Pcsk9 is associated with severity of coronary artery lesions in male patients with premature myocardial infarction

Abstract Background Proprotein convertase subtilisin/kexin type 9 (Pcsk9) correlated with incidence and prognosis of coronary heart disease. However, it is unclear whether Pcsk9 contributed to coronary artery lesion severity in patients with premature myocardial infarction (PMI). The present study investigated associations between Pcsk9 and coronary artery lesion severity in PMI patients who underwent coronary angiography (CAG). Methods This prospective cohort study included young men (age ≤ 45 years, n = 332) with acute MI who underwent CAG between January 2017 and July 2019. Serum Pcsk9 levels and clinical characteristics were evaluated. SYNTAX scores (SYNergy between percutaneous coronary intervention with [paclitaxel-eluting] TAXUS stent and cardiac surgery) were calculated to quantify coronary artery lesions. Results Serum Pcsk9 levels were positively associated with SYNTAX scores (r = 0.173, P < 0.05). The diagnostic cutoff value of PSCK9 level was 122.9 ng/mL, yielding an area under the curve (AUC) of 0.63, sensitivity 81%, and specificity 40%. Serum Pcsk9, LDL-C, Apob, NT-proBnp, CK level, and diabetes history were independent predictors of high SYNTAX scores (P < 0.05). After stratifying by serum LDL-C level (cutoff = 2.6 mmol/L), medium-high Pcsk9 levels had increased risk of high SYNTAX scores in patients with high LDL-C (P < 0.05), and higher serum Pcsk9 levels had increased risk of major adverse cardiac events (MACE) after adjusting for confounding factors (P < 0.05). Conclusion Serum Pcsk9 levels correlates with severity of coronary artery lesion in PMI patients and may serve as a biomarker for severity of coronary artery stenosis in this patient population, which may contribute to risk stratification.

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P686Cancer is not associated with increased cardiac and bleeding events after 2nd- and 3rd-generation drug-eluting stents implantation

European Heart Journal ◽

10.1093/eurheartj/ehz747.0291 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Muramatsu ◽

Y Minami ◽

K Ishida ◽

A Kato ◽

A Katsura ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Intervention ◽

Drug Eluting Stent ◽

Cardiac Events ◽

Bleeding Events ◽

Patients With Cancer ◽

Cancer Group ◽

Increased Risk ◽

Drug Eluting ◽

The Impact

Abstract Background Previous studies demonstrated the impact of concomitant cancer on the increased risk of adverse cardiac and bleeding events after percutaneous coronary intervention (PCI). However, the impact in this 2nd- and 3rd-generation drug-eluting stent (DES) era remains to be elucidated. Purpose To clarify the impact of cancer on clinical outcomes in patients after 2nd- or 3rd -generation DES implantation. Methods A total of 932 patients who underwent PCI with 2nd- or 3rd -generation DES were included. Patients who were diagnosed with cancer after PCI were excluded from the present cohort. The incidence of major adverse cardiac events (MACE) including cardiac death, myocardial infarction and target or non-target vessel revascularization, and bleeding events was compared between the patients with cancer or the history of treatment for cancer (cancer group, n=140) and the patients without cancer (no cancer group, n=792). Bleeding events were evaluated according to the Thrombolysis in Myocardial Infarction definition. Further comparisons were performed between the 2 groups (cancer group, n=126; no cancer group, n=252) after the adjustment of baseline clinical characteristics using 1:2 propensity score-matching analysis. Results The incidence of MACE at median 577 [340–1043] days after the PCI was comparable between the 2 groups in both unadjusted (15.0% vs. 15.0%, p=0.984) (Panel A) and adjusted cohorts (14.3 vs. 13.1%, p=0.796), although the incidence of all cause death in the cancer group was significantly greater than the no cancer group (15.1 vs. 9.5%, p=0.007, in the adjusted cohort). The increased risk of MACE was not observed in any types of cancer or treatment (Panel B). The incidence of bleeding events was also comparable between the 2 groups (4.0 vs. 2.0%, p=0.297, in the adjusted cohort). Conclusion The increased incidence of MACE and bleeding events in patients with cancer was not demonstrated after the 2nd- or 3rd-generation DES implantation. Further studies are required to clarify the safety and efficacy of PCI in patients with cancer.

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Prognostic value of the coronary artery calcium score in suspected coronary artery disease: a study of 644 symptomatic patients

Netherlands Heart Journal ◽

10.1007/s12471-019-01335-7 ◽

2019 ◽

Vol 28 (1) ◽

pp. 44-50 ◽

Cited By ~ 2

Author(s):

D. Rijlaarsdam-Hermsen ◽

M. S. Lo-Kioeng-Shioe ◽

D. Kuijpers ◽

R. T. van Domburg ◽

J. W. Deckers ◽

...

