scholarly journals LONG-TERM CONSEQUENCES OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

2020 ◽  
Vol 73 (4) ◽  
pp. 662-667
Author(s):  
Nataliya V. Izhytska ◽  
Dmytro I. Besh ◽  
Olesya M. Besh ◽  
Adrian Y. Fil
Keyword(s):  
Coronary Intervention ◽  
Main Group ◽  
Therapeutic Window ◽  
Long Term Effects ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
St Elevation

The aim: To investigate long-term effects of primary percutaneous coronary interventions (pPCI) in patients with STEMI basing on the prevalence of clinically relevant endpoints. Materials and methods: Totally 200 patients with STEMI hospitalized within a period of “therapeutic window” for revascularization were included into the study. 100 patients who additionally to pPCI underwent manual thromboaspiration entered the main group. The comparison group consisted of 100 patients who underwent standard pPCI. Results: Six months after the pPCI, the incidence of either major adverse cardiac events and the combined endpoint did not differ in the main and comparative groups (11.8% vs. 12.5%, p = 0.888 and 18.2% vs. 20.8%, p = 0.658, respectively). There were no significant differences in these endpoints taken separately. In twelve months after procedure, also there were no significant differences between the groups. However, a tendency toward lower incidence of chest pain was observed in the main group (p = 0.08) during this period that was lost in 24 months after pPCI. None of these techniques demonstrated significant advantages during the whole duration of the follow-up period. Conclusions: The addition of manual thromboaspiration to the standard pPCI in patients with STEMI and severe thrombosis of the culprit artery did not significantly influence the prognosis.

Combined impact of residual inflammatory risk and chronic kidney disease on long-term clinical outcomes in patients undergoing percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Takahashi ◽  
T Dohi ◽  
T Funamizu ◽  
H Endo ◽  
H Wada ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Hs Crp ◽  
Stable Cad ◽  
Combined Impact ◽  
Group 1

Abstract Background Inflammatory status pre-percutaneous coronary intervention (PCI) and post-PCI has been reported not only associated with poor prognosis, but also to impair renal function. Statins reduce cardiovascular events by lowering lipids and have anti-inflammatory impacts, but residual inflammatory risk (RIR) exists. It remains unclear that the synergistic effect of RIR and chronic kidney disease (CKD) on long-term clinical outcome in stable coronary artery disease (CAD) patients undergoing PCI in statin era. Aim The aim of this study was to investigate the long-term combined impact of RIR evaluating hs-CRP at follow-up and CKD among stable CAD patients undergoing PCI in statin era. Methods This is a single-center, observational, retrospective cohort study assessing consecutive 2,984 stable CAD patients who underwent first PCI from 2000 to 2016. We analyzed 2,087 patients for whom hs-CRP at follow-up (6–9 months later) was available. High residual inflammatory risk was defined as hs-CRP >0.6 mg/L according to the median value at follow up. Patients were assigned to four groups as Group1 (high RIR and CKD), Group2 (low RIR and CKD), Group3 (high RIR and non-CKD) or Group4 (low RIR and non-CKD). We evaluated all-cause death and major adverse cardiac events (MACE), defined as a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke. Results Of patients (83% men; mean age 67 years), there were 299 (14.3%) patients in group 1, 201 (9.6%) patients in group 2, 754 (36.1%) patients in group 3, and 833 (39.9%) patients in group 4. The median follow-up period was 5.2 years (IQR, 1.9–9.9 years). In total, 189 (frequency, 16.1%) cases of all-cause death and 128 (11.2%) MACE were identified during follow-up, including 53 (4.6%) CV deaths, 27 (2.4%) MIs and 52 (4.8%) strokes. The rate of all-cause death and MACE in group 1 was significantly higher than other groups (p<0.001, respectively). There was a stepwise increase in the incidence rates of all-cause death and MACE. After adjustment for important covariates, the presence of high RIR and/or CKD were independently associated with higher incidence of MACE and higher all-cause mortality. (shown on figure). Conclusion The presence of both high RIR and CKD conferred a synergistic adverse effect on the risk for long-term adverse cardiac events in patients undergoing PCI. Kaplan-Meier curve Funding Acknowledgement Type of funding source: None

scholarly journals Gender-wise Long-term Predictors for Major Adverse Cardiac Events Following Percutaneous Coronary Intervention in the Elderly Population

