Xie ◽  
Devin Malik ◽  
Philip Kuriakose
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Hemophilia A ◽  
Conflicts Of Interest ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Background: The incidence of coronary artery disease is increasing in hemophilia patients as their life expectancy improves. However, there are limited evidence-based studies available, and most current guidelines for antiplatelet therapy in patients with hemophilia are largely based on expert opinions. The assessment of benefit and risk of using antiplatelet therapy in these patients remains a clinical challenge. Aim: This study reports our institution's clinical outcome of patients with inherited hemophilia who underwent antiplatelet therapy for percutaneous coronary intervention in the last 10 years. Methods: Retrospective chart review from a single hospital for 10 calendar years of patients with inherited hemophilia A or B and a diagnosis of coronary artery disease who received oral antiplatelet agents. Results: See data Table 1 below. Conclusions: The usage of antiplatelet therapy for coronary artery disease as well as dual-antiplatelet therapy post percutaneous coronary intervention in patients with Hemophilia A or B carries a realistic risk of bleeding. However, outside of one patient with traumatic laceration of the liver, we did not identify any life threatening bleeding events in our patients who were placed on antiplatelet therapy. Since all subjects had no more than mild to moderate factor deficiency, it would be important to see how patients with severe deficiency would do on such therapy. Further studies are needed in the future to provide evidence and clarify the overall risk versus benefit of antiplatelet therapy in hemophilia patients with coronary artery disease. Disclosures No relevant conflicts of interest to declare.

scholarly journals The usefulness of total thrombus-formation analysis system for predicting high bleeding risk in coronary artery disease patients taking anticoagulants who underwent percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Nakanishi ◽  
K Kaikita ◽  
T Mitsuse ◽  
K Tsujita
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Thrombus Formation ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Analysis System ◽  
High Bleeding Risk

Abstract Background Although anticoagulants are widely used for prevention of cerebral infarction in patients with atrial fibrillation (AF), venous thrombosis, and valvular disease, it is possible that anticoagulants increase bleeding events in daily medical practices. Recently, we reported that the total thrombus-formation analysis system (T-TAS) was useful for evaluating bleeding risk in coronary artery disease (CAD) patients. Aim We examined whether T-TAS was practical for predicting bleeding risk in CAD patients taking anticoagulants who underwent percutaneous coronary intervention (PCI). Methods This study was the retrospective analysis of the 500 consecutive CAD patients who underwent PCI. Blood samples obtained on the day of PCI were used in T-TAS to compute the thrombus formation area under the curve (AUC) (AR10-AUC30, AUC for AR chip). We divided the total number of study patients into two groups according to the presence of anticoagulants; 53 CAD patients with triple therapy (TT) and 447 CAD patients with dual antiplatelet therapy (DAPT). We compared clinical characteristics and prognosis between the two groups. The primary endpoint was 1-year bleeding events that were defined by ISTH bleeding criteria. We excluded the CAD patients who underwent emergency PCI, and who were treated for hemodialysis. Results All patients took aspirin and clopidogrel, or aspirin and prasugrel at baseline. Compared to the patients with DAPT, the patients with TT had atrial fibrillation and history of stroke. The AR10-AUC30 levels were significantly lower in the patients with TT than the patients with DAPT (median [interquartile range] 1402.6 [1095.1–1609.8] vs. 1679.8 [1526.4–1783.3], p<0.001). Thirty-five patients (7%) had bleeding events during follow-up [11 cases (20.8%) in the patients with TT, 24 cases (5.4%) in the patients with DAPT]. Kaplan-Meier curve analysis showed a worse 1-year bleeding event-free survival rate in the patients with TT compared with the patients with DAPT (p<0.001). Receiver operating characteristic analysis showed that AR10-AUC30 levels significantly predicted bleeding events (AUC 0.653, 95% CI 0.555–0.751; p=0.003) and the cut-off point was 1586.4 by Youden index in the present study. In multivariate Cox hazards analysis, low AR10-AUC30 level (≤1586.4) (hazard ratio 2.99; 95% CI 1.46–6.11; p=0.003) and taking warfarin (hazard ratio 3.02; 95% CI 1.24–7.34; p=0.015) were significant predictors for 1-year bleeding events. Conclusions The present findings suggested that the AR10-AUC30 level determined by T-TAS could be a useful marker for predicting high bleeding risk in CAD patients taking anticoagulants who underwent PCI. Funding Acknowledgement Type of funding source: None

Genetic predictors for symptoms recurrenсe in coronary artery disease after percutaneous coronary intervention

2017 ◽  
pp. 81-86
Author(s):  
Г.А. Березовская ◽  
Е.С. Клокова ◽  
Н.Н. Петрищев
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Folate Metabolism ◽  
Genotype Distribution ◽  
Polymorphic Markers ◽  
Percutaneous Coronary ◽  
Artery Disease

