scholarly journals A Systematic Literature Review of Three Stenting Strategies for Bifurcation Lesions in Coronary Artery Disease

10.36469/9746 ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 96-105
Author(s):  
Larragem Parsley-Raines ◽  
Dominique M. Brandt ◽  
Dillon L. Carr ◽  
Sabrina Uhry ◽  
Stephanie A. Donauer ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Side Branch ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Target Vessel ◽  
Bifurcation Lesions ◽  
Artery Disease

Background: Bifurcation lesions represent 15-20% of all patients undergoing a percutaneous coronary intervention (PCI) for coronary artery disease. The provisional 1-stent stenting strategy is the preferred strategy to treat bifurcation lesions. Other strategies used to treat bifurcation lesions include 2-stent complex stenting strategies and the Tryton Side Branch Stent® (TSB)—a dedicated side-branch stent for bifurcation lesions, which gained FDA approval in March 2017. Objectives: To conduct a systematic literature review of the safety and effectiveness of three stenting strategies (provisional, complex, and Tryton Side Branch Stent®) for bifurcation lesions with a side-branch diameter ≥2.25 mm, undergoing PCI. Methods: Literature searches in Medline, Cochrane Library, Web of Science and Embase were conducted to identify prospective clinical trials from January 2007-July 2017. Results: 602 articles were identified. Nine articles (6275 patients) met all inclusion criteria. Seven studies (5282 patients) compared provisional to complex stenting strategies. Two studies (993 patients) compared provisional to the TSB. Outcomes of interest reported were target vessel failure in 2 studies, major adverse cardiac event (MACE) (cardiac death, all myocardial infarction, ischemic driven target legion revascularization TLR) in 5 studies. For target vessel failure, the provisional strategy ranged from 5.6% to 15.6 %; complex at 7.2% (one study); and TSB from 11.3% to 17.4%. For MACE, provisional strategy ranged from 8%-13.2%; complex from 11.9%-15.2%; and TSB from 8.2%-18.6%. Conclusions: To our knowledge, this is the first review comparing three bifurcation lesion stenting strategies. Significant heterogeneity in the study design of the nine studies reviewed prevented a meta-analysis. A clinical trial comparing the TSB to both the provisional and complex strategies would provide better inference on the safety and effectiveness when comparing strategies.

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 Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiqi Xue ◽  
Jie Wu ◽  
Yan Ren ◽  
Jiaan Hu ◽  
Ke Yang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Psoas Muscle ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Muscle Area ◽  
Area Index ◽  
Artery Disease

Abstract Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I2 = 60.0%, Pheterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I2 = 0%, Pheterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I2 = 91.0%, Pheterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I2 = 90.5%, Pheterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I2 = 62.0%, Pheterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

scholarly journals Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianfeng Xu ◽  
Fei Cai ◽  
Changran Geng ◽  
Zheng Wang ◽  
Xiaobin Tang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Likelihood Ratio ◽  
Subgroup Analysis ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Emission Computed Tomography ◽  
Artery Disease

Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making.Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated.Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)].Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.

Treatment of bifurcation lesions with a drug-eluting balloon: the PEPCAD V (Paclitaxel Eluting PTCA Balloon in Coronary Artery Disease) trial

2011 ◽  
Vol 7 (K) ◽  
pp. K61-K65 ◽  
Author(s):  
Detlef Mathey ◽  
Imke Wendig ◽  
Michael Boxberger ◽  
Klaus Bonaventura ◽  
Franz Kleber
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Artery Disease ◽  
Drug Eluting Balloon
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