scholarly journals Risk Assessment of Cardiac Events in Patients with Stable Ischemic Heart Disease After Percutaneous Coronary Intervention, Accompanied by Myocardial Damage

2019 ◽  
Vol 6 (3) ◽  
pp. 15-24
Author(s):  
A. V. Vorobyova ◽  
B. B. Bondarenko ◽  
V. A. Bart ◽  
M. P. Malgina ◽  
V. V. Dorofeykov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Stable Coronary Artery Disease ◽  
Myocardial Damage ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Cardiac Events ◽  
Percutaneous Coronary ◽  
Artery Disease

Background. Percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD) is followed often by myocardial injury. Up to now there is no mutual agreement to the infl uence of the perioperative myocardial injury on the long-term prognosis of the IHD patients.Objective. The aim of study was to assess the risk factors for the development of cardiac events in the long-term period in patients with stable coronary artery disease with myocardial damage after PCI.Materials and methods. The study included 113 patients with stable coronary artery disease who underwent planned PCI. Serum troponin levels were determined before and 24 hours after the intervention. Re-examination of patients was carried out after 12–18 months (average 15 months).Results. The post PCI Tn I level over a reference one was registered in 25 patients (22,2 %). During the follow-up period the cardiovascular events took place in 25,6 % patients: acute myocardial infarction (MI) in 3 (2,6 %), angina occurred in 23 %. One-way ANOVA revealed a signifi cant value for cardiac risk events of the patient age, number of stenosed arteries, summary degree of stenosis, and their complicity, number of implanted stents. The fi rst three of them were included in the fi nal combination of the stepwise discriminant analysis. The general linear model of the latter detected additionally statistical signifi cance of the variables “MI in the past” (before PCI) and “number of postdilatations“.Conclusion. In patients with stable ischemic heart disease, included in the study, the determining risk factors for the development of cardiac events were the prevalence and nature of the obstructive lesion of the coronary bed, age, previous myocardial infarction, and especially the performance of PCI. Myocardial damage was not identifi ed as a risk factor for recurrent angina or myocardial infarction.

scholarly journals Management of stable coronary artery disease: from evidence to clinical practice

2017 ◽  
Vol 11 (2) ◽  
pp. 114 ◽  
Author(s):  
Riccardo Gerloni ◽  
Luciano Mucci ◽  
Tiziana Ciarambino ◽  
Manuel Ventura ◽  
Valeria Baglio ◽  
...  
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Cardiac Syndrome ◽  
Percutaneous Coronary ◽  
Artery Disease

Ischemic heart disease, the leading cause of death, is extremely diffuse among patients hospitalized in Internal Medicine ward so that Internist should be able to manage correctly this disease. The following review revises the most recent literature and offers a practical clinical guide to be confident on this topic. After having emphasized that clinical overview remains essential, it briefly mentions advantages and limits of different investigations, reminds readers of possible alternative etiopathogeneses of ischemic heart disease (cardiac syndrome X), reports the most appropriate medical therapy, and gives the opportunity to understand appropriateness of specialist strategies such as coronary artery by-pass grafting and percutaneous coronary intervention. Finally, it illustrates a rational and evidence-based follow-up of these patients, considering that only a small part of them should be followed by a Cardiologist. The aim of a correct management of ischemic heart disease remains to reduce mortality and improve the quality of life.

Abstract 38: Bayesian Meta-analysis of Percutaneous Coronary Intervention Compared to Optimal Medical Therapy in Patients With Stable Ischemic Heart Disease or Post-Acute Myocardial Infarction

