1
|
Mehta A, Vavilin I, Nguyen AH, Batchelor WB, Blumer V, Cilia L, Dewanjee A, Desai M, Desai SS, Flanagan MC, Isseh IN, Kennedy JLW, Klein KM, Moukhachen H, Psotka MA, Raja A, Rosner CM, Shah P, Tang DG, Truesdell AG, Tehrani BN, Sinha SS. Contemporary approach to cardiogenic shock care: a state-of-the-art review. Front Cardiovasc Med 2024; 11:1354158. [PMID: 38545346 PMCID: PMC10965643 DOI: 10.3389/fcvm.2024.1354158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/13/2024] [Indexed: 05/02/2024] Open
Abstract
Cardiogenic shock (CS) is a time-sensitive and hemodynamically complex syndrome with a broad spectrum of etiologies and clinical presentations. Despite contemporary therapies, CS continues to maintain high morbidity and mortality ranging from 35 to 50%. More recently, burgeoning observational research in this field aimed at enhancing the early recognition and characterization of the shock state through standardized team-based protocols, comprehensive hemodynamic profiling, and tailored and selective utilization of temporary mechanical circulatory support devices has been associated with improved outcomes. In this narrative review, we discuss the pathophysiology of CS, novel phenotypes, evolving definitions and staging systems, currently available pharmacologic and device-based therapies, standardized, team-based management protocols, and regionalized systems-of-care aimed at improving shock outcomes. We also explore opportunities for fertile investigation through randomized and non-randomized studies to address the prevailing knowledge gaps that will be critical to improving long-term outcomes.
Collapse
Affiliation(s)
- Aditya Mehta
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Ilan Vavilin
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Andrew H. Nguyen
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Wayne B. Batchelor
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Vanessa Blumer
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Lindsey Cilia
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
- Department of Cardiovascular Disease, Virginia Heart, Falls Church, VA, United States
| | - Aditya Dewanjee
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mehul Desai
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Shashank S. Desai
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Michael C. Flanagan
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Iyad N. Isseh
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Jamie L. W. Kennedy
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Katherine M. Klein
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Hala Moukhachen
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Mitchell A. Psotka
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Anika Raja
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Carolyn M. Rosner
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Palak Shah
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Daniel G. Tang
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Alexander G. Truesdell
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
- Department of Cardiovascular Disease, Virginia Heart, Falls Church, VA, United States
| | - Behnam N. Tehrani
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Shashank S. Sinha
- Department of Cardiovascular Disease, Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| |
Collapse
|
2
|
Zaman F, Isom N, Chang A, Wang YG, Abdelhamid A, Khan A, Makan M, Abdelghany M, Wu X, Liu K. Deep learning from atrioventricular plane displacement in patients with Takotsubo syndrome: lighting up the black-box. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:134-143. [PMID: 38505490 PMCID: PMC10944681 DOI: 10.1093/ehjdh/ztad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 03/21/2024]
Abstract
Aims The spatiotemporal deep convolutional neural network (DCNN) helps reduce echocardiographic readers' erroneous 'judgement calls' on Takotsubo syndrome (TTS). The aim of this study was to improve the interpretability of the spatiotemporal DCNN to discover latent imaging features associated with causative TTS pathophysiology. Methods and results We applied gradient-weighted class activation mapping analysis to visualize an established spatiotemporal DCNN based on the echocardiographic videos to differentiate TTS (150 patients) from anterior wall ST-segment elevation myocardial infarction (STEMI, 150 patients). Forty-eight human expert readers interpreted the same echocardiographic videos and prioritized the regions of interest on myocardium for the differentiation. Based on visualization results, we completed optical flow measurement, myocardial strain, and Doppler/tissue Doppler echocardiography studies to investigate regional myocardial temporal dynamics and diastology. While human readers' visualization predominantly focused on the apex of the heart in TTS patients, the DCNN temporal arm's saliency visualization was attentive on the base of the heart, particularly at the atrioventricular (AV) plane. Compared with STEMI patients, TTS patients consistently showed weaker peak longitudinal displacement (in pixels) in the basal inferoseptal (systolic: 2.15 ± 1.41 vs. 3.10 ± 1.66, P < 0.001; diastolic: 2.36 ± 1.71 vs. 2.97 ± 1.69, P = 0.004) and basal anterolateral (systolic: 2.70 ± 1.96 vs. 3.44 ± 2.13, P = 0.003; diastolic: 2.73 ± 1.70 vs. 3.45 ± 2.20, P = 0.002) segments, and worse longitudinal myocardial strain in the basal inferoseptal (-8.5 ± 3.8% vs. -9.9 ± 4.1%, P = 0.013) and basal anterolateral (-8.6 ± 4.2% vs. -10.4 ± 4.1%, P = 0.006) segments. Meanwhile, TTS patients showed worse diastolic mechanics than STEMI patients (E'/septal: 5.1 ± 1.2 cm/s vs. 6.3 ± 1.5 cm/s, P < 0.001; S'/septal: 5.8 ± 1.3 cm/s vs. 6.8 ± 1.4 cm/s, P < 0.001; E'/lateral: 6.0 ± 1.4 cm/s vs. 7.9 ± 1.6 cm/s, P < 0.001; S'/lateral: 6.3 ± 1.4 cm/s vs. 7.3 ± 1.5 cm/s, P < 0.001; E/E': 15.5 ± 5.6 vs. 12.5 ± 3.5, P < 0.001). Conclusion The spatiotemporal DCNN saliency visualization helps identify the pattern of myocardial temporal dynamics and navigates the quantification of regional myocardial mechanics. Reduced AV plane displacement in TTS patients likely correlates with impaired diastolic mechanics.
