MEDIUM-TERM OUTCOMES OF CORRECTION OF LONG CORONARY ARTERY LESIONS USING BIODEGRADABLE VASCULAR SCAFFOLDS

2020 ◽  
Vol 4 (2) ◽  
pp. 1006-1018
Author(s):  
N.P. Strygo ◽  
◽  
V.I. Stelmashok ◽  
O.L. Polonetsky ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Target Lesion ◽  
Target Vessel ◽  
Coronary Artery Lesions ◽  
Biodegradable Scaffolds ◽  
Group 2 ◽  
One Year ◽  
Target Lesion Failure ◽  
Group 1

Aim. To establish efficacy and safety of endovascular correction of long coronary lesion with biodegradable scaffolds in comparison with everolimus-eluting metallic coronary stents. Materials and methods. From 2013 to 2018 in Republican Scientific and Practical Centre «Cardiology», Minsk, endovascular correction of long (more than 25 mm) coronary artery lesions was performed on 80 patients. Randomly patients were divided into 2 groups: group 1 (n=40) – endovascular correction with the biodegradable everolimus-eluting vascular scaffold Absorb BVS, and group 2 (n=40) – endovascular correction with the everolimus-eluting metallic stent Xience V/Xience Pro. Results. In 12-month observational period there were no cases of death or myocardial infarction in both groups. One-year primary endpoint (death + myocardial infarction + target lesion failure) was 10% in group 1 (scaffolds BVS Absorb) and 8.75% in group 2 (Xience stents), 4 and 3 cases of target lesion failure accordingly (p>0.05). As secondary endpoints there were 3 cases of target lesion revascularization registered and 4 cases of target vessel revascularization in each group, 5 cases of target vessel failure in group 1 and 4 cases in group 2 (p>0.05). There was 1 case of confirmed and 1 case of probable scaffold thrombosis in group 1 (cumulative rate 5%), no cases of stent thrombosis in group 2 (p=0.49). Conclusion. Long lesion correction with biodegradable scaffolds shows similar one-year clinical and angiographic results in comparison with everolimus-eluting stents. Combined endpoint risk (all death cases + myocardial infarction + revascularization due to target lesion failure) statistically did not differ in one-year period in both groups.

scholarly journals Treatment of de novo coronary artery lesions with paclitaxel drug coated balloons (DCB) in diabetic and non-diabetic patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.M.Z Mohd Saad Jalaluddin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
De Novo ◽  
Target Lesion ◽  
Diabetic Group ◽  
Target Lesion Revascularization ◽  
Diabetic Patients ◽  
Coronary Artery Lesions ◽  
Artery Disease

Abstract Background Drug-coated balloon has been widely used to treat In-Stent Restenosis as recommended by ESC/EACT coronary intervention guideline. However, trials of effectiveness of DCB in treating de novo lesions in diabetic patients are limited. This study will highlight the impact of DCB in diabetic patients with only de novo lesions against non-diabetic patients. Aim To compare the outcomes of Paclitaxel Drug Coated Balloon (DCB) in Diabetic and non-diabetic patients with only de novo coronary artery disease. Methods A retrospective, single center study was conducted from January 2016 till December 2018. All diabetic and non-diabetic patients underwent angioplasty to only de novo coronary artery lesions were included in the study. Patients' baseline characteristic, angiographic data, post procedural and 12 months follow-up outcomes including major adverse coronary artery event (MACE), target lesion revascularization (TLR) and myocardial infarction (MI) are compared. Results A total of 1257 patients (726 diabetic and 531 non-diabetic patients) with total 1385 de novo coronary artery lesions (791 lesions in diabetic group and 594 lesions in non-diabetic group) were included in this study. Mean age for non-diabetic group was 57.6±10.6 years and diabetic group was 59.6±9.6 years with male predominance (91.1% in non-diabetic group, n=484 and 79.2% in diabetic group, n=575). Majority of diabetic group has hypertension (83.7%, n=608 vs 58.6%, n+311), chronic renal failure (10.3%, n=75 vs 1.9%, n=10), documented coronary artery disease (55.6%, n=404 vs 47.5%, n=252) and previous coronary angioplasty 39.5%, n=287 vs 28.8%, n=153). Adequate pre-dilatation was done in both groups (98.5%, n=585 in non-diabetic group and 99.4%, n=786 in diabetic group; p=0.000). Mean DCB diameter and length were almost similar in both groups. Mean residual stenosis after DCB was 11.15±16.9% in non-diabetic group and 13.13±13.4% in the diabetic group (p=0.008). 74.6% of non-diabetic group (n=396) and 77.1% of diabetic group (n=560) were on double antiplatelet therapy for 12 months. 86.8% (n=461) of non-diabetic and 88.4% (n=642) of diabetic patients were available for follow up. MACE events were significantly higher (p=0.000) in diabetic group (4.3%, n=31) as compare to non-diabetic group (0.6%, n=3). Target lesion revascularization (TLR) and myocardial infarction (MI) was also significantly higher in diabetic group (TLR 1.4%, N=10 vs 0.6%, n=3, p=0.049; MI 2.6%, n=19 vs 0.4%, n=2, p=0.002). Conclusion Treating de novo coronary lesions in diabetic patients with DCB associated with significantly higher MACE events, target lesion revascularization and myocardial infarction. Diabetic patients appear to have a greater volume of atherosclerotic plaque and increased propensity for atherosclerotic plaque rupture. Funding Acknowledgement Type of funding source: None

