Soluble CD40 ligand and outcome in patients with coronary artery disease undergoing percutaneous coronary intervention

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Fabio Angeli ◽  
Paolo Verdecchia ◽  
Stefano Savonitto ◽  
Sara Cavallini ◽  
Andrea Santucci ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stent Placement ◽  
Cd40 Ligand ◽  
Soluble Form ◽  
Standard Deviation Increase ◽  
Coronary Restenosis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Coronary Events

Abstract Objectives CD40 ligand (CD40L), a transmembrane glycoprotein belonging to the tumor necrosis factor family and expressed by a variety of cells, is involved in the basic mechanisms of inflammation, atherosclerosis and thrombosis. Some studies suggest that the soluble form of CD40L (sCD40L) is a predictor of major cardiovascular events and mortality in a variety of clinical settings, but data from literature are conflicting. Methods We studied consecutive patients with acute (ACS) or chronic (CCS) coronary syndrome who underwent percutaneous coronary artery intervention (PCI). Blood samples for sCD40L dosage were taken at baseline immediately before PCI. We tested the relation between sCD40L and pre-specified outcome measures consisting of new ACS, clinical restenosis and all-cause mortality. We recruited 3,841 patients (mean age 64 ± 11 years, 79% men) with ACS (n=2,383) or CCS (n=1,458). Results During a mean follow-up of two years (±0.6 years), 642 patients developed ACS, 409 developed restenosis (≥70% of at least one of the previously treated coronary segments) and 175 died. For each 1-standard deviation increase in sCD40L (0.80 ng/mL), the hazard ratios (HRs) for ACS, restenosis, and mortality were 1.11 (95% confidence interval [CI]: 1.05 to 1.18, p<0.0001), 1.10 (95% CI: 1.02 to 1.19, p=0.010), and 1.00 (95% CI: 0.86 to 1.16, p=0.983), respectively. In multivariable Cox regression models with adjustment for several potential confounders including age, acute or chronic coronary syndrome, multi-vessel disease, stent placement, diabetes, previous coronary events and dyslipidemia, sCD40L remained an independent predictor of ACS and coronary restenosis. There were no interactions between sCD40L and acute or chronic coronary syndrome or stent placement. Conclusions Among patients with ACS or CCS who undergo PCI, higher levels of sCD40L predict an increased risk of acute coronary events and coronary restenosis, but not of mortality.

scholarly journals The Rise of Transradial Artery Access for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndromes in Australia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Ryan James Ocsan ◽  
Ata Doost ◽  
Paul Marley ◽  
Ahmad Farshid
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Bypass Graft ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Percutaneous Coronary

Objectives. The aim of this study was to evaluate the outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) via transradial artery access (TRA) or transfemoral artery access (TFA). Background. Over the last decade, evidence for the benefit of TRA for PCI has grown, leading to a steady uptake of TRA around the world. Despite this, the topic remains controversial with contrary evidence to suggest no significant benefit over TFA. Methods. A retrospective study of consecutive ACS patients from 2011 to 2017 who underwent PCI via TRA or TFA. The primary outcome was Major Adverse Cardiovascular Events (MACE), a composite of death, myocardial infarction (MI), target lesion revascularisation (TLR), or coronary artery bypass graft surgery (CABG) at 12 months. Secondary outcomes included Bleeding Academic Research Consortium (BARC) bleeding events scored 2 or higher, haematoma formation, and stent thrombosis, in addition to all individual components of MACE. Results. We treated 3624 patients (77% male), with PCI via TFA (n = 2391) or TRA (n = 1233). Transradial artery access was associated with a reduction in mortality (3% vs 6.3%; p < 0.0001 ), MI (1.8% vs 3.9%; p = 0.0004 ), CABG (0.6% vs 1.5%; p = 0.0205 ), TLR (1% vs 2.9%; p < 0.0001 ), large haematoma (0.4% vs 1.8%; p = 0.0003 ), BARC 2 (0.2% vs 1.1%; p = 0.0029 ), and BARC 3 events (0.4% vs 1.0%; p = 0.0426 ). On multivariate Cox regression analysis, TFA, age ≥ 75, prior PCI, use of bare metal stents, cardiogenic shock, cardiac arrest, and multivessel coronary artery disease were associated with an increased risk of MACE. Conclusion. Despite the limitations secondary to the observational nature of our study and multiple confounders, our results are in line with results of major trials and, as such, we feel that our results support the use of TRA as the preferred access site in patients undergoing PCI for ACS to improve patient outcomes.

Platelet monitoring for PCI

2009 ◽  
Vol 29 (04) ◽  
pp. 376-380 ◽  
Author(s):  
D. Capodanno ◽  
D. J. Angiolillo
Keyword(s):  
Interindividual Variability ◽  
State Of The Art ◽  
Coronary Intervention ◽  
Functional Tests ◽  
Treatment Regimens ◽  
Advantages And Disadvantages ◽  
Coronary Syndrome ◽  
Combined Use ◽  
Increased Risk ◽  
Percutaneous Coronary

SummaryDespite the clinical benefit associated with the combined use of aspirin and clopidogrel in patients with acute coronary syndrome or those undergoing percutaneous coronary intervention, a considerable interindividual variability in response to these drugs have been consistently reported. There is a growing interest on applying platelet functional tests with the goal of identifying patients at increased risk of recurrent ischaemic events and potentially tailoring antiplatelet treatment regimens.This manuscript will review the state of the art on the most commonly available platelet functional tests, describing their advantages and disadvantages and exploring their applicability in clinical practice.