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Artery Calcium ◽

Calcium Score ◽

Coronary Revascularisation ◽

Cardiac Events ◽

Prognostic Information ◽

Increased Risk ◽

Fatal Myocardial Infarction

Abstract Aim The long-term value of coronary artery calcium (CAC) scanning has not been studied extensively in symptomatic patients, but was evaluated by us in 644 consecutive patients referred for stable chest pain. Methods We excluded patients with a history of cardiovascular disease and with a CAC score of zero. CAC scanning was done with a 16-row MDCT scanner. Endpoints were: (a) overall mortality, (b) mortality or non-fatal myocardial infarction and (c) the composite of mortality, myocardial infarction or coronary revascularisation. Revascularisations within 1 year following CAC scanning were not considered. Results The mean age of the 320 women and 324 men was 63 years. Follow-up was over 8 years. There were 58 mortalities, while 22 patients suffered non-fatal myocardial infarction and 24 underwent coronary revascularisation, providing 104 combined endpoints. Cumulative 8‑year survival was 95% with CAC score <100, 90% in patients with CAC score >100 and <400, and 82% with CAC score ≥400 Agatston units. Risk of mortality with a CAC score >100 and ≥400 units was 2.6 [95% confidence interval (CI) 1.23–5.54], and 4.6 (95% CI 2.1–9.47) respectively. After correction for clinical risk factors, CAC score remained independently associated with increased risk of cardiac events. Conclusions Risk increased with increasing CAC score. Patients with CAC >100 or ≥400 Agatston units were at increased risk of major adverse cardiac events and are eligible for preventive measures. CAC scanning provided incremental prognostic information to guide the choice of diagnostic and therapeutic options in many subjects evaluated for chest pain.

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Glycoprotein IIb/IIIa Inhibitors Use and Outcome after Percutaneous Coronary Intervention for Non-ST Elevation Myocardial Infarction

BioMed Research International ◽

10.1155/2014/643981 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

J. P. Howard ◽

D. A. Jones ◽

S. Gallagher ◽

K. Rathod ◽

S. Antoniou ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Major Bleeding ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Secondary Outcome ◽

Cardiac Events ◽

Increased Risk ◽

Percutaneous Coronary ◽

St Elevation

Aims. We investigate the effect of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors on long-term outcomes following percutaneous coronary intervention (PCI) after non-ST elevation myocardial infarction (NSTEMI). Meta-analyses indicate that these agents are associated with improved short-term outcomes. However, many trials were undertaken before the routine use of P2Y12inhibitors. Recent studies yield conflicting results and registry data have suggested that GP IIb/IIIa inhibitors may cause more bleeding than what trials indicate.Methods and Results. This retrospective observational study involves 3047 patients receiving dual-antiplatelet therapy who underwent PCI for NSTEMI. Primary outcome was all-cause mortality. Major adverse cardiac events (MACE) were a secondary outcome. Mean follow-up was 4.6 years. Patients treated with GP IIb/IIIa inhibitors were younger with fewer comorbidities. Although the unadjusted Kaplan-Meier analysis suggested that GP IIb/IIIa inhibitor use was associated with improved outcomes, multivariate analysis (including propensity scoring) showed no benefit for either survival (P=0.136) or MACE (P=0.614). GP IIb/IIIa inhibitor use was associated with an increased risk of major bleeding (P=0.021).Conclusion. Although GP IIb/IIIa inhibitor use appeared to improve outcomes after PCI for NSTEMI, patients who received GP IIb/IIIa inhibitors tended to be at lower risk. After multivariate adjustment we observed no improvement in MACE or survival and an increased risk of major bleeding.

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Role of cardiovascular magnetic resonance in the prognosis of patients with myocardial infarction with non-obstructive coronary arteries

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00773-w ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Nuria Vicente-Ibarra ◽

Eloisa Feliu ◽

Vicente Bertomeu-Martínez ◽

Pedro Cano-Vivar ◽

Pilar Carrillo-Sáez ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Cardiovascular Magnetic Resonance ◽

Coronary Artery ◽

Magnetic Resonance ◽

Coronary Arteries ◽

Coronary Artery Lesions ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events

