scholarly journals The Role of Carotid Stenosis in a Prediction of Prognosis of Coronary Artery Disease

PRILOZI ◽  
2021 ◽  
Vol 42 (1) ◽  
pp. 53-66
Author(s):  
Savetka Paljoskovska Jordanova ◽  
Sasko Kedev ◽  
Danica Petkoska Spirova ◽  
Lily Stojanovska ◽  
Marijan Bosevski
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Stenosis ◽  
Cardiovascular Events ◽  
Smoking History ◽  
Carotid Ultrasound ◽  
Number Of Patients ◽  
Elevated Systolic Blood Pressure ◽  
Artery Disease

AbstractAims: The aim of this paper is to indicate if carotid stenosis is predictive for the prognosis of coronary artery disease.Method and materials: Our study is a prospective cohort study. 1031 patients with proven coronary artery disease (CAD) were recruited consecutively. Carotid ultrasound was used to assess IMT, plaque, or stenosis. They were followed for 24 months for adverse cardiovascular events. Selected demographic date such as smoking history, dyslipidemia, hypertension, laboratory values, and clinical data (associated diseases and risk) were collected from each patient. Total cardiovascular events and mortality rate were followed up for the study population. The results were collected prospectively and retrospectively. The study was organized as a clinical, cross-sectional study and comparative study.From the data collected with the clinical research, a file was formed in the statistical program with the help of which the data were statistically analyzed.From the methods of descriptive statistics, absolute frequencies, percentages, arithmetic mean, median, measures of variability, minimum, maximum, standard deviation and logistic regression models were used.Result: Of the total number of patients 1026 had arterial hypertension (HTA). Data on hyperlipidemia (HLP) had been reported in 895 patients. 1.023 patients had peripheral artery disease (PAB). 1031 patients were presented with multivessel coronary artery disease (CAD). There were 1,029 patients with diabetes mellitus (DM), while 1,013 patients had coronary artery by-pass (CABG), and 1,012 had stroke (CVI). Elevated systolic blood pressure was reported in 966 patients. 184 patients had elevated triglycerides and 187 had elevated cholesterol. 1,008 patients have had a history of myocardial infarction. Carotid artery stenosis (CAS) has been found in 1,009 patients, increased body mass index (BMI) in 270 patients.1.031 patients were followed for 24 months. Cardiovascular events were reported in 54 patients (or 5.2%). Revascularization was performed in 28 (4.1%) patients, while 12 (1.8%) of patients died. Diabetes mellitus (OR 1.878 95% CI 0.491 7.184) and Carotid stenosis (OR 2.185 95% CI 0.731 6.53) were found to be predictive factors for future cardiovascular events.Conclusion: Due to our results carotid ultrasound may be a useful tool for risk stratification of coronary artery disease pts.

scholarly journals Smoking is a negative predictor of arteriovenous malformation posttreatment obliteration: analysis of vascular risk factors in 774 patients

2014 ◽  
Vol 37 (3) ◽  
pp. E3
Author(s):  
Richard Dalyai ◽  
Robert M. Starke ◽  
Nohra Chalouhi ◽  
Thana Theofanis ◽  
Christopher Busack ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Multivariate Analysis ◽  
Coronary Artery ◽  
Tertiary Care ◽  
Vascular Pathology ◽  
Smoking History ◽  
Recreational Drugs ◽  
Artery Disease

Object Cigarette smoking has been well established as a risk factor in vascular pathology, such as cerebral aneurysms. However, tobacco’s implications for patients with cerebral arteriovenous malformations (AVMs) are controversial. The object of this study was to identify predictors of AVM obliteration and risk factors for complications. Methods The authors conducted a retrospective analysis of a prospectively maintained database for all patients with AVMs treated using surgical excision, staged endovascular embolization (with N-butyl-cyanoacrylate or Onyx), stereotactic radiosurgery (Gamma Knife or Linear Accelerator), or a combination thereof between 1994 and 2010. Medical risk factors, such as smoking, abuse of alcohol or intravenous recreational drugs, hypercholesterolemia, diabetes mellitus, hypertension, and coronary artery disease, were documented. A multivariate logistic regression analysis was conducted to detect predictors of periprocedural complications, obliteration, and posttreatment hemorrhage. Results Of 774 patients treated at a single tertiary care cerebrovascular center, 35% initially presented with symptomatic hemorrhage and 57.6% achieved complete obliteration according to digital subtraction angiography (DSA) or MRI. In a multivariate analysis a negative smoking history (OR 1.9, p = 0.006) was a strong independent predictor of AVM obliteration. Of the patients with obliterated AVMs, 31.9% were smokers, whereas 45% were not (p = 0.05). Multivariate analysis of obliteration, after controlling for AVM size and location (eloquent vs noneloquent tissue), revealed that nonsmokers were more likely (0.082) to have obliterated AVMs through radiosurgery. Smoking was not predictive of treatment complications or posttreatment hemorrhage. Abuse of alcohol or intravenous recreational drugs, hypercholesterolemia, diabetes mellitus, and coronary artery disease had no discernible effect on AVM obliteration, periprocedural complications, or posttreatment hemorrhage. Conclusions Cerebral AVM patients with a history of smoking are significantly less likely than those without a smoking history to have complete AVM obliteration on follow-up DSA or MRI. Therefore, patients with AVMs should be strongly advised to quit smoking.