scholarly journals PCI in patients with ostium coronary artery lesions: three-year follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Maximkin ◽  
Z Shugushev ◽  
A Chepurnoy ◽  
O Safonova ◽  
A Mambetov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Target Lesion ◽  
Long Term Results ◽  
Coronary Artery Lesions ◽  
Total Frequency ◽  
Stent Restenosis ◽  
Group I ◽  
Group Ii

Abstract Aims To increase the effectiveness of percutaneous coronary interventions (PCI) in patients with ostium coronary artery lesions. Methods 170 patients were included in the study. Inclusion criteria: ostium atheroslerotic lesions of left arterial descending (LAD) or left circumflex (LCx) >70% according to angiography and intravascular ultrasound (IVUS); myocardial ischemia according stress test and FFR measurement. All patients were randomized into 2 groups. In I group (n=85) according to IVUS, atherosclerotic plaque spread from the ostium of LAD and/or LCx to the left main coronary artery (LMCA), and in group II (n=85) - the plaque did not spread into the LMCA. In Group I all patients were initially treated with “Provisional T” stenting of the LMCA, and in Group II – precision stenting of the ostium LAD or LCx. Long-term results were evaluated on 24 and 48 months. Primary endpoints: frequency of MACE (death, MI, revascularizations). Results During hospitalization of complications associated with PCI was not, survival was 100% in all groups. The conversion to complete bifurcation stenting were in 5 patients from Group I and conversion to provisional stenting were in 3 patients from Group II. The long-term results after 24 months was observe in 70 patients from Group I and 72 patients, from Group II. Nonfatal myocardial infarction (MI) was observed in 2 (2.7%) of patients from group II and not in Group I. The incidence of hemodynamic significant stent restenosis and was observed in 4 patients (5.7%) in Group I, and in 7 patients (9.8%) in Group II (p<0.05). The target lesion revascularization (TLR) was performed in 4 patients (5.7%) in Group I, and in 9 patients (12.5%) in Group II (p<0.05). The total frequency of MACE in groups I and II was 4 (5.7%) and 9 (12.5%), respectively (p<0.05). The survival was 100% in both groups. The long-term results after 48 months was observe in 58 patients from Group I and 54 patients, from Group II. All type of death registration in 1 patient from Group I and 2 patients from Group II. Nonfatal myocardial infarction (MI) was observed in 1 patient (1.7%) and 2 patients from Group II (3.7%) (p>0.05). The incidence of hemodynamic significant stent restenosis was observed in 3 patients (5.7%) in Group I, and in 5 patients (9.3%) in Group II (p<0.05). The target lesion revascularization (TLR) was performed in 4 patient (6.9%) in Group I, and in 7 patient (13%) in Group II (p<0.05). The total frequency of MACE in groups I and II was 5 (8.6%) and 10 (18.5%), respectively (p<0.05). The freedom from cardiac events (Kaplan-Maier analysis) was significant difference (92.5 in Group I and 84.5 in Group II (p<0.05). Conclusions IVUS analysis of ostium stenosis of coronary arteries can help in choosing the optimal stenting technique, as well as reliably improve long-term PCI results. Patients after precision stenting of the ostium have worse long-term results, compared with patients after provisional T-stenting. Funding Acknowledgement Type of funding source: None

