Single-center register of myocardial revascularization in patients with coronary artery disease and acute coronary syndrome in the context of COVID-19 pandemic

2021 ◽  
Vol 20 (6) ◽  
pp. 2876
Author(s):  
O. V. Kamenskaya ◽  
A. S. Klinkova ◽  
I. Yu. Loginova ◽  
V. N. Lomivorotov ◽  
A. M. Chernyavskiy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
Artery Disease

Aim. To assess the short- and long-term outcomes of myocardial re- vascularization (MR) in patients with coronary artery disease (CAD) and acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In the period from April to August 2020, 550 patients with CAD and ACS were included in the register. Emergency percutaneous transluminal coronary angioplasty (n=499) and on-pump coronary artery bypass grafting (CABG) (n=51) were performed. The follow-up period lasted 6 months. The pattern of complications after MR and effects of COVID-19 were analyzed.Results. The studied cohort is represented by patients with CAD >65 years old. ST segment elevation ACS was detected in 23%, acute myocardial infarction — in 59,1%, in other cases — unstable angina. During hospitalization after MR, atrial fibrillation prevailed among cardiovascular complications (4,7%). During this period, 29 (5,3%) patients was diagnosed with COVID-19. In the short-term period after MR, 3 (0,5%) people died due to COVID-19 complications-. In the long-term period after MR, 4 (0,7%) cases of non-fatal stroke were registered, while repeated MR — in 7,1%. The all-cause mortality rate was 1,3% (n=7), of which 57,1% of patients died due to COVID-19 complications. In the subgroup of patients who underwent CABG, the greatest number of in-hospital complications was noted, where exudative pleurisy, atrial fibrillation and anemia prevailed. Of the patients with COVID-19, pneumonia in the short-and long-term posto perative periods was recorded in 48,3 and 61,3%, respectively. Pneumonia is associated with respiratory failure, cardiac dysfunction, and anemia. The risk of COVID-19 pneumonia during the entire follow-up period was higher in patients with ACS who underwent CABG (odds ratio, 19,4; confidence interval: 13,3-26,1; p<0,001). The overall survival rate was 98,7%.Conclusion. COVID-19 infection in patients with ACS after MR effects pattern of postoperative complications. The proportion of COVID-19 pneumonia in patients with ACS in hospital, short-  and long-term postoperative periods after MR significantly exceeds that in the general population. The leading factor associated with COVID-19 pneumonia in patients with ACS is on-pump CABG.

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Balcer ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Conventional Coronary Angiography ◽  
Term Survival ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &lt;13.0g/dl for male and &lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&lt;0.0001; IAP: 2.67 [2.06–3.47], p&lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

scholarly journals Relation of Fibrinogen-to-Albumin Ratio to Severity of Coronary Artery Disease and Long-Term Prognosis in Patients with Non-ST Elevation Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Mingkang Li ◽  
Chengchun Tang ◽  
Erfei Luo ◽  
Yuhan Qin ◽  
Dong Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Albumin Ratio ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease ◽  
Long Term Prognosis

Previous studies showed that fibrinogen-to-albumin ratio (FAR) regarded as a novel inflammatory and thrombotic biomarker was the risk factor for coronary artery disease (CAD). In this study, we sought to evaluate the relationship between FAR and severity of CAD, long-term prognosis in non-ST elevation acute coronary syndrome (NSTE-ACS) patients firstly implanted with drug-eluting stent (DES). A total of 1138 consecutive NSTE-ACS patients firstly implanted with DES from January 2017 to December 2018 were recruited in this study. Patients were divided into tertiles according to FAR levels (Group 1: ≤8.715%; Group 2: 8.715%~10.481%; and Group 3: >10.481%). The severity of CAD was evaluated using the Gensini Score (GS). The endpoints were major adverse cardiovascular events (MACE), including all-cause mortality, myocardial reinfarction, and target vessel revascularization (TVR). Positive correlation was detected by Spearman’s rank correlation coefficient analysis between FAR and GS (r=0.170, P<0.001). On multivariate logistic analysis, FAR was an independent predictor of severe CAD (OR: 1.060; 95% CI: 1.005~1.118; P<0.05). Multivariate Cox regression analysis indicated that FAR was an independent prognostic factor for MACE at 30 days, 6 months, and 1 year after DES implantation (HR: 1.095; 95% CI: 1.011~1.186; P=0.025. HR: 1.076; 95% CI: 1.009~1.147; P=0.026. HR: 1.080; 95% CI: 1.022~1.141; P=0.006). Furthermore, adding FAR to the model of established risk factors, the C-statistic increased from 0.706 to 0.720, 0.650 to 0.668, and 0.611 to 0.632, respectively. And the models had incremental prognostic value for MACE, especially for 1-year MACE (NRI: 13.6% improvement, P=0.044; IDI: 0.6% improvement, P=0.042). In conclusion, FAR was associated independently with the severity of CAD and prognosis, helping to improve risk stratification in NSTE-ACS patients firstly implanted with DES.

scholarly journals Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

2017 ◽  
Vol 39 (2) ◽  
pp. 102-110 ◽  
Author(s):  
Hedvig Bille Andersson ◽  
Frants Pedersen ◽  
Thomas Engstrøm ◽  
Steffen Helqvist ◽  
Morten Kvistholm Jensen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Causes Of Death ◽  
Obstructive Coronary Artery Disease ◽  
Term Survival ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

scholarly journals Predictors for dementia during long-term follow-up after aortic valve replacement in an elderly population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
W Mistiaen ◽  
I Deblier ◽  
K Dossche ◽  
A Vanermen
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
Preoperative Predictors ◽  
Emergent Surgery