scholarly journals Prognostic value of soluble suppression of tumorigenesis-2 (sST2) for cardiovascular events in coronary artery disease patients with and without diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
Coronary Syndrome ◽  
End Point ◽  
Artery Disease

Abstract Background Soluble suppression of tumorigenesis-2 (sST2) is implicated in myocardial overload and has long been recognized as an inflammatory marker related to heart failure and acute coronary syndrome, but data on the prognostic value of sST2 in patients with coronary artery disease (CAD) remain limited. This study sought to investigate the prognostic value of sST2 in patients with established CAD and its predictive value in CAD patients with and without type 2 diabetes mellitus (T2DM). Methods A total of 3641 consecutive patients were included in this prospective cohort study. The primary end point was major adverse cardiovascular events (MACEs). The secondary end point was all-cause death. The association between sST2 and outcomes was investigated using multivariable Cox regression. Results During a median follow-up of 6.4 years, MACEs occurred in 775 patients, and 275 patients died. Multiple Cox regression models showed that a higher level of sST2 was an independent predictor of MACEs development (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 sST2 to established risk factors significantly improved risk prediction of the composite outcome of MACEs and all-cause death (C-index, net reclassification index, and integrated discrimination improvement, all p < 0.05). In subgroup analysis depending on diabetes status, the diabetes group had a significantly higher level of sST2, which remained a significant predictor of MACEs and all-cause death in patients with and without T2DM in multivariable models. The area under the curve (AUC) of CAD patients with diabetes mellitus was significantly higher than that of those without T2DM. For MACEs, the AUC was 0.737 (patients with T2DM) vs 0.620 (patients without T2DM). For all-cause death, the AUC was 0.923 (patients with T2DM) vs 0.789 (patients without T2DM). Conclusions A higher level of sST2 is significantly associated with long-term MACEs and all-cause death in CAD patients with and without T2DM. sST2 has strong predictive value for cardiovascular adverse events in CAD patients with T2DM, and these results provide new evidence for the role of sST2.

scholarly journals Prognostic value of suppression of tumorigenesis-2 (ST2) for cardiovascular events in coronary artery disease patients with and without diabetes mellitus

2020 ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
End Point ◽  
Increased Risk ◽  
Artery Disease

Abstract Background: Suppression of tumorigenesis-2 (ST2) is implicated in myocardial overload and has long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but data on the prognostic value of ST2 in patients with coronary artery disease (CAD) remain limited. This study sought to investigate the prognostic value of ST2 in patients with established coronary artery disease and its predictive value in CAD patients with or without type 2 diabetes mellitus (T2DM).Methods: A total of 3641 consecutive patients were included in this prospective cohort study. The primary end point was major adverse cardiovascular events (MACEs). The secondary end point was all-cause death. The association between ST2 and outcomes was investigated using multivariable Cox regression.Results: During a median follow-up of 6.4 years, 775 patients had the occurrence of MACEs 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 ST2 was an independent predictor for MACEs developments (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 ST2 to established risk factors significantly improved risk prediction of the composite outcome of MACEs and all-cause death (C-statistic, net reclassification index, and integrated discrimination improvement, all p<0.05). Subgroup analyses showed that ST2 remained a significant predictor of MACEs and all-cause death in patients with and without T2DM in multivariable models.Conclusions: A higher level of ST2 is significantly associated with long-term MACEs and all-cause death in CAD patients with and without T2DM. ST2 may provide incremental prognostic value beyond traditional risk factors.

