scholarly journals Prognostic Value of Fibrinogen in Patients With Coronary Artery Disease and Prediabetes or Diabetes Following Percutaneous Coronary Intervention: Five-year Findings From a Large Cohort Study

2021 ◽  
Author(s):  
Deshan Yuan ◽  
Ping Jiang ◽  
Pei Zhu ◽  
Sida Jia ◽  
Ce Zhang ◽  
...  
Keyword(s):  
Fasting Blood Glucose ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Cardiac Mortality ◽  
Glycemic Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Large Cohort Study ◽  
Artery Disease

Abstract Background: Fibrinogen (FIB) is an independent risk factor for mortality and cardiovascular events in the general population. However, the relationship between FIB and long-term mortality among CAD patients undergoing PCI remains unclear, especially in individuals complicated with diabetes mellitus (DM) or prediabetes (Pre-DM). Methods: 6,140 patients with CAD undergoing PCI were included in the study and subsequently divided into three groups according to FIB levels (FIB-L, FIB-M, FIB-H). These patients were further grouped by glycemic status [normoglycemia (NG), Pre-DM, DM]. The primary endpoint was all-cause mortality. The secondary endpoint was cardiac mortality. Results: FIB was positively associated with hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) in CAD patients with and without DM (P <0.001). During a median follow-up of 5.1 years, elevated FIB was significantly associated with long-term all-cause mortality (adjusted HR: 1.86; 95% CI: 1.28-2.69; P=0.001) and cardiac mortality (adjusted HR: 1.82; 95% CI: 1.15-2.89; P=0.011). Similarly, patients with DM, but not Pre-DM, had increased risk of all-cause and cardiac mortality compared with NG group (all P<0.05). When grouped by both FIB levels and glycemic status, diabetic patients with medium and high FIB levels had higher risk of mortality [(adjusted HR: 2.57; 95% CI: 1.12-5.89), (adjusted HR: 3.04; 95% CI: 1.35-6.82), all P<0.05]. Notably, prediabetic patients with high FIB also had higher mortality risk (adjusted HR: 2.27; 95% CI: 1.01-5.12). Conclusions: FIB was strongly associated with long-term all-cause and cardiac mortality among CAD patients undergoing PCI, especially in those with DM and Pre-DM. FIB test may help to identify high-risk individuals in this specific population.

scholarly journals Prognostic value of fibrinogen in patients with coronary artery disease and prediabetes or diabetes following percutaneous coronary intervention: 5-year findings from a large cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Deshan Yuan ◽  
Ping Jiang ◽  
Pei Zhu ◽  
Sida Jia ◽  
Ce Zhang ◽  
...  
Keyword(s):  
Fasting Blood Glucose ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Cardiac Mortality ◽  
Glycemic Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Large Cohort Study ◽  
Artery Disease

Abstract Background Fibrinogen (FIB) is an independent risk factor for mortality and cardiovascular events in the general population. However, the relationship between FIB and long-term mortality among CAD patients undergoing PCI remains unclear, especially in individuals complicated with diabetes mellitus (DM) or prediabetes (Pre-DM). Methods 6,140 patients with CAD undergoing PCI were included in the study and subsequently divided into three groups according to FIB levels (FIB-L, FIB-M, FIB-H). These patients were further grouped by glycemic status [normoglycemia (NG), Pre-DM, DM]. The primary endpoint was all-cause mortality. The secondary endpoint was cardiac mortality. Results FIB was positively associated with hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) in CAD patients with and without DM (P < 0.001). During a median follow-up of 5.1 years (interquartile range 5.0–5.2 years), elevated FIB was significantly associated with long-term all-cause mortality (adjusted HR: 1.86; 95% CI 1.28–2.69; P = 0.001) and cardiac mortality (adjusted HR: 1.82; 95% CI 1.15–2.89; P = 0.011). Similarly, patients with DM, but not Pre-DM, had increased risk of all-cause and cardiac mortality compared with NG group (all P < 0.05). When grouped by both FIB levels and glycemic status, diabetic patients with medium and high FIB levels had higher risk of mortality [(adjusted HR: 2.57; 95% CI 1.12–5.89), (adjusted HR: 3.04; 95% CI 1.35–6.82), all P < 0.05]. Notably, prediabetic patients with high FIB also had higher mortality risk (adjusted HR: 2.27; 95% CI 1.01–5.12). Conclusions FIB was independently associated with long-term all-cause and cardiac mortality among CAD patients undergoing PCI, especially in those with DM and Pre-DM. FIB test may help to identify high-risk individuals in this specific population.

