scholarly journals predictors of long-term fatal cardiovascular events after planned percutaneous coronary interventions

2018 ◽  
pp. 34-43
Author(s):  
E. O. Vershinina ◽  
A. N. Repin
Keyword(s):  
Antiarrhythmic Drugs ◽  
Kidney Injury ◽  
Heart Rhythm ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Cerebrovascular Accident ◽  
Clinical Complications ◽  
Erythrocyte Sedimentation ◽  
Heart Rhythm Disorders ◽  
Percutaneous Coronary

Aim.To evaluate the frequency and identify predictors of long­term fatal cardiovascular events (CVE) after planned percutaneous coronary interventions (PCI).Material and methods. We conducted a retrospective study that included 150 patients who underwent planned endovascular intervention on the coronary arteries. Outcomes of interventions were assessed 6 years after the PCI, by analyzing medical records and telephone interviews. The primary endpoint of the study was cardiovascular­related death.Results.Fatal CVE were recorded in 10,6% of patients. A statistically significant relationship was found between the development of fatal CVE in the long­term period after planned PCI and the presence of initial chronic obstructive pulmonary disease in patients (OR=12,3; CI (3,6­41,5); р<0,001), atrial fibrillation (OR=5,1; CI (1,6­16,3); p=0,003), diabetes mellitus (OR=3,2; CI (1,1­9,8); p=0,032), acute cerebrovascular accident (OR=8,6; CI (2,0­36,4); p=0,001); any clinical complications of interventions (OR=3,1; CI (1,1­9,0); p=0,028), taking of antiarrhythmic drugs (OR=5,9; CI (1,3­27,4); p=0,012), statins taking at the time of PCI (OR=0,3; CI (0,1­0,8); p=0,013). According to the results of the ROC­analysis, the most significant predictor of fatal CVE in the long­term period was erythrocyte sedimentation rate more than 14,5 mm/h (AUC=0,677; CI (0,507­0,835); p=0,027). According to 6­year observation, Kaplan­Meier curves showed a significant effect of multifocal atherosclerosis, acute periprocedural kidney injury and heart rhythm disorders recorded during PCI, on the incidence of long­term fatal CVE.Conclusion.A statistically significant relationship between the development of fatal CVE in the long­term period after planned PCI and the presence of initial comorbid pathology in patients (chronic obstructive pulmonary disease, atrial fibrillation, diabetes mellitus, multifocal atherosclerosis, acute cerebrovascular accident), erythrocyte sedimentation rate more than 14,5 mm/h, concomitant drug therapy at the time of the intervention (taking of antiarrhythmic drugs, statins). Significant predictors of adverse long­term outcome after planned endovascular myocardial revascularization were clinical complications of PCI, recorded during the hospital period, especially acute periprocedural kidney injury and heart rhythm disorders.

Heart rhythm disorders in patients with chronic obstructive pulmonary disease

2016 ◽  
Author(s):  
Sergiu Matcovschi ◽  
Valentin Calancea ◽  
Tatiana Dumitras ◽  
Nicolae Bodrug ◽  
Doina Barba ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Heart Rhythm ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Heart Rhythm Disorders

scholarly journals Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial

2019 ◽  
Vol 6 (4) ◽  
pp. 222-230
Author(s):  
Mariusz Tomaniak ◽  
Ply Chichareon ◽  
Kuniaki Takahashi ◽  
Norihiro Kogame ◽  
Rodrigo Modolo ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Aims To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence. Methods and results This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm. Conclusion In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected. Clinical trial registration unique identifier NCT01813435.

Incidence and causes of new-onset dyspnea in 3,719 patients treated with clopidogrel and aspirin combination after coronary stenting

2008 ◽  
Vol 100 (08) ◽  
pp. 314-318 ◽  
Author(s):  
Ilya Pokov ◽  
Wiktor Kuliczkowski ◽  
Javad Vahabi ◽  
Dan Atar ◽  
Victor Serebruany
Keyword(s):  
Antiplatelet Agent ◽  
Coronary Intervention ◽  
Underlying Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Telephone Interviews ◽  
Coronary Stent Implantation ◽  
Percutaneous Coronary ◽  
Registry Analysis

SummaryThe experimental oral antiplatelet agent AZD6140 causes dyspnea in randomized trials. Whether clopidogrel may also cause dyspnea remains controversial. We sought to define the incidence and causes of dyspnea in a large post-percutaneous coronary intervention (PCI) cohort based on open-labeled consecutive registry analysis of in-hospital charts and discharge diagnoses. Data were collected at six-month follow-up by means of telephone interviews or returned questionnaires during outpatient visits. Patients undergoing coronary stent implantation were loaded with 600 mg clopidogrel followed by 75 mg/daily in combination with 75–325 mg of aspirin daily for at least six months. Data from 3,719 patients were analyzed. Dyspnea was diagnosed in 157 (4.2%) patients caused by chronic obstructive pulmonary disease (n=43 or 27% of the dyspnea group), heart failure (n=30 or 19%), cancer (n=22 or 14%), pneumonia (n=17 or 11%); asthma (n=8 or 5%), pulmonary hypertension (n=8 or 5%);pericarditis (n=5 or 3%);cardiac arrhythmias (n=4 or 2.5%); pleural effusion (n=1), pulmonary embolism (n=1), anxiety (n=1), or unknown (n=17,or 11%).The incidence of dyspnea at six months in a post-stent cohort treated with aspirin and clopidogrel is low (4.2%). The majority of patients with dyspnea (140/157) exhibit a distinct underlying disease or condition, in contrast to only 17 patients (0.45% of total cohort) in whom the pathogenesis of dyspnea remained unidentified. These data closely match the frequency of dyspnea that was observed in the CAPRIE trial, suggesting that therapy with clopidogrel, and/or aspirin holds very small (if any) risk for dyspnea.

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