Persistence and cardiovascular outcomes with ramipril, atorvastatin, ASA as a single pill compared to the multi pill combination. A subanalysis of the START study, a claims data analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.G Predel ◽  
B Weisser ◽  
S Wassmann ◽  
R.E Schmieder ◽  
J Blettenberg ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Number Of Patients ◽  
All Cause Mortality ◽  
Single Pill ◽  
Artery Disease

Abstract Background/Introduction Large randomized clinical trials have shown the efficacy of aspirin (ASA), angiotensin converting enzyme inhibitors (ACEI) and statins (S) in secondary prevention. However, adherence to medication is low in patients suffering from a cardiovascular event and decreases with each additional tablet. Therefore, a single pill (SP) approach is considered to increase drug persistence and decrease cardiovascular events in this patient population. Purpose Data that show an advantage for a SP regimen containing ASA, ACEI, and S compared to the identical loose combination (LC) regarding persistence, and clinical outcomes under conditions of daily practise in one study are missing. We conducted the START study to answer these questions. A subset, in which we anlysed data from patients in secondary prevention is presented here. Methods The START study was a retrospective, non-interventional analysis of an anonymised claims dataset covering patients suffering from cardiovascular diseases insured by the German AOK PLUS public health insurance in the years 2012–2017. Patients at age ≥18 years with an indication for the use of a combination treatment in cardiovascular disorders – including the use of ASA, ramipril, and atorvastatin - in a SP or identical LC were followed up to 1 year. After 1:1-Propensity Score Matching (PSM) persistence (defined as redemption of prescription with a lack &gt;60 days) and clinical outcomes were compared using non-parametric tests. Results Before PSM, 564,941 patients had a cardiovascular event in the medical history, 427,046 suffered from coronary artery disease. 275 received the three substances described above as SP, 6,662 as LC. After PSM, data from 211 patients were suitable for further analysis in each group. Baseline characteristics were comparable between SP and LC groups. Persistence to treatment was significant lower in the LC group (Hazard Ratio, HR, 0.25 [95% CI 0.19–0.34], p&lt;0.001). 8 clinical outcomes were analysed. Lower Incidence Rate Ratio (IRR) was found in the SP group for myocardial infarction (IRR 0.46; 95% CI 0.07–2.36), stroke (IRR 0.51; 95% CI 0.04–4.46), transitory ischemic attac (IRR 0.77; 95% CI 0.01–60.12), coronary artery disease (IRR 0.60; 95% CI 0.25–1.43), and all cause mortality (IRR 0.38; 95% CI 0.06–1.79). All cause hospitalisation was significant lower in the SP group (IRR 0.58; 95% CI 0.47–0.72; p&lt;0.001). Conclusion The number of patients receiving a SP regimen in secondary prevention was relatively low. However, persistence to medication was significantly higher in the SP group. In addition, a tendency for a lower IRR was also observed for cardiovascular events and all cause mortality in the SP group. The results of our analysis support the use of a SP regimen in secondary prevention of cardiovascular events. Funding Acknowledgement Type of funding source: None

scholarly journals Antithrombotic Therapy for Atherosclerotic Cardiovascular Disease Risk Mitigation in Patients With Coronary Artery Disease and Diabetes Mellitus

Circulation ◽  
2020 ◽  
Vol 142 (22) ◽  
pp. 2172-2188
Author(s):  
Davide Capodanno ◽  
Dominick J. Angiolillo
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Artery Disease

Patients with diabetes mellitus (DM) are characterized by enhanced thrombotic risk attributed to multiple mechanisms including hyperreactive platelets, hypercoagulable status, and endothelial dysfunction. As such, they are more prone to atherosclerotic cardiovascular events than patients without DM, both before and after coronary artery disease (CAD) is established. In patients with DM without established CAD, primary prevention with aspirin is not routinely advocated because of its increased risk of major bleeding that largely offsets its ischemic benefit. In patients with DM with established CAD, secondary prevention with antiplatelet drugs is an asset of pharmacological strategies aimed at reducing the risk of atherosclerotic cardiovascular events and their adverse prognostic consequences. Such antithrombotic strategies include single antiplatelet therapy (eg, with aspirin or a P2Y 12 inhibitor), dual antiplatelet therapy (eg, aspirin combined with a P2Y 12 inhibitor), and dual-pathway inhibition (eg, aspirin combined with the vascular dose of the direct oral anticoagulant rivaroxaban) for patients with chronic ischemic heart disease, acute coronary syndromes, and those undergoing percutaneous coronary intervention. Because of their increased risk of thrombotic complications, patients with DM commonly achieve enhanced absolute benefit from more potent antithrombotic approaches compared with those without DM, which most often occurs at the expense of increased bleeding. Nevertheless, studies have shown that when excluding individuals at high risk for bleeding, the net clinical benefit favors the use of intensified long-term antithrombotic therapy in patients with DM and CAD. Several studies are ongoing to establish the role of novel antithrombotic strategies and drug formulations in maximizing the net benefit of antithrombotic therapy for patients with DM. The scope of this review article is to provide an overview of current and evolving antithrombotic strategies for primary and secondary prevention of atherosclerotic cardiovascular events in patients with CAD and DM.

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