2020 ◽  
Vol 5 (01) ◽  
pp. 18-24
Author(s):  
A. Siva Ramakrishna ◽  
V. Satish Kumar Rao ◽  
Garre Indrani
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Coronary Intervention ◽  
The Elderly ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary

Abstract Background We aimed to recognize the predictors of long-term major adverse cardiac events (MACE) in the elderly candidates for elective percutaneous coronary intervention (PCI) in relation to gender at our center. Methods In this retrospective cohort study, we reviewed the data of the elderly patients (age ≥70 years) who underwent elective PCI who met our study criteria in our institution during 2008 and 2018. Demographical data, clinical history, angiographic details, PCI procedure, and follow-up data of the patients enrolled in the study were studied by using the angiographic and PCI procedure details. Patients were characterized in the study group as those with or without MACE, which were then compared and analyzed using the statistical analysis in a univariable and binary linear regression analysis. Results A total of 355 elderly patients (older than 70 years) undergoing elective PCI were selected who fulfilled the inclusion criteria; 277 patients were men and had more comorbidities, including hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease, history of heart failure, previous coronary artery bypass graft, and presentation with acute coronary syndrome. MACE occurred in 24 events patients of whom 20 were suffering from DM. Binary logistic regression showed that the only determinant for the 1-year follow-up outcome is diabetes (p = 0.000). Even in univariate analysis, DM (0.01) is the determinant. DM is a strong predictor for death in univariate analysis (p = 0.00). Conclusion PCI is a safe and effective method of coronary revascularization in elderly patients, and some risk factors can predict long-term MACE in this group of patients.

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

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.

Association between the rs342293 polymorphism and adverse cardiac events in patients undergoing percutaneous coronary intervention

2014 ◽  
Vol 111 (06) ◽  
pp. 1060-1066 ◽  
Author(s):  
Iciar Arbesu ◽  
Bernd Jilma ◽  
Gerald Maurer ◽  
Irene M. Lang ◽  
Christine Mannhalter ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Coronary Intervention ◽  
Cardiovascular Outcome ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Cardiac Adverse Events

SummaryThe single nucleotide polymorphism (SNP) rs342293 has been shown to influence platelet number and mean platelet volume (MPV). We investigated the association between the rs342293 polymorphism and cardiovascular outcome in a prospective cohort study. The rs342293 polymorphism was analysed in 404 patients with coronary artery disease undergoing percutaneous coronary intervention. The rates of cardiac adverse events were recorded during two years of follow-up. The polymorphism was associated with MPV (median 10.1 fL, interquartile range [IQR]: 9.6 to 10.6 in patients with the CC-allele vs 10.4 fL, IQR: 9.9 to 11.1 in G>C SNP carriers; p<0.001), but not with platelet count. Survival analysis indicated that carriers of the rs342293 G variant had a substantially higher risk to develop cardiac adverse events compared with wild type carriers during two years of follow-up (33% vs 22%; adjusted hazard ratio = 1.63, 95% confidence interval = 1.06–2.52, p=0.027). The rs342293 SNP could explain 2.9% of the variability in MPV (p=0.01). In conclusion, patients undergoing coronary stenting who carry the G-variant of the rs342293 SNP which is associated with larger MPV are at higher risk for adverse cardiovascular outcome.