Safety and Effectiveness of the SVELTE Fixed-Wire and Rapid Exchange Bioresorbable-Polymer Sirolimus-Eluting Coronary Stent Systems for the Treatment of Atherosclerotic Lesions: Results of the OPTIMIZE Randomized Study

2021 ◽  
Author(s):  
Dean J. Kereiakes ◽  
Robert L. Feldman ◽  
A.J.J. Ijsselmuiden ◽  
Shigeru Saito ◽  
Giovanni Amoroso ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Target Lesion ◽  
Coronary Stent ◽  
Target Vessel ◽  
End Point ◽  
Rapid Exchange ◽  
Direct Stenting ◽  
Durable Polymer ◽  
Bioresorbable Polymer ◽  
Target Lesion Failure

Background: The SVELTE fixed-wire and rapid exchange bioresorbable-polymer sirolimus-eluting coronary stent systems (SVELTE sirolimus-eluting stent [SES]) are novel, low-profile devices designed to facilitate direct stenting, transradial access, and enhance procedural efficiencies. Methods: Eligible subjects (N=1639) scheduled to undergo percutaneous coronary intervention for non–ST-segment–elevation myocardial infarction or stable coronary artery disease were randomly assigned (1:1) to treatment with either SVELTE SES or a control durable polymer everolimus-eluting coronary stent. The primary end point was 12-month target lesion failure and a noninferiority margin was specified as 3.58% with an expected event rate of 6.5%. Results: Target lesion failure was observed in 10.3% of SVELTE SES and 9.5% of control everolimus-eluting stent subjects under intention to treat analysis (difference=0.8%; P NI =0.034). Clinically indicated target lesion revascularization and stent thrombosis were observed in 1.5% versus 1.9% ( P =0.57) and 0.38% versus 0.51% ( P =0.72) of SVELTE SES versus control everolimus-eluting stent–treated subjects, respectively. Protocol-defined target vessel myocardial infarction (9.4% versus 8.2%) was higher than anticipated and more frequent at sites that utilized troponin versus creatine kinase myocardial band assays. Conclusion: The SVELTE SES did not meet the prespecified threshold for noninferiority. Unexpectedly, high rates of target vessel myocardial infarction in both treatment groups contributed to higher than expected rates of target lesion failure, effectively underpowering the study. No differences between the SVELTE SES and control everolimus-eluting stent were observed for primary clinical or angiographic end point events. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03190473.

scholarly journals MYOCARDIAL INFARCTION WITH AN INITIALLY NORMAL ELECTROCARDIOGRAM

2020 ◽  
pp. 23-25
Author(s):  
Amit Kumar Tiwari ◽  
Prabhat Kumar Sinha ◽  
Jyoti Prakash Lal Karn ◽  
Debarshi Jana
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Myocardial Damage ◽  
Final Diagnosis ◽  
Coronary Arteriography ◽  
St Depression ◽  
Wave Inversion ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

