Importance of electrocardiographic markers in predicting cardiac events in children

ECG is a common diagnostic tool in medical practice. Sudden cardiac death (SCD) is a rare but devastating event. The most common cause of SCD in the young is a primary arrhythmic event, which is often produced by malignant ventricular arrhythmia. Several electrocardiographic markers for ventricular repolarization and depolarization have been proposed to predict this arrhythmic risk and SCD in children. Although many of these parameters can easily be used in clinical practice, some of them need specific techniques for interpretation. In this review, we summarized the current knowledge regarding the clinical importance and the ability of these ECG parameters to predict adverse cardiac events in the pediatric population.

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Clinical impact of regression from sustained to paroxysmal atrial fibrillation: the Fushimi AF registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0678 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Fujino ◽

H Ogawa ◽

S Ikeda ◽

K Doi ◽

Y Hamatani ◽

...

Keyword(s):

Cardiac Death ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Clinical Impact ◽

Cox Proportional Hazards Model ◽

Cardiac Events ◽

Hazards Model ◽

Adverse Cardiac Events

Abstract Background Atrial fibrillation (AF) commonly progresses from paroxysmal type to sustained type in the natural course of the disease, and we previously demonstrated that the progression of AF was associated with increased risk of clinical adverse events. There are some patients, though less frequently, who regress from sustained to paroxysmal AF, but the clinical impact of the regression of AF remains unknown. Purpose We sought to investigate whether regression from sustained to paroxysmal AF is associated with better clinical outcomes. Methods Using the dataset of the Fushimi AF Registry, patients who were diagnosed as sustained (persistent or permanent) AF at baseline were studied. Conversion of sustained AF to paroxysmal AF during follow-up was defined as regression of AF. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, stroke, and hospitalization for heart failure (HF). Event rates were compared between the patients with and without regression of AF. In patients with sustained AF at baseline, predictors of MACE were identified using Cox proportional hazards model. Results Among 2,253 patients who were diagnosed as sustained AF at baseline, regression of AF was observed in 9.0% (202/2,253, 2.0 per 100 patient-years) during a median follow-up of 4.0 years. Of these, 24.3% (49/202, 4.6 per 100 patient-years) of the patients finally recurred to sustained AF during follow-up. The proportion of asymptomatic patients was lower in patients with regression of AF than those without (with vs without regression; 49.0% vs 69.5%, p<0.01). The percentage of beta-blocker use at baseline was similar between the two groups (37.2% vs 33.8%, p=0.34). The prevalence of patients who underwent catheter ablation or electrical cardioversion during follow-up was higher in patients with regression of AF (catheter ablation: 15.8% vs 5.5%; p<0.01, cardioversion: 4.0% vs 1.4%; p<0.01, respectively). The rate of MACE was significantly lower in patients with regression of AF as compared with patients who maintained sustained AF (3.7 vs 6.2 per 100 patient-years, log-rank p<0.01). Figure shows the Kaplan-Meier curves for MACE, cardiac death, hospitalization for heart failure, and stroke. In patients with sustained AF at baseline, multivariable Cox proportional hazards model demonstrated that regression of AF was an independent predictor of lower MACE (adjusted hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.28 to 0.88, p=0.02), stroke (HR: 0.51, 95% CI: 0.30 to 0.88, p=0.02), and hospitalization for HF (HR: 0.50, 95% CI: 0.29 to 0.85, p=0.01). Conclusion Regression from sustained to paroxysmal AF was associated with a lower incidence of adverse cardiac events. Funding Acknowledgement Type of funding source: None

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Abstract 2562: Two-Year Clinical Follow-Up of COREA-TAXUS Trial: Long-Term Safety And Efficacy of Celecoxib for 6 Months After Paclitaxel-Eluting Stents Implantation

Circulation ◽

10.1161/circ.118.suppl_18.s_747 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jin-Wook Chung ◽

