scholarly journals The analysis of in-hospital and long-term results of percutaneous coronary intervention supported by extracorporeal membrane oxygenation in patients with coronary artery disease

2021 ◽  
Vol 10 (4) ◽  
pp. 96-105
Author(s):  
I. E. Vereshchagin ◽  
V. I. Ganyukov ◽  
R. S. Tarasov ◽  
R. A. Kornelyuk

Aim. To analyze in-hospital and long-term (12 months) results of percutaneous coronary intervention (PCI) supported by extracorporeal membrane oxygenation (ECMO) in patients with stable coronary heart disease and multivessel coronary artery disease, and to justify the use of such approach in the treatment of this group of patients.Methods. The retrospective analysis included 13 patients with stable coronary artery and multivessel coronary disease. The mean SYNTAX score before the intervention was 31.4±10.8. Between 30 days and 12 months in the postoperative period, the frequency and type of the following major adverse cardiovascular events (MACE) was assessed: all-cause death, myocardial infarction, stroke, repeat revascularization. Twelve months after the event, the data on the frequency and type of adverse cardiovascular events were collected by means of telephone follow-up.Results. Coronary intervention supported by ECMO was performed in all patients. 8 (61.6%) patients required an open surgical approach for ECMO cannula insertion. Door to balloon time was 109.6±79.2 minutes. The mean duration of ECMO support was 101.7±45.4 minutes. Haemodynamic instability, abnormalities in pulmonary gas exchange and rhythm disturbances were not revealed during primary PCI, making it possible to wean off the ECMO post-PCI. The mean residual SYNTAX score was 9.3±11.8. BARC class ≥3 bleeding complications were observed in 6 of 13 patients. Long-term major adverse cardiovascular events with fatal outcomes occurred in 3 (23.1%) patients.Conclusion. Supporting high-risk PCI with ECMO in patients with stable coronary artery disease, multivessel coronary artery disease and low left ventricular ejection fraction made it possible to successfully perform the intervention in all patients. Nevertheless, the long-term (12 months) results show a high percentage of recurrent myocardial infarction, which can be associated with high residual SYNTAX score.

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Cãlin Homorodean ◽  
Adrian Corneliu Iancu ◽  
Daniel Leucuţa ◽  
Şerban Bãlãnescu ◽  
Ioana Mihaela Dregoesc ◽  
...  

Objectives. The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). Background. Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. Methods. 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. Results. Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). Conclusions. In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up.


2020 ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  

Abstract Background: Suppression of tumorigenesis-2 is implicated in the myocardial overload and it was long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but the data on prognostic value of suppression of tumorigenesis-2 on patients with coronary artery disease remains limited. The study ought to investigate the prognostic value of suppression of tumorigenesis-2 in patients with established coronary artery disease.Methods: In this prospective cohort study, a total of 3641 consecutive patients were included. The primary end point was major adverse cardiovascular events. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p<0.001) and all-cause death (log-rank p<0.001). The secondary end point was all-cause death. The association between suppression of tumorigenesis-2 and outcomes was investigated using multivariable COX regression.Results: During a median follow up of 6.4 years, there were 775 patients had the occurrence of major adverse cardiovascular events and 275 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p<0.001) and all-cause death (log-rank p<0.001). Multiple COX regression models showed that higher level of suppression of tumorigenesis-2 was an independent predictor in developing major adverse cardiovascular events (HR=1.36, 95% CI 1.17-1.56, p<0.001) and all-cause death (HR=2.01, 95%CI 1.56-2.59, p<0.001). The addition of suppression of tumorigenesis-2 to established risk factors significantly improved risk prediction of the composite outcome of major adverse cardiovascular events and all-cause death (c-statistic, net reclassification index, and integrated discrimination improvement, all p<0.05).Conclusions: Higher level of suppression of tumorigenesis-2 is significantly associated with long-term all-cause death and major adverse cardiovascular events. Suppression of tumorigenesis-2 may provide incremental prognostic value beyond traditional risk factors.


Author(s):  
A. Marushko ◽  
G. Mankovsky ◽  
Ye. Marushko ◽  
S. Kuzmenko ◽  
N. Rudenko

At the present time, left main (LM) stenting is an alternative to coronary artery bypass grafting in patients with coronary artery disease (CAD) and haemodynamically significant LM lesion. Despite of long history of LM interventions, long-term results are still poorly understood. Presented data are still conflicting and need further affirmation. Aim. To investigate long-term outcomes of percutaneous coronary intervention (PCI) in patients with LM lesions. Materials and methods. The study included 27 patients with CAD with haemodynamically significant LM lesion who underwent PCI. The risk was calculated using the SYNTAX Score and the SYNTAX Score II in all the patients. According to the results of the calculation, patients were divided into 3 groups: the low risk group (SYNTAX Score = 0-22) included 16 (59.3%) patients, the medium risk group (SYNTAX Score = 23-32) included 8 (29.6%) patients, and the high-risk group (SYNTAX Score > 32) included 3 (11.1%) patients. Results. The incidence of major adverse cardiovascular events during the mean follow-up period of 30.9 months was 11.1%, while 89.9% of patients had good immediate and long-term results of the procedure. Fatal cases were reported only in groups of patients with intermediate and high risk according to evaluation by the SYNTAX score. No fatal cases were observed in low risk group of patients according to the SYNTAX score. Thus, patient affiliation with one of the risk groups based on the SYNTAX Score scale affected the long-term LM PCI outcomes. Conclusions. In patients with LM lesion, PCI can be performed with good long-term results in 89.9% of cases. The main criterion for the selection of patients for LM PCI is the risk calculation data based on the SYNTAX Score scale, taking into account the decision of the Heart Team.


2021 ◽  
Vol 17 ◽  
Author(s):  
Azka Latif ◽  
Muhammad Junaid Ahsan ◽  
Noman Lateef ◽  
Vikas Kapoor ◽  
Hafiz Muhammad Fazeel ◽  
...  

: Red cell distribution width (RDW) serves as an independent predictor towards the prognosis of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention (PCI). A systematic search of databases such as PubMed, Embase, Web of Science, and Cochrane library was performed on October 10th, 2019 to elaborate the relationship between RDW and in hospital and long term follow up all-cause and cardiovascular mortality, major adverse cardiac events (MACE) and development of contrast-induced nephropathy (CIN) in patients with CAD undergoing PCI. Twenty-one studies qualified this strict selection criteria (number of patients = 56,425): one study was prospective, and the rest were retrospective cohorts. Our analysis showed that patients undergoing PCI with high RDW had a significantly higher risk of in-hospital all-cause mortality (OR 2.41), long-term all-cause mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16) and odds of developing CIN (OR: 1.42) when compared to the patients with low RDW. Therefore, incorporating RDW in the predictive models for the development of CIN, MACE, and mortality can help in triage to improve the outcomes in coronary artery disease patients who undergo PCI.


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