Hospital outcome of percutaneous coronary stenting in long segment lesions

Background: Coronary heart disease is increasing at an alarming rate among elder people in Bangladesh. For long segment lesion in heart, percutaneous coronary intervention is now a common procedure with great success rate. The aim of this study was to assess immediate outcome of percutaneous coronary stenting of long segment lesions.Methods: This prospective observational study was conducted at the Department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during the period from January 2005 to December 2006. The sample size was 100 patients undergoing PCI of long and short coronary lesions.Results: No complications found in 82.0% and 88.0% of cases in group I and II respectively. Coronary dissection occurred in 6% and 4% cases in group I and II respectively. ST elevation and pathological Q were 46.0% in pre and 50.0% in post PCI period in group I. In group II patients 48.0% in pre and 52.0% in post PCI period showed ST elevation and pathological Q wave. ST depression and/or T inversion was 18.0% in pre and 16.0% in post PCI period in group I, in group II this value was 22.0% and 14.0% respectively. In group I patients, CK-MB increased from 24.33±7.72 U/l in baseline to 43.30±10.99 U/l 6-8 hrs after procedure and before discharge CK-MB decreased to 31.91±11.17 U/l. In the group II patients, it increased from 25.42±5.84 U/l in baseline to 39.38±6.98 U/l 6-8 hrs after procedure and before discharge CK-MB decreased to 29.64±8.21 U/l.Conclusions: This study concludes that the immediate outcome of long segment coronary stenting is safe and highly effective.

Direct Oral Anticoagulants (DOACs)-Based Versus Warfarin-Based Antithrombotic Regimens in Patients with Atrial Fibrillation Underwent Successful Coronary Stenting at Siriraj Hospital

Objective: To investigate the 1-year bleeding outcome between direct oral anticoagulants (DOACs)-based regimens and warfarin-based regimens in real-world practice in Thai patients with atrial fibrillation (AF) and significant coronary artery disease (CAD). Materials and Methods: The present study was a retrospective study. The authors reviewed the electronic medical charts of patients treated at the Siriraj Hospital between January 1, 2012 and October 31, 2019. The inclusion criteria were patients with AF and significant CAD that underwent percutaneous coronary intervention (PCI) with a stent and were prescribed or planned to prescribe anticoagulants after the PCI. The primary end point was the International Society on Thrombosis and Hemostasis (ISTH) bleeding during a 1-year follow-up period after successful coronary stenting. The trial assessed for the difference in the bleeding outcome and composite efficacy end point of myocardial infarction, ischemic stroke, and systemic embolism between patients that received warfarin-based regimen and those that received DOACs-based regimen. Results: The prevalence of patients that received additional oral anticoagulation was 5.1% (679/13,306 patients). One hundred seventy patients met the study inclusion and exclusion criteria. The incidence of the primary end point was 9.0% in the warfarin-based regimen compared with 8.1% in the DOACs-based regimen (p=1.000). The incidence of the composite efficacy end point was 8.3% in the warfarin-based regimen compared with 0% in the DOACs-based regimen (p=0.124). Conclusion: In patients with AF and significant CAD that underwent PCI, the use of a DOACs-based regimen had no statistically significant difference in bleeding outcome but associated with lower ischemic endpoint. However, due to the limited study sample size, the study had insufficient power to declare the results statistically significant. Keywords: Coronary artery disease; Atrial fibrillation; DOAC; Warfarin

Significance of abdominal obesity and endothelial dysfunction marker in patients undergoing elective coronary stenting

Aim. To study the prognostic significance of abdominal obesity and endothelial dysfunction marker in patients undergoing elective coronary stenting.Material and Methods. The study included 225 patients with coronary artery disease at an average age of 57 [51; 63] years admitted to hospital for the purpose of performing planned endovascular myocardial revascularization through stenting. Depending on the presence or absence of adverse cardiovascular events, the patients were divided into two groups. Group 1 included 127 patients with an unfavorable course of disease; group 2 comprised 98 examined patients with a favorable course. The serum levels of endothelin-1 (ET-1), insulin, interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-10 (IL -10) and the ratio of waist to hip circumference (waist-to-hip ratio) were assessed directly before stenting the coronary arteries. The insulin resistance index (HOMA-IR) was calculated using the formula: fasting insulin (μIU/mL) × fasting blood glucose (mmol/L)/22.5. The lipid spectrum was determined by the enzymatic colorimetric method.Results. Correlation analysis of data in group 1 showed the presence of strong relationships of waist-to-hip ratio with body mass index (BMI) (r = 0.776; p = 0.000), ET-1 (r = 0.873; p = 0.000), and HOMA-IR index (r = 0.544; p = 0.000); weak relationships were found with basal glycemia (r = 0.238; p = 0.019), IL-10 (r = 0.295; p = 0.006), and IL-1 (r = 0.219; p = 0.047). Correlation analysis of data in group 2 showed the presence of week relationships of waist-to-hip ratio with BMI (r = 0.371; p = 0.002) and ET-1 (r = 0.471; p = 0.000) only.Conclusion. The study showed that ET-1 and the waist-to-hip ratio are strongly associated with the risk of adverse cardiovascular events after coronary stenting compared with other markers studied.