To analyze the paradox of acute myocardial infarction(AMI) with an initially normal electrocardiogram(ECG), we reviewed the records of 100 patients discharged with 21 final diagnosis of AM1 over a 1-year period. Twentyonepatient were identified whose initial ECG was normal andwho underwent coronary arteriography during the index hospitalization. According to the ECG evolution, three distinctgroups were identified: Group 1 : those who subsequently developedST elevation or Q waves (n = 7), Group 2: those whodeveloped ST depression or T-wave inversion (n = 8), andGroup 3:those whose ECG remained normal (n = 6). Trop-T positive, Peakcreatine kinase (CK), timing of the first ECG change, lifethreateningcomplications, and location of the infarct-relatedcoronary lesion were recorded. Infarct-related coronary lesionswere also classified into those in a major coronary trunkversus those in secondary branches. The incidence of AMI with a normal ECG was 3.7%. There was no difference in thefrequency of coronary artery involvement in the groups studied:left anterior descending (33%), right coronary artery(38%). and circumflex (28%). All ECG changes developedwithin the first 48 h of hospitalization; 17±15 h in Group 1, and24±12 h in Group 2. All six patients who had a persistentlynormal ECG (Group 3) had lesions in branch vessels (p <0.05 when compared with Group 1 plus Group 2). Patientswho developed ST elevation or Q waves (Group 1) alwayshad a major artery trunk involved (p <0.05 when comparedwith Group 2 plus Group 3). Patients in Group 3 had less myocardial damage and fewer complications compared with theother two groups. Myocardial infarction with an initial normalECG is uncommon and may result from involvement of any ofthe three coronary arteries. Electrocardiographic evolutionusually occurs within the first 48 h of hospitalization. Patientswhose ECGs remain normal appear to have culprit lesions incoronary branches, smaller infarctions, and fewer in-hospital complications.

scholarly journals Effectiveness and prognostic value of intravscular imaging in patients with left main coronary artery stenosis and heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Maximkin ◽  
Z Shugushev ◽  
A Chepurnoy ◽  
J M Bolivougui ◽  
A Faybushevich ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Left Main Coronary Artery ◽  
Terminal Part ◽  
Left Main ◽  
Cardiac Events ◽  
Group 2 ◽  
Group 1

Abstract Aims A comparative analysis and evaluate the effectiveness and prognostic value of optical coherence tomography (OCT) and fractional flow reserve (FFR) guiding measurement in patients with stenosis of the terminal part of the left main coronary artery (LMCA). Methods 222 patients were selected in the study. Inclusion criteria: true bifurcation stenosis of the LMCA according to quantitative coronary angiography (QCA) and classification by A. Medina. Criteria for determining the hemodynamic significance of stenosis: according OCT - minimal lumen area (MLA) in the terminal part of LMCA &lt;6 mm2; according FFR guiding – &lt;0.8 (in LCx or LAD or both). Patients, who have not been diagnosed hemodynamically significant stenosis, were further subjected to the dynamic observation. All received optimal medical therapy. The study continued to participate patients whose compliance to receive drugs was not lower than 80%. Primary endpoints: frequency of MACE (death, myocardial infarction, revascularizations). The follow-up were 12, 24, 36 months. Results The OCT was performed in 110 patients and FFR guiding measurement – in 112 patients. According to the OCT, were hemodynamically significant stenoses are determined in 36 (32.7%) patients and after FFR-guiding measurement – in 32 (28.6%) of patients (χ2=2.184 p&gt;0.05). Patients without hemodynamically significant stenoses distributed into 2 groups: group 1 (n=74) – according to the OCT and group 2 (n=80) – according to the FFR. The long-term results were monitored in all patients. The frequency of myocardial infarction in group 1 were 1.4% and in group 2 – 7.5% (p&lt;0.05).The frequency of revascularization in group 1 were 5.4% and in group 2 – 15% (p&lt;0.05). The total frequency of major cardiac events were 6.75% in group I and 22.5% in group II (χ2=6.435; p&lt;0.001). The survival without major cardiac events (Kaplan-Maier analysis) were significantly differ between the groups, of 93.25% in group 1 and 77.5% – in group 2 (χ2=7.162 p&lt;0.001). Conclusions The effectiveness of the OCT imaging and the FFR-guiding measurement in determining the hemodynamic significance of the bifurcation stenosis of the LMCA, not different. However, in the long term period, patients with insignificant stenosis identified by the FFR, have a worse prognosis and are distinguished by a major cardiac events, compared with the OCT, which does not allow us to recommend the FFR method as the main one for determining the hemodynamic significance of LMCA. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100

scholarly journals Effect of late culprit coronary artery revascularization on prognosis of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 25 (8) ◽  
pp. 3796
Author(s):  
A. A. Frolov ◽  
K. V. Kuzmichev ◽  
I. G. Pochinka ◽  
E. G. Sharabrin ◽  
A. G. Savenkov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Artery Revascularization ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