Prognostic Impact of Red Cell Distribution Width on the Development of Contrast Induced Nephropathy, Major Adverse Cardiac Events, and Mortality in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.

2021 ◽  
Vol 17 ◽  
Author(s):  
Azka Latif ◽  
Muhammad Junaid Ahsan ◽  
Noman Lateef ◽  
Vikas Kapoor ◽  
Hafiz Muhammad Fazeel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Distribution Width ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease

: 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.

Real-world referral pattern and outcomes of diabetic patients who undergo revascularization: data from the prospective Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry†

2019 ◽  
Vol 56 (2) ◽  
pp. 328-334 ◽  
Author(s):  
Eilon Ram ◽  
Ilan Goldenberg ◽  
Leonid Sternik ◽  
Yael Peled ◽  
Amit Segev ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Term Survival ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Percutaneous Revascularization ◽  
Vessel Coronary Artery

Abstract OBJECTIVES Diabetes mellitus patients with multivessel coronary artery disease present with a poor prognosis. We aimed to explore real-life clinical outcomes of diabetic patients who were referred for coronary revascularization. METHODS We used data from the Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry. Using descriptive statistics, Kaplan–Meier, Cox and logistic regression, we described a revascularization referral pattern, short-term outcomes and long-term survival among 475 diabetic patients with multivessel and/or left main disease, 48% of whom underwent surgical and 52% percutaneous revascularization. RESULTS Factors independently associated with referral for surgery included the presence of left main stenosis [odds ratio (OR) 1.89; P = 0.030] and a higher Syntax score (OR 1.15 per point increment; P < 0.001), whereas an older age (OR 1.03 per 1-year increment in age; P = 0.019), prior percutaneous coronary intervention (OR 1.83; P = 0.009) and the presence of renal impairment (OR 2; P = 0.026) were associated with percutaneous coronary intervention referral. At 7 months of follow-up, multivariable analysis did not reveal any difference in mortality risk between the surgical and percutaneous revascularization groups [hazard ratio (HR) 1.23, 95% confidence interval (CI) 0.5–3.04; P = 0.649], whereas after 7 months, surgical revascularization was associated with a significant survival benefit (HR 2.24, 95% CI 1.03–4.87; P = 0.042). CONCLUSIONS Our observation suggests that in a real-world setting, only approximately one-half of diabetic patients with multivessel disease are referred to surgical revascularization despite guideline indications. Surgical compared to percutaneous revascularization in this population was associated with improved long-term survival that became evident 7 months after the revascularization procedure.

Prognostic Value of Admission Blood Urea Nitrogen/Creatinine Ratio in Patients with STEMI Undergoing Late Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Caijuan Dong ◽  
Yanbo Xue ◽  
Yan Fan ◽  
Ruochen Zhang ◽  
Yunfei Feng ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Blood Urea Nitrogen ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Creatinine Ratio ◽  
Cardiac Mortality ◽  
Urea Nitrogen ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Objective: Numerous patients with ST-segment elevation myocardial infarction (STEMI), especially in developing countries, undergo late percutaneous coronary intervention (PCI), defined as time of PCI > 24 hours from symptom onset. This study is aimed to identify the predictive value of admission blood urea nitrogen/creatinine ratio (BUN/Cr) on long-term all-cause mortality and cardiac mortality in STEMI patients receiving late PCI. Methods: Eligible STEMI patients who received late PCI between 2009 and 2011 were consecutively enrolled. They were classified into two groups based on the median BUN/Cr: low BUN/Cr group and high BUN/Cr group. Patients were followed up by phone or face to face interviews and medical records review. The primary endpoint was defined as all-cause mortality and cardiac mortality. Results: 780 STEMI patients were enrolled finally. The median BUN/Cr was 14.29. The median follow-up period was 41 months, with 37 all-cause deaths and 25 cardiac deaths. Compared to the low BUN/Cr group, high BUN/Cr group had higher all-cause mortality (6.4% vs. 3.1%, P=0.029), and cardiac mortality (6.3% vs. 1.5%, P<0.001). The Cox proportional hazard analysis revealed that high BUN/Cr at admission was an independent predictor of long-term cardiac mortality (P=0.003), but not of all-cause mortality (P=0.077). Conclusions: High BUN/Cr ratio at admission was an independent predictor of cardiac mortality in STEMI patients receiving late PCI. Brief Summary: In a retrospective study of STEMI patients receiving late PCI, we found that high BUN/Cr ratio (BUN/Cr>14.29) at admission was an independent predictor of long-term cardiac mortality, but not of all-cause mortality. The study showed that BUN/Cr ratio could be a potential indicator of risk stratification models for STEMI patients undergoing late PCI.