Aortocoronary Bypass Surgery in Patients with Recurrent Post-Coronary Stenting Angina

Background. A wide adoption of percutaneous coronary operations has led to an average one-third reduction in the aortocoronary bypass surgery (ACB) rate and altering of the ACB patient profile to mainly represent advanced occlusive coronary atherosclerosis.Materials and methods. The study analyses treatment outcomes in coronary heart disease patients with recurrent angina after a previous endovascular intervention. Over years 2009–2015, 1,023 ACB operations were performed at the Almetyevsk — OAO Tatneft Medical Unit cardiac surgery rooms. Pre-surgery coronary artery stenting (CAS) was rendered at various terms in 96 patients (23 % women, 76 % men; cohort 1). The main cohort (n = 96) was divided into 2 subgroups: IA (n = 64), single CAS; IB (n = 32), multiple CAS patients. For statistical significance, cohort 2 (control) comprised 185 patients (21 % women, 79 % men) to include every 5th history of the remaining 927 patients operated within same period.Results and discussion. The mean aortic occlusion time was shorter in multiple CAS patients vs. other cohorts (61.3 ± 31.2 vs. 72.5 ± 27.8 and 70.7 ± 41.2 min). Cohort 1 had an overall higher emergency resternotomy rate due to ongoing bleeding (7.4 and 8.3 vs. 2.0 %). Furthermore, pre-surgery multiple CAS patients more likely faced the complications of perioperative MI (8.5 vs. 3.1 and 1.4 %) and acute postoperative heart failure (7.2 vs. 2.3 and 1.4 %, p < 0.01). This cohort often required inotropic support (9.3 vs. 3.8 and 2.1 %).Conclusion. Statistical analysis revealed a significantly higher complication and mortality rate in patients with previous coronary stenting compared to ACB patients. Adverse ACB outcomes were observed with multiple-coronary stenting cases, in contrast to the cohort with no pre-surgery interventions.

Vasoprotective effects hypotensive therapy in patients with coronary heart disease combined with chronic kidney disease stage 2-3 after coronary stenting

Aim To study the condition of coronary vasculature by data of coronarography (CG) in patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH) associated with stage 2-4 chronic kidney disease (CKD) and to evaluate the effect of a 12-week complex treatment with perindopril or with a combination of perindopril/amlodipine on changes in vascular wall stiffness, endothelial function, and structure and function parameters in this patient category after coronary stenting.Material and methodsr This study included 87 patients with chronic IHD and AH associated with stage 2-3 CKD for whom CG was performed due to ineffectiveness of the antianginal therapy. The patients were divided into three subgroups: subgroup 1 included 28 patients who received a conservative treatment with perindopril 10 mg/day; subgroup 2 consisted of 25 patients who underwent coronary stenting and were prescribed perindopril; subgroup 3 consisted of 34 patients who underwent stenting and were prescribed the perindopril/amlodipine combination. The reference group included 47 patients with IHD and AH with preserved kidney function. Anatomic and functional parameters of the heart, arterial stiffness, pulse wave velocity, cardio-ankle vascular index, augmentation index, central aortic systolic and pulse pressure, endothelium-dependent vasodilation, plasma concentration of endothelin-1 (ET-1), and plasma concentration of nitric oxide metabolites were evaluated at baseline and after 12 weeks of treatment.Results In patients with IHD, AH, and stage 2-3 CKD, arterial stiffness was more pronounced than in patients with preserved kidney function. Concentrations of ET-1 were significantly higher and levels of nitric oxide were lower in CKD. Supplementing the complex therapy with perindopril resulted in a considerable hypotensive effect in all subgroups, improvement of the kidney function, and positive dynamics of arterial stiffness and endothelial function. Changes in these parameters were more pronounced in patients after coronary stenting than in patients receiving only a conservative treatment. The use of perindopril/amlodipine following stenting exerted the most significant angioprotective and cardioprotective effect.Conclusion Patients with IHD and AH in combination with early CKD have pronounced impairment of the condition of arterial blood vessels and the heart. Addition of perindopril to the treatment not only exerted a hypotensive effect but also beneficially influenced mechanisms of progression of this combined pathology.