Aim. To evaluate the effect of culprit coronary artery revascularization after 48 hours from the symptoms’ onset on the prognosis of patients with ST-elevation myocardial infarction (STEMI).Material and methods. Of the 1172 patients admitted to City Clinical Hospital № 13 in 2018 due to STEMI, 43 patients (4%) were included in the retrospective study. There were following inclusion criteria: hospitalization after 48 hours from the symptoms’ onset, no clinical signs of myocardial ischemia, and complete coronary artery occlusion according to angiography. The mean age of the subjects was 61,3±10,6 years, 34 (79%) men and 9 (21%) women. The subjects were divided into two groups: group 1 (n=22) — management with percutaneous coronary intervention (PCI), group 2 (n=21) — management with medications. The groups differ only in the severity of coronary atherosclerosis according to SYNTAX score: group 1 — 14,0 [11.0; 19.5], group 2 — 26,0 [16,5; 31,0] (p=0,009). At the end of inpatient treatment, patients underwent echocardiography. Death and myocardial infarction were monitored during hospitalization and for 12 months after discharge.Results. During hospitalization, 2 patients died (4,7%; one in each group, p=1,00). No recurrent MI were reported. The left ventricular ejection fraction in the PCI group was 50 [46; 54] %, in the group with drug therapy — 43 [38; 50] % (p=0,01). Out of 43 included patients, long-term outcomes were followed up in 32 (74%). Among them, 1 (5,8%) patient died in group 1, 6 (33,3%) patients — in group 2 (p=0,04). In total, death or recurrent MI in the first group was observed in 2 (12%) patients, in the second group — in 5 (33%) patients (p=0,14).Conclusion. Revascularization of a fully occluded culprit coronary artery in stable patients with STEMI after 48 hours of symptoms’ onset is associated with a higher inhospital left ventricular ejection fraction and a decrease in 12-month mortality.

scholarly journals Comparison of Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Stents and Thin, Durable-Polymer Everolimus-Eluting Stents in Calcified or Small Vessel Lesions

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Kazuhiro Dan ◽  
Hector M. Garcia-Garcia ◽  
Paul Kolm ◽  
Stephan Windecker ◽  
Shigeru Saito ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Randomized Controlled Trials ◽  
Target Lesion ◽  
Small Vessel ◽  
Controlled Trials ◽  
Target Vessel ◽  
Randomized Controlled ◽  
Durable Polymer ◽  
Bioresorbable Polymer ◽  
Target Lesion Failure

Background: The ultrathin-strut bioresorbable-polymer sirolimus-eluting stent (BP-SES) demonstrated comparable performance to durable-polymer everolimus-eluting stent (DP-EES) in randomized controlled trials. The purpose of this study was to evaluate the performance of a BP-SES compared with a DP-EES in calcified or small vessel lesions, which represent higher risk of restenosis. Methods: From the pooled BIOFLOW (BIOFLOW-II, IV, and V; BIOTRONIK - A Prospective Randomized Multicenter Study to Assess the Safety and Effectiveness of the Orsiro Sirolimus Eluting Coronary Stent System in the Treatment of Subjects With up to Three De Novo or Restenotic Coronary Artery Lesions ) randomized controlled trials, a total of 1553 BP-SES and 784 DP-EES patients with valid 1-year follow-up data were available. Coronary lesions were assessed for the presence of moderate-to-severe calcification or small vessels (reference vessel diameter, ≤2.75 mm) by core laboratory analysis. One-year clinical outcomes were assessed with or without the lesion subsets between BP-SES and DP-EES. Results: Baseline characteristics were similar between the groups. Among patients with small vessel disease, target lesion failure (8.0% versus 12.4%; P <0.01) and target vessel myocardial infarction (4.2% versus 7.6%; P <0.01) were significantly lower in BP-SES than in DP-EES. No difference in the outcome between the stents was shown in patients with non-small vessel lesions. In patients with calcified lesions, target lesion failure (12.2% versus 6.9%; P =0.056), and cardiac death (1.9% versus 0.3%; P =0.081) were numerically higher in DP-EES than in BP-SES. In the noncalcified lesion analysis, target vessel myocardial infarction in DP-EES was significantly higher than in BP-SES. Stent thrombosis was similar between the stents in both lesion groups. Conclusions: Among patients with more complex disease representing a higher risk of target lesion failure, the effectiveness of an ultrathin-strut BP-SES compared with a thin-strut DP-EES was maintained through 1 year. Registration: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01356888, NCT01939249, NCT02389946.