Abstract 3008: Intracoronary Compared with Intravenous Bolus Abciximab Application in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Coronary Intervention The randomized Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Holger Thiele ◽  
Kathrin Schindler ◽  
Josef Friedenberger ◽  
Ingo Eitel ◽  
Georg Fürnau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Bolus Administration ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
St Elevation

Background Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary bolus application of abciximab results in high local drug concentrations and may be more effective than standard intravenous bolus application for reduction of infarct size, no-reflow and improvement in perfusion. Methods Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus administration of abciximab with subsequent 12 hour intravenous infusion. Primary endpoint was infarct size and extent of microvascular obstruction assessed by delayed enhancement magnetic resonance. Secondary endpoints were ST-resolution at 90 minutes, Thrombolysis in Myocardial Infarction (TIMI)-flow and perfusion grade post PCI, and the occurrence of major adverse cardiac events within 30 days. Results The primary endpoint infarct size could be reduced by absolute 7% (17.7% i.c. versus 24.7% i.v., p=0.005). Similarly, the extent of microvascular obstruction was significantly smaller in i.c. patients in comparison to i.v. patients (p=0.02). Myocardial perfusion measured as early ST-segment resolution was significantly improved in i.c. patients with an absolute ST-resolution of 76±23% versus 64±31% (p=0.009). The TIMI flow after PCI was not different between treatment groups (p=0.51), but there was a trend towards an improved perfusion grade (p=0.12). There was a trend towards a higher major adverse cardiac event rate after intravenous versus intracoronary abciximab application (15.6% versus 5.2%, p=0.06; relative risk 3.00; 95% confidence intervals 0.94 –10.80). Conclusions: Intracoronary bolus administration of abciximab is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion in primary PCI. An adequately powered trial for major adverse cardiac event reduction is warranted.

scholarly journals Circulating Platelet-Derived Microparticles Associated with Postdischarge Major Adverse Cardiac Events in ST-Elevation Acute Myocardial Infarction

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Anggoro Budi Hartopo ◽  
Dyah Samti Mayasari ◽  
Ira Puspitawati ◽  
Hasanah Mumpuni
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Prognostic Implication ◽  
Adverse Cardiac Events ◽  
St Elevation ◽  
Elevation Acute Myocardial Infarction

Introduction. Platelet-derived microparticles (PDMPs) measurement adds prognostic implication for ST-elevation acute myocardial infarction (STEMI). The long-term implication of PDMPs in STEMI needs to be corroborated. Methods. The research design was a cohort study. Subjects were STEMI patients and were enrolled consecutively. The PDMPs were defined as microparticles bearing CD41(+) and CD62P(+) markers detected with flow cytometry. The PDMPs were measured on hospital admission and 30 days after discharge. The outcomes were major adverse cardiac events (MACE), i.e., a composite of cardiac death, heart failure, cardiogenic shock, reinfarction, and resuscitated ventricular arrhythmia, occurring from hospitalization until 1 year after discharge. Results. We enrolled 101 subjects with STEMI. During hospitalization, 17 subjects (16.8%) developed MACE. The PDMPs were not different between subjects with MACE and those without (median (IQR): 3305.0/μL (2370.0–14690.5/μL) vs. 4452.0/μL (2024.3–14396.8/μL), p=0.874). Forty-five subjects had increased PDMPs in 30 days after discharge as compared with on-admission measurement. Subjects with increased PDMPs had significantly higher 30-day MACE as compared to subjects with decreased PDMPs 17 (37.8%) vs. 6 (16.7%, p=0.036). There was a trend toward higher MACE in subjects with increased PDMPs as compared to those with decreased PDMPs in 90 days after discharge (48.9% vs. 30.6%, p=0.095) and 1 year after discharge (48.9% vs. 36.1%, p=0.249). Conclusion. The PDMPs level was increased from the day of admission to 30 days after discharge in patients with STEMI. The persistent increase in the PDMPs level in 30 days after the STEMI event was associated with the 30-day postdischarge MACE and trended toward increased MACE during the 90-day and 1-year follow-up.

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