Han-Mo Yang ◽

Dong-A Kwon ◽

Jung-Won Suh ◽

Kyung-Woo Park ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Death ◽

Target Lesion ◽

Controlled Study ◽

Control Group ◽

Cardiac Events ◽

Open Label ◽

Adverse Cardiac Events ◽

Fatal Myocardial Infarction

Background: The effect of celecoxib on restenosis after angioplasty with a Taxus stent (COREA-TAXUS) trial is an open-label randomized controlled study, where we reported celecoxib was effective in reducing 6months late loss of Taxus stent. With this cohort, we analyzed long-term clinical outcomes. Method: Two hundred sixty seven patients underwent successful paclitaxel-eluting stents implantation for native coronary lesions. Patients were randomized to receive celecoxib (400 mg before the intervention, and 200 mg twice daily for 6 months after the procedure) or not. Clinical endpoints were cardiac death, non-fatal myocardial infarction, and revascularization of the target lesion. Results: At 6 months, frequency of adverse cardiac events was significantly lower in the celecoxib group (5.3% versus 16.2%, P=0.005), mainly because of reduced need for revascularization of the target lesion (5.3% versus 15.4%, P=0.009). Between 6 and 24 months, frequency of adverse cardiac events was not different between the celecoxib group and the control group (1.6% versus 4.4%, P=NS: 0% versus 0% for cardiac death; 0.8% versus 0.9% for non-fatal myocardial infarction; 0.8% versus 3.5% for revascularization of target lesion, P=all NS). At 2 years, frequency of adverse cardiac events was still significantly lower in the celecoxib group (6.9% versus 19.9%, P=0.002) Conclusion: In the COREA-TAXUS trial, the adjunctive use of celecoxib for 6 months after Taxus stent implantation was safe and clinically effective for 2 years.

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Abstract 18600: Very Long-term Clinical Outcome After Sirolimus-eluting Stent Implantation

Circulation ◽

10.1161/circ.132.suppl_3.18600 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shoichi Kuramitsu ◽

Hiroaki Matsuda ◽

Hiroyuki Jinnouchi ◽

Takashi Hiromasa ◽

Takenori Domei ◽

...

Keyword(s):

Clinical Outcome ◽

Cumulative Incidence ◽

Cardiac Death ◽

Coronary Intervention ◽

Target Lesion ◽

Cardiac Events ◽

Important Concern ◽

Adverse Cardiac Events ◽

Sirolimus Eluting Stent

Background: Late adverse events such as stent thrombosis (ST) or late target-lesion revascularization (TLR) after sirolimus-eluting stents (SES) implantation remain an important concern. However, there is little data regarding clinical outcome beyond 5 years after SES implantation. We sought to assess very long-term clinical outcome after SES implantation. Methods: Between April 2004 and December 2006, a total of 686 patients with 894 lesions underwent percutaneous coronary intervention only with SES. We assessed the major adverse cardiac events (MACE), defined as a composite of cardiac death, TLR, definite ST. Results: At 10 years, cumulative incidence of MACE and cardiac death were 50.8% and 8.2%, respectively. Cumulative incidence of TLR within 1 year was 12.6%. However, late TLR beyond 1 year continued to occur without attenuation up to 10 years (2.3%/year) (5 years, 22.8%; 10 years, 33.3%). Cumulative incidence of definite ST was low (30 days, 0.3%; 1 year, 0.9%; 5 years, 1.8%; and 10 years, 3.3%), whereas definite ST also continued to occur without attenuation (0.27%/year). The predictors of MACE were hemodialysis (hazard ratio [HR] 2.87, 95% confidence intervals [CI]:1.76-4.53, p <0.001) and age ≥75 years (HR 1.72, 95% CI: 1.31-2.26, p <0.001). Conclusions: Late catch-up phenomenon regarding ST and TLR continued up to 10 years without attenuation. Careful clinical follow-up is required in patients treated with SES beyond 5 years.

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Abstract 20675: Longest Available Follow-Up of Drug-Eluting Stents in Real World Practice - Outcomes up to 12 Years From the DESIRE Registry

Circulation ◽

10.1161/circ.130.suppl_2.20675 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ricardo A Costa ◽

Amanda Sousa ◽

Adriana Moreira ◽

J. Ribamar Costa ◽

...