scholarly journals Percutaneous coronary intervention outcomes in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

Rheumatology ◽  
2020 ◽  
Vol 59 (9) ◽  
pp. 2512-2522 ◽  
Author(s):  
Sara C Martinez ◽  
Mohamed Mohamed ◽  
Jessica Potts ◽  
Abhishek Abhishek ◽  
Edward Roddy ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Lupus Erythematosus ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Autoimmune Rheumatic Disease ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease ◽  
National Perspective

Abstract Objective Patients with autoimmune rheumatic disease (AIRD) are at an increased risk of coronary artery disease. The present study sought to examine the prevalence and outcomes of AIRD patients undergoing percutaneous coronary intervention (PCI) from a national perspective. Methods All PCI-related hospitalizations recorded in the US National Inpatient Sample (2004–2014) were included, stratified into four groups: no AIRD, RA, SLE and SSc. We examined the prevalence of AIRD subtypes and assessed their association with in-hospital adverse events using multivariable logistic regression [odds ratios (OR) (95% CI)]. Results Patients with AIRD represented 1.4% (n = 90 469) of PCI hospitalizations. The prevalence of RA increased from 0.8% in 2004 to 1.4% in 2014, but other AIRD subtypes remained stable. In multivariable analysis, the adjusted odds ratio (aOR) of in-hospital complications [aOR any complication 1.13 (95% CI 1.01, 1.26), all-cause mortality 1.32 (1.03, 1.71), bleeding 1.50 (1.30, 1.74), stroke 1.36 (1.14, 1.62)] were significantly higher in patients with SSc compared with those without AIRD. There was no difference in complications between the SLE and RA groups and those without AIRD, except higher odds of bleeding in SLE patients [aOR 1.19 (95% CI 1.09, 1.29)] and reduced odds of all-cause mortality in RA patients [aOR 0.79 (95% CI 0.70, 0.88)]. Conclusion In a nationwide cohort of US hospitalizations, we demonstrate increased rates of all adverse clinical outcomes following PCI in people with SSc and increased bleeding in SLE. Management of such patients should involve a multiteam approach with rheumatologists.

scholarly journals Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
ChuanNan Zhai ◽  
HongLiang Cong ◽  
Kai Hou ◽  
YueCheng Hu ◽  
JingXia Zhang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Death ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Left Main ◽  
Repeat Revascularization ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease

Abstract Background The optimal revascularization technique in diabetic patients with complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD), remains controversial. The current study aimed to compare adverse clinical endpoints of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM). Methods Relevant studies were found from MEDLINE, OVID, Science Direct, Embase and the Cochrane Central database from January 2010 to April 2019. Risk ratio (RR) with 95% confidence interval (CI) was used to express the pooled effect on discontinuous variables. Outcomes evaluated were all-cause mortality, major adverse cardiac/cerebrovascular events (MACCE), cardiac death, myocardial infarction, stroke, and repeat revascularization. Results Sixteen studies were included (18,224 patients). PCI was associated with the increase risk for MACCE (RR 1.59, 95% CI 1.38–1.85), cardiac death (RR 1.76, 95% CI 1.11–2.80), MI (RR 1.98, 95% CI 1.53–2.57), repeat revascularization (RR 2.61, 95% CI 2.08–3.29). The risks for all-cause mortality (RR 1.23, 95% CI 1.00–1.52) and stroke (RR 0.71, 95% CI 0.48–1.03) were similar between two strategies. Stratified analysis based on studies design and duration of follow-up showed largely similar findings with the overall analyses, except for a significant increased risk of all-cause mortality (RR 1.32, 95% CI 1.04–1.67) in long-term group, and CABG was associated with a higher stroke rate compared to PCI, which are results that were found in RCTs (RR 0.47, 95% CI 0.28–0.79) and mid-term groups (RR 0.39, 95% CI 0.23–0.66). Conclusions CABG was superior to PCI for diabetic patients with complex CAD (including left main CAD and/or MVD), but might be associated with a higher risk of stroke mid-term follow-up. Number of Protocol registration PROSPERO CRD 42019138505.

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