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lionel J Malebranche ◽  
Aaron Horne ◽  
Doralisa Morrone ◽  
Ruth T Aguiar ◽  
Paul Kolm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Medical Therapy ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Background: The role of Percutaneous Coronary Intervention (PCI) in acute coronary syndromes is well established, but more controversial in stable ischemic heart disease (SIHD). We investigated the outcomes of Myocardial Infarction (MI) / death and all-cause mortality among published trials that compared PCI with optimal medical therapy (OMT). Methods: We retrieved all published papers that compared PCI with OMT in patients with SIHD or post-MI. Three clinician-researchers independently reviewed and abstracted a total of 110 articles meeting our inclusion criteria. 17 randomized controlled trials (RCT) published between 2000 and 2012 were analyzed by Bayesian random effects meta-analysis. Results: 21,256 patients were analyzed: 11,502 had PCI and 9,754 OMT. There was no difference between PCI and OMT for the combined outcome of MI/death across all trials (RR = 0.99, 95% CI = 0.72-1.33, p = 0.98), although there was a trend for benefit with PCI all-cause mortality (RR = 0.81, 95% CI = 0.64-1.05, p = 0.48). When trials were analyzed by patient population, SIHD or post-MI, the trend for mortality benefit was noted only for the post-MI patients (Table 1). Conclusion: PCI did not yield any additional benefit above OMT for the end points of MI/Death or all-cause mortality in SIHD. However, there was a trend for reduced mortality with PCI in post-MI patients.

scholarly journals Effect of ranolazine on the course of ischemic heart disease after percutaneous coronary intervention

2020 ◽  
pp. 5-10
Author(s):  
О.А. Yepanchintseva ◽  
◽  
O.J. Zharinov ◽  
І.V. Shklianka ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Beta Blockers ◽  
Myocardial Damage ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Second Line ◽  
Good Tolerability ◽  
Percutaneous Coronary

Optimization of antiischemic therapy is necessary in many patients with stable forms of coronary heart disease after or during revascularization. From the standpoint of current guidelines, the addition of second-line drugs, in particular ranolazine, to beta-blockers and/or calcium antagonists is considered during anginal attacks due to incomplete revascularization, to prevent myocardial damage during percutaneous coronary interventions, and in cases when revascularization is not possible. The results of many clinical studies have proven the antiischemic effect and safety of ranolazine after coronary artery stenting. Potential advantages of ranolazine compared with other second-line antianginal drugs are the absence of significant changes in hemodynamic parameters, good tolerability and proven antiarrhythmic effects. Key words: chronic ischemic heart disease, percutaneous coronary intervention, ranolazine.

scholarly journals Unique referral system contributes to long-term net clinical benefits in patients undergoing secondary prevention therapy after percutaneous coronary intervention

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242707
Author(s):  
Shigetaka Kageyama ◽  
Koichiro Murata ◽  
Ryuzo Nawada ◽  
Tomoya Onodera ◽  
Yuichiro Maekawa
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Referral System ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Clinical Benefits

Cardiovascular disease, including ischemic heart disease, is a leading cause of death worldwide. Improvement of the secondary prevention of ischemic heart disease is necessary. We established a unique referral system to connect hospitals and outpatient clinics to coordinate care between general practitioners and cardiologists. Here, we evaluated the impact and long-term benefits of our system for ischemic heart disease patients undergoing secondary prevention therapy after percutaneous coronary intervention. This single-center retrospective observational study included 3658 consecutive patients who underwent percutaneous coronary intervention at Shizuoka City Hospital between 2010 and 2019. After percutaneous coronary intervention, patients were considered conventional outpatients (conventional follow-up group) or subjected to our unique referral system (referral system group) at the attending cardiologist’s discretion. To audit compliance of the treatment with the latest Japanese guidelines, we adopted a circulation-type referral system, whereby general practitioners needed to refer registered patients at least once a year, even if no cardiac events occurred. Clinical events in each patient were evaluated. Net adverse clinical events were defined as a combination of major adverse cardiac, cerebrovascular, and major bleeding events. There were 2241 and 1417 patients in the conventional follow-up and referral system groups, with mean follow-ups of 1255 and 1548 days and cumulative net adverse clinical event incidences of 27.6% and 21.5%, respectively. Kaplan–Meier analysis showed that the occurrence of net adverse clinical events was significantly lower in the referral system group than in the conventional follow-up group (log-rank: P<0.001). Univariate and multivariate analyses revealed that the unique referral system was a significant predictor of the net clinical benefits (hazard ratio: 0.56, 95% confidence interval: 0.37–0.83, P = 0.004). This result was consistent after propensity-score matching. In summary, our unique referral system contributed to long-term net clinical benefits for the secondary prevention of ischemic heart disease after percutaneous coronary intervention.

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