Keyword(s):

Myocardial Infarction ◽

Stent Thrombosis ◽

Cardiac Death ◽

Cardiac Events ◽

Residual Stenosis ◽

Adverse Cardiac Events ◽

Drug Eluting ◽

Event Rates

Background: Despite the marked efficacy demonstrated by drug-eluting stents (DES) in reducing neointimal proliferation, and therefore, the need for target lesion revascularization (TLR), persistent concerns regarding long-term safety and efficacy, especially in more complex subset, are still. Methods: The DESIRE Registry is a large, prospective, non-randomized, single center study assessing the late outcomes of unselected pts treated with DES. Overall, 5,541 pts were consecutively enrolled from May/02-Jun/14. Clinical follow-up (FU) (97%) was performed yearly up to 12 yrs (median 4.9 yrs). Stent thrombosis (ST) was defined according to the ARC. Results: Mean age was 65 yrs, 31% had diabetes, 29% current smokers, 42% presented with ACS (17% recent myocardial infarction, MI), and the majority of lesions were highly complex (67% type B2/C). Overall, there were 8,919 lesions treated with 9,537 DES, and angiographic success was 99%. During the FU period, cumulative event rates were major adverse cardiac events (cardiac death, myocardial infarction, or TLR) 32%, myocardial infarction 8%, TLR 21%, and cardiac death 6%. As for stent thrombosis, overal rate was 2.4%, given that 95% of patients were free from this event up to 12 years. In the multivariate model, independent predictors of major adverse cardiac events were: prior revascularization by percutaneous intervention (HR 1.21, p=0.03) or surgery (HR 1.53, p<0.001), dyslipidemia (HR 1.20, p=0.03), renal insufficiency (HR 1.41, p<0.001), peripheral vascular disease (HR 2.06, p<0.001), long lesions (HR 1.38, p<0.001), acute coronary syndrome (HR 1.39, p<0.001), and residual stenosis (HR 1.02, p<0.001). As for stent thrombosis, predictors were: recent myocardial infarction (HR 2.66, p=0.001), multiple stents implanted (HR 1.89, p=0.002), saphenous vein graft (HR 2.21, p=0.004), and residual stenosis (HR 1.03, p=0.03). Conclusions: At very long-term follow-up (up to 12 years) in a large cohort of patients from the real world practice, cumulative event rates included TLR in 21% and stent thrombosis in 2.4%. Overall, there were no safety concers, given that 95% of patients were free from stent thrombosis up to 12 years.

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Ticagrelor-based antiplatelet regimens in patients treated with coronary artery bypass grafting: a meta-analysis of randomized controlled trials

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz260 ◽

2019 ◽

Cited By ~ 1

Author(s):

Moritz von Scheidt ◽

Dario Bongiovanni ◽

Ulrich Tebbe ◽

Bernd Nowak ◽

Jan Stritzke ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Cardiac Death ◽