Abstract Introduction Patients undergoing surgical aortic valve replacement (SAVR) with a biological prosthesis usually receive this type of valve because higher age and comorbid conditions. This is the type of patient for whom transcatheter valve implantation (TAVI) has been developed and applied as a mean for less invasive treatment. However, this is also the age group at risk for dementia, a condition which severely reduces the quality of life. Purpose The predictors for the development of dementia during long-term follow-up after SAVR need identification. Methods From January 2008 to June 2017, 1305 patients underwent SAVR with a biological valve. Of these patients, 1221 left the hospital alive (93.6%). In a retrospective file study, the effect of age, gender, preoperative comorbid condition (chronic renal or pulmonary disease, diabetes, treated or treatable cancer, hypertension, stroke) and cardiac status (left ventricular function, coronary artery disease, myocardial infarction, prior CABG or PCI, severity of symptoms, atrial fibrillation, ventricular arrhythmias, conduction defects with or without a need for permanent pacemaker), operative data (bypass time&gt;120 minutes, concomitant CABG, mitral valve repair, maze procedure, procedure on the ascending aorta) and in-hospital postoperative complications (endocarditis, thromboembolism, bleeding, atrial fibrillation, heart failure, pulmonary and renal complications) on the development of dementia was studied. Factors with an effect in a univariate Kaplan-Meier survival analysis were entered in a Cox' proportional hazard analysis. Results There was a follow-up of 7726 patient-years (mean 5.9y). Five-year survival was 78.8±1.3%. At 10 year, this was 50.7±2.1%. Dementia during long-term follow-up was diagnosed in 162/1080 patients (15%). Predictors for the development of dementia are grouped as 1) preoperative, 2) operative and 3) postoperative, and ranked according the p-value. 1) Preoperative predictors – Age &gt;75 years: Odds ratio: 2.89, with 95% Confidence interval between 2.02–4.14 and p&lt;0.001 – Need for emergent surgery: OR=2.84 (1.56–5.19), p=0.001 – Coronary artery disease: OR=1.57 (1.12–2.21), p=0.009 – Diabetes mellitus: OR=1.56 (1.08–2.24), p=0.017 – Atrial fibrillation: OR=1.51 (1.07–2.15), p=0.020 2) Operative predictors – Bypass time &gt;120 minutes: OR=1.40 (1.01–1.94), p=0.043 3) Postoperative predictors – Delirium: OR=3.35 (2.26–4.97), p&lt;0.001 – Acute renal injury: OR=1.98 (1.39–2.81),p&lt;0.001 – Thromboembolism: OR=2.10 (1.02–4.30), p=0.043 Conclusions Development of dementia during long-term follow-up after SAVR in elderly is not uncommon. High age and need for emergent surgery are the dominant preoperative predictors. Long cardiopulmonary bypass, which is usually a marker for more complex procedures is the only operative predictor. Postoperative delirium during hospital stay is a warning sign. The only modifiable factor is need for emergent surgery. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings

2021 ◽  
Vol 10 (9) ◽  
pp. 1863
Author(s):  
Jorge Rodríguez-Capitán ◽  
Andrés Sánchez-Pérez ◽  
Sara Ballesteros-Pradas ◽  
Mercedes Millán-Gómez ◽  
Rosa Cardenal-Piris ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Obstructive Coronary Artery Disease ◽  
Hazard Ratio ◽  
Coronary Syndrome ◽  
Cardiovascular Prognosis ◽  
Artery Disease

The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20–50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23–2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40–3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10–2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25–3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.

scholarly journals Long-term follow-up after endovascular revascularisation for acute limb ischaemia - a retrospective single-centre cohort

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Fabian Johner ◽  
Robert Clemens ◽  
Marc Husmann ◽  
Christoph Thalhammer ◽  
Burkhardt Seifert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Limb Ischaemia ◽  
Acute Limb Ischemia ◽  
Free Survival ◽  
Acute Limb Ischaemia ◽  
Artery Disease

Abstract. Background: We evaluated the long-term outcome after endovascular revascularisation for acute limb ischaemia (ALI). Patients and methods: From a prospectively maintained database, 318 endovascular interventions for ALI were identified between 2004 and 2010. Event history and survival were analysed using the Kaplan-Meier method and Cox regression. Endpoints were target vessel revascularisation (TVR), non-target extremity revascularisation (NTER), amputation, major vascular events, coronary artery revascularisation and amputation-free survival. Results: Follow-up data of 303 patients (mean age 68.5 ± 12.7 years, 40 % female) were available. The mean follow-up time was 38.7 ± 26.2 months. TVR was performed in 40.1 ± 2.9 % at 1 year and 66.5 ± 3.8 % at 5 years. NTER at 1 and 5 years were 7.1 ± 1.5 % and 29.2 ± 4 %, respectively. The proportion of patients who needed major or minor amputation was 4.3 ± 1.2 % after 1 year and 9 ± 2.1 % after 5 years. Amputation-free survival at 1 year was 90.3 ± 1.8 % and 74.8 ± 3.2 % at 5 years. Coronary artery disease (HR 2.22, 95 % CI 1.33 to 3.7, p = 0.002) and atrial fibrillation (HR 2.56, % CI 1.3 to 5.04, p = 0.007) were independently associated with a worse amputation-free survival. The cumulative proportion surviving one year following acute limb ischemia was 95.4 ± 1.2 % and 79.7 ± 3.1 % after 5 years. Conclusions: Long-term amputation-free survival after successful revascularisation for ALI is high; negative predictors are coronary artery disease and atrial fibrillation.

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