scholarly journals Incresed inflammatory response in patients with the first myocardial infarction and nonsignificant stenosis of infarct-related artery

2012 ◽  
Vol 69 (9) ◽  
pp. 787-793
Author(s):  
Nenad Ratkovic ◽  
Dragan Dincic ◽  
Branko Gligic ◽  
Snjezana Vukotic ◽  
Aleksandra Jovelic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Inflammatory Diseases ◽  
Mean Value ◽  
Significant Stenosis ◽  
Infarct Related Artery ◽  
The Mean ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Introduction/Aim. Atherosclerosis presents a serial of highly specific cellular and molecular responses, and could be described as inflammatory diseases. Accordingly, for development of acute myocardial infarction (AMI), structure and vulnerability of atherosclerotic plaque are more important than the extent of stenosis of infarct-related artery. Consequently, inflammation and atherosclerosis and its complications are in good correlation. C-reactive protein (CRP) as nonspecific inflammatory marker, has prognostic significance in coronary artery diseases. The aim of this study was to establish the correlation between inflammatory response expressed as levels of CRP and fibrinogen in serum and extent of coronary artery stenosis. Methods. Study included 35 patients with acute myocardial infarction, as the first manifestation of coronary artery disease, which were treated with thrombolytic therapy according to the guidelines. All the patient had a reperfusion. The patients with acute or chronic inflammatory diseases, an increased value of sedimentation, fibrinogen, CK ?190 U/L, early and late complications of AMI were excluded. CRP was measured on admission, after 24, 48 and 72 hrs, and 21 days latter, while fibriogen only on admission. Results. All the patients underwent coronary angiography, and were divided into two groups: the group 1 (23 patients), with significant stenosis of infarct-related artery (stenosis ? 75%), and the group 2 (13 patients) without significant stenosis (< 75%). Mean value of CRP serum level on admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p < 0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L, and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the group 2 (p < 0.001). There was no significant difference between the groups 1 and 2 related to gender, age, localization of AMI, CK, EF value, and risk factors for coronary artery disease. Conclusion. The patients with nonsignificant stenosis of infarct-related artery had increased inflammtory responses according to the CRP value, as a result of inflammatory process in atherosclerotic plaque and/or enhanced individual reactivity.

scholarly journals Coronary endarterectomy in myocardial revascularization

2021 ◽  
Vol 26 (8) ◽  
pp. 4310
Author(s):  
Ya. Yu. Visker ◽  
D. N. Kovalchuk ◽  
A. N. Molchanov ◽  
O. R. Ibragimov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Mechanical Ventilation ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Endarterectomy ◽  
Perioperative Myocardial Infarction ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Aim. To compare the immediate outcomes of combined coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) and isolated CABG.Material and methods. This retrospective study included 192 patients with stable angina who underwent myocardial revascularization in the period from January 2016 to August 2018. The patients were divided into 2 groups. Group 1 included patients who underwent combined CABG and CE, while group 2 — patients who underwent isolated CABG. Patients in both groups did not differ in the main preoperative characteristics, with the exception of the incidence of obesity and right coronary artery disease.Results. In-hospital mortality in group 1 was 2,2% (n=2), in group 2 — 2% (n=2). The incidence of perioperative myocardial infarction in group 1 was 1% (n=1) and in group 2 — 0%. There were no significant differences between groups in the following postoperative parameters: in-hospital mortality, perioperative myocardial infarction, need and duration of inotropic support, duration of mechanical ventilation (MV) and need for long-term mechanical ventilation, stroke, arrhythmias, resternotomy for bleeding. In group 1, encephalopathy (11,8%) and respiratory failure (12,9%) were significantly more common.Conclusion. Combined CABG and CE is a safe technique for achieving complete myocardial revascularization in diffuse coronary artery disease, since, in comparison with isolated CABG, there is no increase in the incidence of death and perioperative myocardial infarction. However, in this category of patients, an increase in the incidence of non-lethal, non-disabling cerebral and pulmonary complications should be expected.

