scholarly journals Coronary Artery Disease: Optimal Lipoprotein(a) for Survival—Lower Is Better? A Large Cohort With 43,647 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Jin Liu ◽  
Liwei Liu ◽  
Bo Wang ◽  
Shiqun Chen ◽  
Buyun Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Kidney Diseases ◽  
Plasma Lipoprotein ◽  
Large Cohort ◽  
Lipoprotein A ◽  
All Cause Mortality ◽  
Artery Disease

Background: A high level of lipoprotein(a) can lead to a high risk of cardiovascular events or mortality. However, the association of moderately elevated lipoprotein(a) levels (≥15 mg/dL) with long-term prognosis among patients with coronary artery disease (CAD) is still uncertain. Hence, we aim to systematically analyzed the relevance of baseline plasma lipoprotein(a) levels to long-term mortality in a large cohort of CAD patients.Methods: We obtained data from 43,647 patients who were diagnosed with CAD and had follow-up information from January 2007 to December 2018. The patients were divided into two groups (<15 and ≥15 mg/dL). The primary endpoint was long-term all-cause death. Kaplan–Meier curve analysis and Cox proportional hazards models were used to investigate the association between moderately elevated baseline lipoprotein(a) levels (≥15 mg/dL) and long-term all-cause mortality.Results: During a median follow-up of 5.04 years, 3,941 (18.1%) patients died. We observed a linear association between lipoprotein(a) levels and long-term all-cause mortality. Compared with lipoprotein(a) concentrations <15 mg/dL, lipoprotein(a) ≥15 mg/dL was associated with a significantly higher risk of all-cause mortality [adjusted hazard ratio (aHR) 1.10, 95%CI: 1.04–1.16, P-values = 0.001). Similar results were found for the subgroup analysis of non-acute myocardial infarction, non-percutaneous coronary intervention, chronic heart failure, diabetes mellitus, or non-chronic kidney diseases.Conclusion: Moderately elevated baseline plasma lipoprotein(a) levels (≥15 mg/dL) are significantly associated with higher all-cause mortality in patients with CAD. Our finding provides a rationale for testing the lipoprotein(a)-reducing hypothesis with lower targets (even <15 mg/dL) in CAD outcome trials.

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

P5331Aspirin use for prevention of cardiovascular events in patients with high lipoprotein(a): a population-based study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Karrthik ◽  
M Gad ◽  
N Bazarbashi ◽  
K Ahuja ◽  
Y Sammour ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Lipoprotein A ◽  
Preventive Cardiology ◽  
All Cause Mortality ◽  
History Of ◽  
Artery Disease

Abstract Background High lipoprotein(a) [Lp(a)] levels have been shown to increase Myocardial Infarction (MI) and all-cause mortality. However, studies evaluating the optimal preventive measures for that subset of cardiac patients are scarce. This study aims to study the outcomes of aspirin use versus no aspirin for the prevention of all-cause mortality and myocardial infarction in patients with high Lp(a) levels. Purpose We sought to determine the effect of Aspirin in reducing the rate of MI and all-cause mortality among patients with high lipoprotein(a) [Lp(a) ≥50mg/dL] Methods Patients who attended the preventive cardiology clinic from 2005 to 2016 and included in the Preventive Cardiology Database were included in the current single-center, retrospective, observational cohort study that was conducted according to the guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology Statement) checklist. The primary outcome was the incidence of myocardial infarction and the secondary outcome was all-cause mortality. Patients were excluded in cases of I) Lp(a)a <50mg/dL, II) history of malignancy, or III) being on anticoagulation/ dual antiplatelet therapy. The median duration of follow-up was 92 months from time of Lp(a) measurement to the last follow-up. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided. A propensity score-matched analysis was performed with 1:1 nearest match for Age, Gender, Race, Smoking status, BMI, Diabetes, Peripheral artery disease, Carotid artery disease, coronary artery disease, chronic kidney disease, Heart failure, Hypertension, Dyslipidemia, Stroke, family history of coronary artery disease, Lp (a), LDL, HDL, Triglycerides, glucose and total cholesterol. Results 1,805 patients fulfilled the inclusion and exclusion criteria out of 7,410 patients initially identified with recorded Lp(a) levels in the Preventive Cardiology Database. Of these, 376 patients were taking aspirin, and 1429 patients were not receiving aspirin. After propensity score matching for different baseline characteristics and comorbidities as mentioned above, 316 patients were matched in each group. Patients who were on Aspirin had a significantly lower rate of MI events compared to patients who were not on aspirin (6.96% vs 12.02%, P=0.03) and a lower rate, however statistically non-significant, of all-cause mortality (2.84% vs 4.11%, P=0.385). Conclusion The use of aspirin in patients with elevated Lp(a) levels significantly lowers the rate of myocardial infarction events. Larger randomized clinical trials are warranted to evaluate the use of aspirin for primary and secondary prevention of major adverse cardiovascular events in patients with high Lp(a) levels.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110280
Author(s):  
Sukru Arslan ◽  
Ahmet Yildiz ◽  
Okay Abaci ◽  
Urfan Jafarov ◽  
Servet Batit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vessel Diameter ◽  
Side Branch ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Balcer ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Conventional Coronary Angiography ◽  
Term Survival ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &lt;13.0g/dl for male and &lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&lt;0.0001; IAP: 2.67 [2.06–3.47], p&lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

