scholarly journals Independent Predictors of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention During Hospitalization

Kardiologiia ◽  
2018 ◽  
Vol 58 (12) ◽  
pp. 22-29 ◽  
Author(s):  
J. A. Mansurova ◽  
L. K. Karazhanova
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Stent Thrombosis ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Purpose: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period.Materials and methods. We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12–48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end­points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy.Results. Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F­induced RPR (р<0.001), levels of creatinine (р<0.001), hemoglobin (р<0.001), and glucose (р=0.026), age (р=0.01), iron­deficiency anemia (р=0.01), left ventricular ejection fraction (р=0.004), number of stents (р=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP­induced RPR >76 % (р=0.003), levels of creatinine >189 µmol / L (р=0.003), and hemoglobin <114 g / L (р=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (А / А) on development of stent thrombosis was also detected (р=0.028).Conclusion. ADP­induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.

Abstract 14068: One-year Outcomes of Dpp-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching From Data of Multicenter Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takehiro Hata ◽  
Kentaro Jujo
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Dipeptidyl Peptidase 4 Inhibitors

Introduction: Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Results: Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B). Conclusion: Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.

Role of beta blockers following percutaneous coronary intervention for acute coronary syndrome

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316605
Author(s):  
Kah Yong Peck ◽  
Nick Andrianopoulos ◽  
Diem Dinh ◽  
Louise Roberts ◽  
Stephen J Duffy ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cox Proportional Hazards Model ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

AimsThere is a paucity of evidence supporting routine beta blocker (BB) use in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The aim of this study was to evaluate BB use post PCI and its association with mortality. Furthermore, the study aimed to evaluate the association between BB and mortality in the subgroups of patients with left ventricular ejection fraction (LVEF) <35%, LVEF 35%–50% and LVEF >50%.MethodsUsing a large PCI registry, data from patients with ACS between January 2005 and June 2017 who were alive at 30 days were analysed. Those patients taking BB at 30 days were compared with those who were not taking BB. The primary outcome was all-cause mortality. The mean follow-up was 5.3±3.5 years.ResultsOf the 17 562 patients, 83.3% were on BB. Mortality was lower in the BB group (13.1% vs 19.5%, p=0.0001). Multivariable Cox proportional hazards model showed that BB use was associated with lower overall mortality (adjusted HR 0.87, 95% CI 0.78 to 0.97, p=0.014). In the subgroup analysis, BB use was associated with reduced mortality in LVEF <35% (adjusted HR 0.63, 95% CI 0.44 to 0.91, p=0.013), LVEF 35%–50% (adjusted HR 0.80, 95% CI 0.68 to 0.95, p=0.01), but not LVEF >50% (adjusted HR 1.03, 95% CI 0.87 to 1.21, p=0.74).ConclusionBB use remains high and is associated with reduced mortality. This reduction in mortality is primarily seen in those with reduced ejection fraction, but not in those with preserved ejection fraction.

Abstract 311: One-year Outcomes of DPP-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching from Data of Multicenter Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Takehiro Hata ◽  
Nobuhisa Hagiwara ◽  
Kentaro Jujo
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Dipeptidyl Peptidase 4 Inhibitors

Introduction: Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Results: Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B). Conclusion: Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.

scholarly journals Differing effects of beta-blockers on long-term clinical outcomes following percutaneous coronary intervention between patients with mid-range and reduced left ventricular ejection fraction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Shitara ◽  
Ryo Naito ◽  
Takatoshi Kasai ◽  
Hirohisa Endo ◽  
Hideki Wada ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background The aim of this study was to determine the difference in effects of beta-blockers on long-term clinical outcomes between ischemic heart disease (IHD) patients with mid-range ejection fraction (mrEF) and those with reduced ejection fraction (rEF). Methods Data were assessed of 3508 consecutive IHD patients who underwent percutaneous coronary intervention (PCI) between 1997 and 2011. Among them, 316 patients with mrEF (EF = 40–49%) and 201 patients with rEF (EF < 40%) were identified. They were assigned to groups according to users and non-users of beta-blockers and effects of beta-blockers were assessed between mrEF and rEF patients, separately. The primary outcome was a composite of all-cause death and non-fatal acute coronary syndrome. Results The median follow-up period was 5.5 years in mrEF patients and 4.3 years in rEF patients. Cumulative event-free survival was significantly lower in the group with beta-blockers than in the group without beta-blockers in rEF (p = 0.003), whereas no difference was observed in mrEF (p = 0.137) between those with and without beta-blockers. In the multivariate analysis, use of beta-blockers was associated with reduction in clinical outcomes in patients with rEF (hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.36–0.97; p = 0.036), whereas no association was observed among those with mrEF (HR 0.74; 95% CI 0.49–1.10; p = 0.137). Conclusions Our observational study showed that use of beta-blockers was not associated with long-term clinical outcomes in IHD patients with mrEF, whereas a significant association was observed in those with rEF.

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

Pharmacology of oral antiplatelet drugs

ESC CardioMed ◽  
2018 ◽  
pp. 195-200
Author(s):  
Tabassome Simon
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Compelling Evidence ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Percutaneous Coronary

Compelling evidence from randomized controlled studies have confirmed the efficacy of dual antiplatelet therapy, with aspirin and a P2Y12 inhibitor, in reducing the risk of cardiovascular events particularly among patients with acute coronary syndrome and/or those undergoing percutaneous coronary intervention. They thus represent one of the most frequently prescribed drugs worldwide.

scholarly journals Echocardiographic Parameters as Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Miroslava Sladojevic ◽  
Srdjan Sladojevic ◽  
Dubravko Culibrk ◽  
Snezana Tadic ◽  
Robert Jung
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Right Ventricle ◽  
Validation Cohort ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Echocardiographic Parameters

Different ways have been used to stratify risk in acute coronary syndrome (ACS) patients. The aim of the study was to examine the usefulness of echocardiographic parameters as predictors of in-hospital outcome in patients with ACS after percutaneous coronary intervention (PCI). A data of 2030 patients with diagnosis of ACS hospitalized from December 2008 to December 2011 was used to develop a risk model based on echocardiographic parameters using the binary logistic regression. This model was independently evaluated in validation cohort prospectively (954 patients admitted during 2012). In-hospital mortality in derivation cohort was 7.73%, and 6.28% in validation cohort. Developed model has been designed with 4 independent echocardiographic predictors of in-hospital mortality: left ventricular ejection fraction (LVEF RR=0.892; 95%CI=0.854–0.932,P<0.0005), aortic leaflet separation diameter (AOvs RR=0.131; 95%CI=0.027–0.627,P=0.011), right ventricle diameter (RV RR=2.675; 95%CI=1.109–6.448,P=0.028) and right ventricle systolic pressure (RVSP RR=1.036; 95%CI=1.000–1.074,P=0.048). Model has good prognostic accuracy (AUROC=0.84) and it retains good (AUROC=0.78) when testing on the validation cohort. Risks for in-hospital mortality after PCI in ACS patients using echocardiographic measurements could be accurately predicted in contemporary practice. Incorporation of such developed model should facilitate research, clinical decisions, and optimizing treatment strategy in selected high risk ACS patients.

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