scholarly journals Adverse events in acute myocardial infarction patients: the DAPT Score for risk stratification in an Asian population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Nakada ◽  
A Lee ◽  
W Huang ◽  
K K Yeo ◽  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Bleeding Risk ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Ischemic Events ◽  
Group 1

Abstract Background Dual antiplatelet therapy (DAPT) is essential in mitigating adverse ischemic events after myocardial infarction (MI), and current guidelines have recommended the therapy to be administered for at least 1 year. Though prolonged DAPT helps to reduce ischemic events in high-risk patients, it can also increase the risk of significant bleeding. Risk stratification tools, such as the DAPT Score, can help to identify patients who are most or least likely to benefit from prolonged DAPT. Purpose To evaluate the performance of the DAPT Score as a predictor of major adverse cardiovascular events (MACE) in an Asian cohort who underwent percutaneous coronary intervention (PCI) for MI. Methods The analysis cohort consisted of 2086 MI patients (86% of primary PCI patients) who were admitted to Singaporean hospitals between 2012 and 2014. Demographic, clinical and therapeutic data regarding the index hospitalisation and 12-month follow-up period were collected. Patients were grouped according to their DAPT Score (high ischemic vs high bleeding risk) and DAPT duration (12 vs &lt;12 months; Figure 1). The primary endpoint was MACE (all-cause mortality, recurrent MI and stroke). MACE as an outcome was evaluated using multivariable Cox regression adjusted for age, gender, ethnicity, smoking status, prior MI, PCI or coronary artery bypass graft, hypertension, dyslipidaemia, cerebrovascular disease, diabetes mellitus, family history of coronary artery disease, vein graft stent and type of MI at presentation. Results The overall incidence rate of MACE in this cohort was 12.3%. There was a significantly higher MACE rate in Group 2 patients compared to Group 1 patients (high ischemic risk and &lt;12-month DAPT vs high ischemic risk and 12-month DAPT; hazard ratio: 1.37, 95% confidence interval: 1.02–1.83, P=0.038). No other significant differences in MACE rates were observed among the rest of the groups (Group 3: 1.44 [0.89–2.34]; Group 4: 1.15 [0.61–2.16], P&gt;0.050). Furthermore, MACE was independently associated with diabetes, hypertension, prior MI and cerebrovascular disease (1.49 [1.10–2.02], 1.43 [1.00–2.05], 1.41 [1.01–1.98], 3.06 [2.15–4.37], respectively, P&lt;0.050). Patients &lt;65 years and males were found to be protected against MACE (0.71 [0.51–0.99], 0.72 [0.52–0.99], respectively, P&lt;0.050). The overall bleeding rate was 2.2% (Group 1: 2.0%; Group 2: 1.7%; Group 3: 6.0%; Group 4: 0.7%). Conclusions The DAPT Score predicted MACE up to 12 months after PCI in MI patients with high ischemic risk and &lt;12 months of DAPT. This highlights the importance of adequate duration of DAPT in high ischemic risk MI patients. Moreover, the elderly, female, diabetic, hypertensive and those with prior cerebrovascular disease or MI were at increased risk for MACE. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council - Health Services Research Grants (Ministry of Health, Singapore) Cohorts Cox regression for MACE

Sign in / Sign up

Export Citation Format

Share Document