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.

scholarly journals Long-term outcomes of peripheral arterial disease patients with significant coronary artery disease undergoing percutaneous coronary intervention

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251542
Author(s):  
Byoung Geol Choi ◽  
Ji-Yeon Hong ◽  
Seung-Woon Rha ◽  
Cheol Ung Choi ◽  
Michael S. Lee
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Arterial Disease ◽  
Significant Coronary Artery Disease ◽  
Arterial Disease ◽  
Term Survival ◽  
Artery Disease ◽  
Peripheral Arterial

Background Patients with peripheral arterial disease (PAD) have known to a high risk of cardiac mortality. However, the effectiveness of the routine evaluation of coronary arteries such as routine coronary angiography (CAG) in PAD patients receiving percutaneous transluminal angioplasty (PTA) is unclear. Methods A total of 765 consecutive PAD patients underwent successful PTA and 674 patients (88.1%) underwent routine CAG. Coronary artery disease (CAD) was defined as angiographic stenosis ≥70%. Patients were divided into three groups; 1) routine CAG and a presence of CAD (n = 413 patients), 2) routine CAG and no CAD group (n = 261 patients), and 3) no CAG group (n = 91 patients). To adjust for any potential confounders that could cause bias, multivariable Cox-proportional hazards regression and propensity score matching (PSM) analysis was performed. Clinical outcomes were evaluated by Kaplan-Meier curved analysis at 5-year follow-up. Results In this study, the 5-year survival rate of patients with PAD who underwent PTA was 88.5%. Survival rates were similar among the CAD group, the no CAD group, and the no CAG group, respectively (87.7% vs. 90.4% vs. 86.8% P = 0.241). After PSM analysis between the CAD group and the no CAD group, during the 5-year clinical follow-up, there were no differences in the incidence of death, myocardial infarction, strokes, peripheral revascularization, or target extremity surgeries between the two groups except for repeat PCI, which was higher in the CAD group than the non-CAD group (9.3% vs. 0.8%, P<0.001). Conclusion PAD patients with CAD were expected to have very poor long-term survival, but they are shown no different long-term prognosis such as mortality compared to PAD patients without CAD. These PAD patients with CAD had received PCI and/or optimal medication treatment after the CAG. Therefore a strategy of routine CAG and subsequent PCI, if required, appears to be a reasonable strategy for mortality risk reduction of PAD patients. Our results highlight the importance for evaluation for CAD in patients with PAD.

Abstract 18995: Statins in Familial Hypercholesterolemia - Effects on Coronary Artery Disease and All-cause Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Joost Besseling ◽  
Gerard K Hovingh ◽  
John J Kastelein ◽  
Barbara A Hutten
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Familial Hypercholesterolemia ◽  
Lipid Lowering ◽  
Premature Coronary Artery Disease ◽  
Lipid Lowering Therapy ◽  
Time Varying ◽  
All Cause Mortality ◽  
Artery Disease

Introduction: Heterozygous familial hypercholesterolemia (heFH) is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and increased risk for premature coronary artery disease (CAD) and death. Reduction of CAD and mortality by statins has not been properly quantified in heFH. The aim of the current study is to determine the effect of statins on CAD and mortality in heFH. Methods: All adult heFH patients identified by the Dutch FH screening program between 1994 and 2014 and registered in the PHARMO Database Network were eligible. Of these patients we obtained hospital, pharmacy (in- and outpatient), and mortality records in the period between 1995 and 2015. The effect of statins (time-varying) on CAD and all-cause mortality was determined using a Cox proportional hazard model, while correcting for the use of other lipid-lowering therapy, thrombocyte aggregation inhibitors, antihypertensive and antidiabetic medication (all time-varying). Furthermore, we used inverse probability for treatment weighting (IPTW) to account for differences between statin-treated and untreated patients regarding history of CAD before follow-up, age at start of follow-up and age of screening, as well as body mass index, LDL-C and triglycerides. Results: Of the 25,479 identified heFH patients, 11,021 gave informed consent to obtain their medical records, of whom 2,447 could be retrieved. We excluded 766 patients younger than 18. The remaining 1,681 heFH patients comprised our study population and these had very similar characteristics as compared to the 23,798 excluded FH patients, e.g. mean (SD) LDL-C levels were 214 (74) vs. 203 (77) mg/dL. Among 1,151 statin users, there were 133 CAD events and 15 deaths during 10,115 statin treated person-years, compared to 17 CAD events and 9 deaths during 4,965 person-years in 530 never statin users (combined rate: 14.6 vs. 5.2, respectively, p<0.001). After applying IPTW to account for indication bias and correcting for use of other medications, the hazard ratio of statin use for CAD and all-cause mortality was 0.61 (0.40 - 0.93). Conclusions: In heFH patients, statins lower the risk for CAD and mortality by 39%.

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