Abstract Background It is estimated that 5% to 10% of patients with myocardial infarction (MI) present with no obstructive coronary artery lesions. Until now, most studies have focused on acute coronary syndrome, including different clinical entities with a similar presentation encompassed under the term MINOCA (MI with non-obstructive coronary arteries). The aim of this study is to assess the prognosis of patients diagnosed with true infarction, confirmed by cardiovascular magnetic resonance (CMR), in the absence of significant coronary lesions. Methods Prospective multicenter registry study, including 120 consecutive patients with a CMR-confirmed MI without obstructive coronary artery lesions. The primary clinical outcome was major adverse cardiovascular events (MACE: death, non-fatal infarction, stroke, or cardiac readmission), assessed over three years. Results Seventy-six patients (63.3%) were admitted with a diagnosis of acute coronary syndrome, and 44 (36.6%) for other causes (mainly heart failure); the definitive diagnosis was established by CMR. Most patients (64.2%) were men, and the mean age was 58.8 ± 13.5 years. Patients presented with small infarcts: 83 (69.1%) showed late gadolinium enhancement (LGE) in one or two myocardial segments, mainly transmural (in 77.5% of patients) and with a preserved left ventricular ejection fraction (median 54.8%, interquartile range 37–62). The most frequent infarct location was inferolateral (n = 38, 31.7%). During follow-up, 43 patients (35.8%) experienced a MACE, including 9 (7.5%) who died. In multivariable analysis, LGE in two versus one myocardial segment doubled the risk of adverse cardiac events (hazard ratio [HR] 2.32, 95% confidence interval [CI] 0.97–5.83, p = 0.058). Involvement of three or more myocardial segments almost tripled the risk (HR 2.71, 95% CI 1.04–7.04, p = 0.040 respectively). Conclusions Patients with true MI but without significant coronary artery lesions predominantly had small infarcts. Myocardial 3-segment LGE involvement is associated with a significantly higher risk of adverse cardiac events.

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Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction

Journal of Clinical Medicine ◽

10.3390/jcm10020258 ◽

2021 ◽

Vol 10 (2) ◽

pp. 258

Author(s):

Seung-Hyun Kim ◽

Michael Behnes ◽

Kambis Mashayekhi ◽

Alexander Bufe ◽

Markus Meyer-Gessner ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Prognostic Impact ◽

Total Occlusion ◽

Increased Risk ◽

Percutaneous Coronary ◽

Periprocedural Myocardial Infarction

Coronary chronic total occlusion (CTO) has gained increasing clinical attention as the most advanced form of coronary artery disease. Prior studies already indicated a clear association of CTO with adverse clinical outcomes, especially in patients with acute myocardial infarction (AMI) and concomitant CTO of the non-infarct-related coronary artery (non-IRA). Nevertheless, the prognostic impact of percutaneous coronary intervention (PCI) of CTO in the acute setting during AMI is still controversial. Due to the complexity of the CTO lesion, CTO-PCI leads to an increased risk of complications compared to non-occlusive coronary lesions. Therefore, this review outlines the prognostic impact of CTO-PCI in patients with AMI. In addition, the prognostic impact of periprocedural myocardial infarction caused by CTO-PCI will be discussed.

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Myocardial infarction in an adult with cystic fibrosis and heart and lung transplant

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2013.535 ◽

2013 ◽

Vol 8 ◽

Author(s):

James Eaden ◽

Daniel Peckham

Keyword(s):

Myocardial Infarction ◽

Cystic Fibrosis ◽

Coronary Artery ◽

Right Coronary Artery ◽

Lung Transplant ◽

Coronary Intervention ◽

Cardiac Risk ◽

Cardiac Transplant ◽

Cardiac Events ◽

Left Anterior Descending Artery

We present a case of myocardial infarction in a 19 year old female with cystic fibrosis who had a heart and lung transplant performed at the age of four years old. She presented atypically with a one day history of severe, intermittent, central, sharp chest pain, radiating to her back and down her left arm. A coronary angiogram showed proximal stenosis of the left anterior descending artery and right coronary artery. She was treated with percutaneous coronary intervention, involving drug eluting stents to the left anterior descending artery (LAD) and the right coronary artery (RCA). In this study we discuss the pathophysiology, investigations and treatment of cardiac transplant vasculopathy. Although complete reversal of LAD and RCA stenosis was achieved, routine followup with coronary angiography and careful control of cardiac risk factors will be important to identify and reduce future restenosis and adverse cardiac events.

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Association of NT-proBNP and Subsequent Major Adverse Cardiovascular and Cerebral Events in Patients with Successful PCI for ACS and Normal LVEF

10.21203/rs.3.rs-38337/v1 ◽

2020 ◽

Author(s):

Jia-Li Wang ◽

Shu-Mei Zhao ◽

Hui Chen ◽

Chun-Yan Guo ◽

Xue-Qiao Zhao ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Score ◽

Area Under The Curve ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Increased Risk ◽