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

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.

Association between Vitamins and Minerals with Antioxidant Effects and Coronary Artery Calcification in Adults and Older Adults: A Systematic Review

2019 ◽  
Vol 25 (22) ◽  
pp. 2474-2479 ◽  
Author(s):  
Alisson Diego Machado ◽  
Gustavo Rosa Gentil Andrade ◽  
Jéssica Levy ◽  
Sara Silva Ferreira ◽  
Dirce Maria Marchioni
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Serum Levels ◽  
Antioxidant Compounds ◽  
Increased Risk ◽  
Coronary Events ◽  
Antioxidant Effects

Background: Coronary Artery Calcification (CAC) is considered an important cardiovascular risk factor. There is evidence that CAC is associated with an increased risk of atherosclerosis, coronary events and cardiovascular mortality. Inflammation is one of the factors associated with CAC and despite the interest in antioxidant compounds that can prevent CAC, its association with antioxidants remains unclear. Objective: This study aimed to systematically review the association between vitamins and minerals with antioxidant effects and CAC in adults and older adults. Methods: We conducted a systematic review using PubMed for articles published until October 2018. We included studies conducted in subjects aged 18 years and older with no previous cardiovascular disease. Studies involving animal or in vitro experiments and the ones that did not use reference methods to assess the CAC, dietary intake or serum levels of vitamin or mineral were excluded. Results: The search yielded 390 articles. After removal of duplicates, articles not related to the review, review articles, editorials, hypothesis articles and application of the inclusion and exclusion criteria, 9 articles remained. The results of the studies included in this systematic review suggest that magnesium is inversely associated with CAC and results on the association between CAC and vitamin E have been conflicting. Conclusion: Additional prospective studies are needed to elucidate the role of these micronutrients on CAC.

P1549Serum soluble Klotho is associated with extent of coronary artery calcification in patients with stable angina pectoris undergoing percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Koga ◽  
S Ikeda ◽  
R Akashi ◽  
Y Yamagata ◽  
T Yonekura ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Stable Angina ◽  
Coronary Artery Calcification ◽  
Coronary Intervention ◽  
Soluble Form ◽  
Stable Angina Pectoris ◽  
Low Calcium ◽  
Percutaneous Coronary

Abstract Background Klotho, which was originally identified as an aging suppressor, is a key regulator of bone and mineral metabolism. Transmembrane and soluble forms of Klotho protein have been identified. The transmembrane form serves as an obligate co-receptor for fibroblast growth factor 23 (FGF23). However, the physiological importance of soluble form of Klotho has not been determined. Purpose The present study aimed to test the hypothesis that circulating soluble Klotho levels can predict the presence or extent of coronary artery calcification (CAC) in patients with coronary artery disease. Methods We analyzed CAC of culprit lesions in patients with 75 stable angina pectoris who were not on dialysis and were scheduled for percutaneous coronary intervention (PCI) following intravascular ultrasound (IVUS). Arc and length of each calcium within the culprit lesion was measured by IVUS. The main outcome measure was the calcium index; a volumetric IVUS-derived measure which was calculated as total calcium length/lesion length × maximal calcium arc/360°. Low calcium index was defined as calcium index <0.042 of the first quartile value. Serum Klotho and FGF23 were measured before PCI. Patients were divided into two groups according to median serum Klotho value: low-Klotho (n=37, ≤460 pg/mL) and high-Klotho group (n=38, >460 pg/mL). Results Compared with patients with low-Klotho, those with high-Klotho had higher estimated glomerular filtration rate (eGFR) (69±20 vs. 55±16 mL/min/1.73 m2, p<0.001), lower FGF23 levels (51±24 vs. 67±41 pg/mL, p=0.010). Patients with high-Klotho had significantly lower calcium index than those with low-Klotho (0.17±0.21 vs. 0.24±0.23, p=0.043). Serum Klotho levels correlated significantly and inversely with calcium index (r=−0.31, p=0.006). The correlation between Klotho and calcium index was pronounced at analysis in patients with eGFR <60 mL/min/1.73 m2 (r=−0.52, p<0.001). Logistic regression analysis showed that high-Klotho is a sole significant independent factor associated with low calcium index (odds ratio 7.17, p=0.004). Presence of high-Klotho had high sensitivity and negative predictive value for identifying low calcium index (83% and 92%, respectively). Conclusions Serum Klotho values were independently and inversely associated with the degree of CAC assessed by IVUS. These findings have important clinical implications for serum Klotho as a biomarker that reflects the extent of CAC.