Гены тромбообразования и фолатного обмена играют важную роль в развитии и прогрессии ишемической болезни сердца (ИБС). Однако о возможной роли полиморфных маркеров в рецидиве ИБС после чрескожного коронарного вмешательства (ЧКВ) известно недостаточно. Цель исследования: Оценить роль генетических факторов системы тромбообразования и фолатного обмена (полиморфных маркеров генов F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB ), в возобновление клиники ИБС после ЧКВ. Методика: Исследование проводили с использованием выборки из 90 больных ИБС в возрасте от 40 до 75 лет: 75 пациентов после планового ЧКВ (60 мужчин и 15 женщин) и 15 лиц после экстренного ЧКВ (12 мужчин и 3 женщины). Молекулярно-генетическое исследование было выполнено с помощью комплекта реагентов «Сердечно-сосудистые заболевания СтрипМетод»® (ViennaLab Diagnostics GmbH, Австрия), выявляющие следующие варианты: F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB . Результаты: В результате исследования была показана ассоциация полиморфного маркера G103T ( Val34Leu ) гена F13A1 (фактор свертываемости крови 13, субъединица A1) с развитием рецидивирующего состояния ИБС после ЧКВ. Выявлены статистически значимые различия в распределении частот генотипов полиморфного маркера Val34Leu гена F13A1 . Показано, что частота генотипа Val/Val у пациентов с осложнениями была выше, чем у пациентов без таковых: 0,700 и 0,400 соответственно (c = 7,78; p = 0,020), при этом генотип Val/Val проявил себя как фактор риска развития осложнений: ОШ = 3,50 (95%ДИ 1,37-8,93). При сравнении аллелей выявили, что частота аллеля L у больных с осложнениями была ниже, чем у лиц без таковых: 0,167 и 0,375 соответственно (p = 0,004), и носительство аллеля L уменьшало вероятность развития осложнений: ОШ = 0,33 (95%ДИ 0,15-0,72). Заключение: Носительство варианта 34V гена F13A1 , кодирующего A-субъединицу фактора свёртывания 13, предрасполагает к возобновлению клинических проявлений ИБС после ЧКВ. Genes of thrombosis and folate metabolism play an important role in development and progression of coronary artery disease (CAD). However, a possible role of polymorphic markers in CAD relapse following percutaneous coronary intervention (PCI) is not sufficiently understood. Background. Reports have indicated an association of genetic factors generally related with thrombophilia and recurrence of symptoms for coronary artery disease (CAD) following a percutaneous coronary intervention (PCI) due to restenosis and in-stent thrombosis. However, the relapse can also be caused by progression of atherosclerosis and endothelial dysfunction in unoperated blood vessels. Aim: To assess the role of genetic risk factors involved in thrombosis and folate metabolism (polymorphic markers of F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB genes) in recurrence of CAD symptoms after PCI. Methods: The study included 90 patients with CAD aged 40-75; 75 of these patients had undergone elective PCI (60 men and 15 women) and 15 patients - emergency PCI (12 men and 3 women). Molecular genetic tests were performed using a CVD StripAssays® reagent kit (ViennaLab Diagnostics GmbH, Austria) to identify the following genetic variations: F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB . Results: The study results showed a significant association of the G103T ( Val34Leu ) polymorphism in the F13A1 gene with relapses of IHD after PCI. Significant differences were found in genotype distribution frequencies of the Val34Leu polymorphism in the F13A1 gene. The frequency of Val / Val genotype was higher in patients with complications than without complications, 0.700 and 0.400, respectively (c = 7.78, p = 0.020). Furthermore, the Val/Val genotype can be classified as a risk factor for complications (OR = 3.50; 95% CI, 1.37-8.93). The L allele frequency was lower in patients with complications than in those without complications (0.167 and 0.375, respectively, p = 0.004), and carriage of the L allele reduced the likelihood of complications (OR = 0.33; 95% CI 0.15-0.72). Conclusion: Carriage of the 34V variant in the F13A1 gene that encodes the coagulation factor XIII A subunit predisposes to a relapse of CAD symptoms after PCI.

Should Percutaneous Coronary intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?.

2020 ◽  
Vol 16 ◽  
Author(s):  
George Kassimis ◽  
Grigoris V. Karamasis ◽  
Athanasios Katsikis ◽  
Joanna Abramik ◽  
Nestoras Kontogiannis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Symptom Relief ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of the optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.

scholarly journals Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

2021 ◽  
Author(s):  
Simone Biscaglia ◽  
Barry F. Uretsky ◽  
Matteo Tebaldi ◽  
Andrea Erriquez ◽  
Salvatore Brugaletta ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Qualitative Method ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Diffuse Disease ◽  
Percutaneous Coronary ◽  
Functional Patterns ◽  
Artery Disease

Abstract Purpose Wire-based coronary physiology pullback performed before percutaneous coronary intervention (PCI) discriminates coronary artery disease (CAD) distribution and extent, and is able to predict functional PCI result. No research investigated if quantitative flow ratio (QFR)–based physiology assessment is able to provide similar information. Methods In 111 patients (120 vessels) treated with PCI, QFR was measured both before and after PCI. Pre-PCI QFR trace was used to discriminate functional patterns of CAD (focal, serial lesions, diffuse disease, combination). Functional CAD patterns were identified analyzing changes in the QFR virtual pullback trace (qualitative method) or after computation of the QFR virtual pullback index (QVPindex) (quantitative method). QVPindex calculation was based on the maximal QFR drop over 20 mm and the length of epicardial coronary segment with QFR most relevant drop. Then, the ability of the different functional patterns of CAD to predict post-PCI QFR value was tested. Results By qualitative method, 51 (43%), 20 (17%), 15 (12%), and 34 (28%) vessels were classified as focal, serial focal lesions, diffuse disease, and combination, respectively. QVPindex values >0.71 and ≤0.51 predicted focal and diffuse patterns, respectively. Suboptimal PCI result (post-PCI QFR value ≤0.89) was present in 22 (18%) vessels. Its occurrence differed across functional patterns of CAD (focal 8% vs. serial lesions 15% vs. diffuse disease 33% vs. combination 29%, p=0.03). Similarly, QVPindex was correlated with post-PCI QFR value (r=0.62, 95% CI 0.50–0.72). Conclusion Our results suggest that functional patterns of CAD based on pre-PCI QFR trace can predict the functional outcome after PCI. Clinical Trial Registration ClinicalTrials.gov, number NCT02811796. Date of registration: June 23, 2016.

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