Normal Lvef

Abstract Background: Does N-Terminal pro-brain natriuretic peptide (NT-proBNP) predict subsequent major adverse cardiovascular and cerebral event (MACCE) in patients received successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and had normal left ventricular ejection fraction (LVEF)? Methods: 3986 ACS patients were divided into 4 groups based on the quartile (Q) values of peak NT-proBNP measured during hospitalization. All patients were followed for MACCE, a composite of all-cause death, non-fatal myocardial infarction (MI) or stroke, and heart failure requiring hospitalization (HFRH), during a median of 35 months. The incidence of MACCE was compared among Q1-Q4. Receiver operation characteristic curves (ROC) were generated to compare the area under the curve (AUC) for MACCE, cardiovascular (CV) death and HFRH by adding NT-proBNP to the TIMI (thrombolysis in myocardial infarction) risk score.Results: The incidences of MACCE (5.6%, 9.1%, 13.0%, 20.1%, P <0.001), all-cause death (1.0%, 2.5%, 4.1%, 8.4%, P <0.001), non-fatal MI (2.0%,3.4%,4.8%,6.2%, P <0.001) and HFRH (1.5%, 2.3%, 4.1%, 5.9%, P <0.001) were significantly increased from Q1 to Q4, but, not stroke (1.4%, 1.4%, 1.3%, 2.1%, P =0.438). Each median level (337pg/ml) increase in NT-proBNP was significantly and independently associated with increased risk of MACCE (HR 1.02, 95%CI, 1.01-1.03; P <0.001). Compared with TIMI (thrombolysis in myocardial infarction) risk score alone, TIMI+NT-proBNP showed improved AUCs: CV death (0.76 vs. 0.72, P =0.0008), and HFRH (0.68 vs. 0.66, P =0.0017), MACCE (0.70 vs. 0.69, P =0.0012), respectively. Conclusion: NT-proBNP was significantly and independently associated with increased risk of subsequent MACCE in 3 years in ACS patients who received successful PCI and had normal LVEF, and improved the prognosis of major adverse events in addition to the TIMI risk score.

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Dual Antiplatelet Therapy Can Be Discontinued at Three Months after Implantation of Zotarolimus-Eluting Stent in Patients with Coronary Artery Disease

ISRN Cardiology ◽

10.1155/2013/518968 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Tadashi Wada ◽

Makoto Nakahama ◽

Hironobu Toda ◽

Atsuyuki Watanabe ◽

Katsushi Hashimoto ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Bleeding Risk ◽

Coronary Intervention ◽

Cardiac Events ◽

Bleeding Events ◽

Artery Disease

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention increases the risk of bleeding. We studied the safety and clinical outcomes of switching from DAPT to aspirin monotherapy at 3 months after ZES implantation. We retrospectively evaluated 168 consecutive patients with coronary artery disease who had been implanted with a ZES from June 2009 through March 2010. After excluding 40 patients according to exclusion criteria such as myocardial infarction, 128 patients were divided into a 3-month DAPT group (67 patients, 88 lesions) and a 12-month conventional DAPT group (61 patients, 81 lesions). Coronary angiographic followup and clinical followup were conducted at more than 8 months and at 12 months after ZES implantation, respectively. Minor and major bleeding events, stent thrombosis (ST), and major adverse cardiac events (MACE) (death, myocardial infarction, cerebrovascular accident, target lesion revascularization, and target vessel revascularization) were evaluated. There were no statistically significant differences in the incidences of ST and MACE between the two groups. The incidence of bleeding events was significantly lower in the 3-month group than in the 12-month group (1.5% versus 11.5%, ). DAPT can be safely discontinued at 3 months after ZES implantation, which reduces bleeding risk.

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Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

Interventional Cardiology Review ◽

10.15420/icr.2012.7.1.37 ◽

2012 ◽

Vol 7 (1) ◽

pp. 37

Author(s):

Donald E Cutlip ◽

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Statistical Significance ◽

Bare Metal Stents ◽

Coronary Intervention ◽

Metal Stents ◽

Increased Risk ◽

Percutaneous Coronary ◽

Patients With Diabetes ◽

The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

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Isolated right ventricular myocardial infarction: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa494 ◽

2020 ◽

Author(s):

Adeogo Akinwale Olusan ◽

Paul Francis Brennan ◽

Paul Weir Johnston

Keyword(s):

Myocardial Infarction ◽

Computed Tomography ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Ventricular ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Left Circumflex Artery ◽

Right Ventricular Myocardial Infarction ◽

Percutaneous Coronary

Abstract Background Isolated right ventricular myocardial infarction (RVMI) due to a recessive right coronary artery (RCA) occlusion is a rare presentation. It is typically caused by right ventricle (RV) branch occlusion complicating percutaneous coronary intervention. We report a case of an isolated RVMI due to flush RCA occlusion presenting via our primary percutaneous coronary intervention ST-elevation myocardial infarction pathway. Case summary A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre. Discussion This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.

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