IMMEDIATE AND 4-YEAR OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN CORONARY ARTERY DISEASE

2021 ◽  
pp. 8-11
Author(s):  
Saroj Mandal ◽  
Sidnath Singh ◽  
Kaushik Banerjee ◽  
Aditya Verma ◽  
Vignesh R.
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Mean

Background: The treatment of LMCAD has shifted from coronary artery bypass grafting (CABG) to Percutaneous coronary intervention (PCI). However, data on long-term outcomes of PCI for LMCA disease, especially in patients with acute coronary syndrome (ACS) remains limited and conicting. This study aims to nd the association of the immediate and 4-year mortality in ACS patients with LMCA disease treated by PCI based on ejection fractions at admission. Methods: A retrospective analytical study was conducted. Patients were divided at admission into those with reduced left ventricular ejection fraction and those with preserved ejection fraction. Results: Forty (58.8%) of the patients presented with preserved EF. The mean age of the patients was 71.6±7.1 years. The mean LVEF of the preserved group was 61.6±4.3% and signicantly higher than that of the reduced group. Age and cardiovascular risk factor prole was similar between the two groups. Patients with reduced ejection fraction had signicantly higher levels of serum creatinine and signicantly lower levels of Hb and HDL. Mean hospital stay was signicantly longer for patients with preserved EF. In-hospital deaths were also similar between the two groups. The reduced EF group had a signicantly higher allcause mortality in the 4-year follow-up period. The mean years of follow-up for all participants was 4.2±1.3 years. Conclusion: It was seen that in patients presenting with ACS and undergoing PCI due to LMCAD, LVEF at admission, singly and in in multivariate regression is an important predictor of in hospital and 4-year mortality

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

scholarly journals Recurrent Spontaneous Coronary Artery Dissection in 4 Vascular Territories

2018 ◽  
Vol 45 (2) ◽  
pp. 106-109
Author(s):  
Nader Makki ◽  
Poorvi Dalal ◽  
Quinn Capers ◽  
Ernest Mazzaferri ◽  
Talal Attar
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Premenopausal Women ◽  
Rare Condition ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Multiple Episodes

Spontaneous coronary artery dissection, a rare cause of acute coronary syndrome, is due to nonatherosclerotic coronary events and is probably underrecognized as a cause of myocardial infarction. The condition typically affects premenopausal women who are otherwise healthy. Among more than 1,200 reported cases, recurrent dissection has been described 63 times, and only 3 reports have documented multiple episodes of dissection involving different vascular territories. We present the case of a woman in her 30s who, over a 9-year period, presented 4 times with coronary dissection in different vascular territories. She was first treated conservatively, then with stents, and ultimately by means of coronary artery bypass grafting. In addition to this case, we discuss this rare condition and its management.

Abstract 1849: Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Disease in Octogenarians

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan DeBlois ◽  
Pierre Voisine ◽  
Olivier F Bertrand ◽  
Siamak Mohammadi ◽  
Gerald Barbeau ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Cerebrovascular Event ◽  
Left Main ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Very little data exists regarding percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass graft (CABG) for the treatment of unprotected left main disease (LMD) in octogenarians, and no studies to date have compared CABG and PCI for the treatment of LMD in this population. The objectives of our study were to compare the acute and midterm follow-up results of PCI and CABG for the treatment of significant LMD in octogenarians. Methods: A total of 163 consecutive patients ≥80 years old diagnosed with LMD have undergone coronary revascularization in our center between 2002 and 2006. One hundred and one patients underwent CABG and 62 patients had PCI (non-surgical candidates: 30%, very high surgical risk patients: 61%, patient refusal of CABG: 9%). All complications occurring within the first 30 days following the procedure were recorded, and major adverse cardiovascular events -MACCE- (cardiac death, myocardial infarction, cerebrovascular event, revascularization) were evaluated at follow-up. Results: Patients who underwent PCI were older (85 ± 3 yrs vs. 82 ± 2 yrs, p<0.0001), presented more frequently with an acute coronary syndrome (92% vs. 50%, p<0.0001), and had a higher EuroSCORE (9.5 ± 2.7 vs. 8.5 ± 2.5, p=0.01). Drug-eluting stents were used in 48% of PCI patients. There were no significant differences in the incidence of MACCE at 30 days between groups (CABG: 28%, PCI: 19%, p=0.22), but the CABG group was associated with a higher rate of atrial fibrillation (48% vs. 14%, p<0.0001) and acute renal failure (17% vs. 6%, p=0.05). The incidence of MACCE occurring between 30 days and 24 ± 17 months follow-up was higher in the PCI group (32% vs. 13%, p=0.005), but the cumulative incidence of MACCE was similar in both groups (CABG 39% vs. PCI 44%, p=0.53). Conclusions: PCI was associated with a 30-day cardiac event rate similar to that of CABG for the treatment of unprotected LMD in octogenarians. Surgical patients experienced fewer cardiac events during the follow-up period, but the cardiovascular event-free survival rate was similar between groups at 2-year follow-up. Further randomized studies with longer-term follow-up comparing both revascularization strategies in this high risk coronary population are warranted.

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