Primary Outcome ◽

Meta Analysis ◽

Major Adverse Cardiac Events ◽

Secondary Outcome ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events

Abstract OBJECTIVES The optimal antiplatelet strategy in patients undergoing CABG remains unclear. This is the first meta-analysis investigating the clinical outcomes associated with ticagrelor-based antiplatelet regimens in patients receiving CABG. METHODS Relevant scientific databases were searched for studies investigating antiplatelet regimens after CABG from inception until April 1, 2019. Studies which randomly assigned CABG patients to either ticagrelor-based or control antiplatelet regimens were eligible. The primary outcome of this analysis was all-cause death. The main secondary outcome was MI. Other outcomes of interest were cardiac death, major adverse cardiac events, stroke and bleeding. This study is registered with PROSPERO, number CRD42019122192. RESULTS Five trials comprising 3996 patients (2002 assigned to ticagrelor-based and 1994 to control antiplatelet regimens) were eligible for quantitative synthesis. The median follow-up was 12 months. Control antiplatelet regimens consisted of either aspirin or clopidogrel or both. As compared to control, ticagrelor-based regimens reduced the risk of all-cause death [0.61 (0.43–0.87); P = 0.007], cardiac death [0.58 (0.39–0.86); P = 0.007] and major adverse cardiac events [0.79 (0.63–0.98); P = 0.03], without difference in the risk of MI [0.76 (0.50–1.18); P = 0.22], stroke [0.99 (0.56–1.78); P = 0.98] or bleeding [1.04 (0.95–1.14); P = 0.41]. There was a treatment effect modification for the primary outcome associated with trials enrolling predominantly patients with acute coronary syndrome (P for interaction = 0.038). CONCLUSIONS In patients receiving CABG, ticagrelor-based regimens reduce mortality and major adverse cardiac events without excess bleeding risk as compared with aspirin monotherapy or the combination of aspirin and clopidogrel. The benefit of ticagrelor-based regimens is more relevant in those studies enrolling predominantly patients with acute coronary syndrome. These findings require further confirmation in randomized trials focused on this subset of patients and powered for clinical outcomes.

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Prognostic Value of Residual Coronary Artery Lesions on the SYNTAX Scale in Patients with Acute Myocardial Infarction without SТ Segment Elevation in the Mid-Term Period

Kardiologiia ◽

10.18087/cardio.2021.7.n1501 ◽

2021 ◽

Vol 61 (7) ◽

pp. 36-43

Author(s):

I. R. Rafaeli ◽

A. Yu. Kireeva ◽

A. N. Rogatova ◽

Al. V. Azarov ◽

S. P. Semitko

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Death ◽

Clinical Manifestations ◽

Area Under The Curve ◽

Composite Endpoint ◽

Low Risk ◽

Syntax Score ◽

Cardiac Events ◽

Adverse Cardiac Events

Aim To study the effect of residual coronary injury after a percutaneous coronary intervention (PCI), as evaluated with the SYNTAX scale (residual SYNTAX score, RSS), on the mid-term prognosis for patients with non-ST elevation acute myocardial infarction (NSTEMI) and also to determine threshold RSS values for patients at high and low risk of adverse cardiac events.Material and methods A single-center, retrospective study was performed. From 421 patients with NSTEMI after PCI with stenting, 169 patients were selected who originally had multivessel coronary disease and who had undergone a repeated inpatient examination, including mid-term (11.7±3.0 mos.) coronary angiography. The endpoints were recurrent clinical manifestations of angina, repeat revascularization (RR), unstable angina (UA), recurrent acute myocardial infarction (AMI), cardiac death, and also a composite endpoint (major adverse cardiac events, MACE) that included UA, recurrent AMI, and cardiac death. After revealing a significant direct correlation between RSS and the probability of recurrent AMI, UA, MACE, or RR (p <0.05) using the ROC analysis, we have established threshold RSS values that divided patients into groups with high and low risk of the cardiac events listed above.Results For a significantly high risk of recurrent AMI (area under the curve, AUC 0.79±0.05; 95 % confidence interval, CI 0.68–0.89; р=0.048), the threshold RSS score was 8 (sensitivity 100 %, specificity 70.9 %). For UA and MACE, the RSS scores were both 3 (AUC 0.68±0.5; 95 % CI 0.58–0.79; p=0.005 and AUC 0.71±0.05; 95 % CI 0.61–0.8; p=0.001, respectively). The probability of UA during the observation period with RSS >3 was 4.07 times higher and that of MACE was 5.23 times higher than with RSS<3 (95 % CI 1.44–11.49; р=0.01 and 95 % CI 1.88–14.53; р=0.001, respectively).Conclusion The study demonstrated a significant, direct correlation between the RSS and the risk of adverse cardiac events in patients with NSTEMI during one year of observation. Specific threshold values were obtained, which may help in choosing both the extent of revascularization and the tactics for postoperative management of patients.

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Abstract 17094: A New Grading of Tricuspid Regurgitation Beyond Severe and Its Clinical Importance

Circulation ◽

10.1161/circ.142.suppl_3.17094 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Omori Taku ◽

Goki Uno ◽

Shunsuke Shimada ◽

Florian Rader ◽

Robert J Siegel ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Cardiac Death ◽

Clinical Importance ◽

Right Atrial ◽

Grading System ◽

Cardiac Events ◽

Vena Contracta ◽

Kaplan Meier ◽

Significant Difference ◽

Dimensional Echocardiography

Introduction: Recently a new grading system for tricuspid regurgitation (TR) beyond severe has been proposed. However, few studies assessing the validity of the new grade of TR has been conducted. We evaluated the new grading system of TR by comparing it with patient hemodynamics and outcome. Methods: We retrospectively reviewed patients who underwent 2 dimensional echocardiography and had severe TR in 2014. According to the vena contracta width (VC) of TR jet, the patients were classified into 3 groups: VC<11mm, 11<=VC<14 and VC >=14mm (160,113 and 86 patients respectively). Stroke volume (SV), cardiac index (CI) and right atrial pressure (RAP) were estimated by echocardiography. Cardiac events were defined as cardiac death or admission for heart failure (HF). Results: 376 patients were diagnosed as severe TR. We excluded 15 patients on mechanical respiratory support and 2 with missing clinical data. Remaining 359 severe TR patients (75 ± 16 years, 204 (57%) female) were investigated. TR patients with VC >=14mm had significantly lower SV and CI compared to the other groups, though there was no difference in SV and CI between those with VC<11 and those with 11<=VC<14 (Figure). Compared to TR patients with VC<11, those with VC >=14 had a significantly higher frequency of RAP >=15mmHg (Odds ratio (OR) 1.30; 95% Confidence Interval (CI), 1.01 to 3.08; p=0.047 ), though those with 11<=VC<14 had no significant difference (OR 1.30; 95% CI 0.79 to 1.37; p=0.31 ) (Figure). During a follow-up period (median, 205 days; range, 36 to 1032 days), 124 (35%) patients experienced cardiac events (30 cardiac death and 94 HF admission). The Kaplan-Meier curves showed that TR patients with VC>=14 was at higher risk for cardiac events (Figure). Conclusion: TR patients with VC >=14mm showed significantly worse hemodynamics and outcome than those with VC<14mm. TR with VC >=14mm should be considered to clinical grade of TR that is beyond severe.

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Prospective study one-year clinical outcomes of the Calypso coronary stent in patients presenting with acute coronary syndrome

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-1-44-49 ◽

2017 ◽

Vol 21 (1) ◽

pp. 44 ◽

Cited By ~ 1

Author(s):

V. L. Vorobev ◽

A. A. Semenihin ◽

N. I. Grachev ◽

V. V. Verin

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Conflict Of Interest ◽

Cardiac Death ◽

Target Lesion ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

One Year

Aim. To evaluate the effectiveness of the stent use Calypso Angiolain Russia with primary percutaneous transluminal coronary angioplasty (PTCA). Methods. The study prospectively included 150 patients who underwent PTCA in acute coronary syndrome (ACS) for the period from January to December 2015. During the one-year follow-up period were evaluated indicators insolvency target lesion (cardiac death, myocardial infarction in the pool target artery, target lesion revascularization when clinically indicated), major adverse cardiac events (death from any cause, myocardial infarction, repeat revascularization as clinically indicated). Results. In one year, the incidence of target lesion failure was 6.66% for cardiac death rate of 1.33%, myocardial infarction in the target artery 3.33% and target lesion revascularization at 5.3%. The frequency of cardiac major adverse cardiac events was 12% at mortality 2.66%, myocardial infarction 4% and revascularization when clinically indicated 8.66%. Conclusion. The use of stents in primary PTCA Calypso is possible, the percentage of cardiovascular complications is comparable with the data of clinical trials.Received 31 January 2017. Accepted 17 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

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