Collapse
Affiliation(s)
- Fahim Zaman
- Department of Electrical and Computer Engineering, University of Iowa, 103 S. Capitol St., 3318 SC, Iowa City, IA 52242, USA
| | - Nicholas Isom
- Division of Cardiology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Amanda Chang
- Division of Cardiology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Yi Grace Wang
- Department of Mathematics, California State University Dominguez Hills, 1000 E. Victoria Street, Carson, CA 90747, USA
| | - Ahmed Abdelhamid
- Division of Cardiology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Arooj Khan
- Division of Cardiology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Majesh Makan
- Division of Cardiology, Department of Internal Medicine, Washington University, 4940 Parkview Place, St Louis, MO 63110, USA
| | - Mahmoud Abdelghany
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, University of Iowa, 103 S. Capitol St., 3318 SC, Iowa City, IA 52242, USA
| | - Kan Liu
- Division of Cardiology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Division of Cardiology, Department of Internal Medicine, Washington University, 4940 Parkview Place, St Louis, MO 63110, USA
| |
Collapse
|
3
|
Abiodun OO, Anya T, Chukwu JC, Adekanmbi V. Prevalence, Risk Factors and Cardiovascular Comorbidities of Resistant Hypertension among Treated Hypertensives in a Nigerian Population. Glob Heart 2024; 19:17. [PMID: 38344745 PMCID: PMC10854423 DOI: 10.5334/gh.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
The true prevalence and cardiovascular comorbidities of resistant hypertension (RH) in Nigeria and Africa are not known. We sought to determine the prevalence and cardiovascular comorbidities of resistant hypertension in a treated Nigerian hypertensive population. We analyzed 1,378 patients with essential hypertension from a prospective clinical registry, the Federal Medical Centre Abuja Hypertension Registry. Resistant hypertension was defined as blood pressure ≥140/90 mmHg despite the use of ≥3 guideline-recommended antihypertensive medications including a diuretic, reninangiotensin system blocker and calcium-channel blocker at optimal or best-tolerated doses or blood pressure <140/90 mmHg on ≥4 antihypertensive medications. Resistant hypertension was confirmed with the use of home blood pressure monitoring while adherence was determined by monitoring prescription orders. The prevalence of resistant hypertension was 15.5%, with 12.3% as controlled resistant hypertension and 3.3% as uncontrolled resistant hypertension. Risk factors independently associated with the odds of resistant hypertension were male sex (adjusted odds ratio [AOR]: 1.62, 95% confidence interval [CI] 1.19-2.21, p = 0.002), obesity, and diabetes mellitus. Furthermore, patients with resistant hypertension were more likely to have heart failure with preserved ejection fraction (AOR: 3.36, 95% CI 1.25-9.07, p = 0.017), cerebrovascular disease, and chronic kidney disease. In our treated hypertensive cohort, resistant hypertension was associated with an increased risk of cerebrovascular disease, chronic kidney disease, and heart failure with preserved ejection fraction, and it appears this burden maybe 2-3 times more in those with resistant hypertension compared to those without. Concerted efforts to prevent or promptly treat resistant hypertension in our population will reduce cardiovascular comorbidities.
Collapse
Affiliation(s)
| | - Tina Anya
- Department of Internal Medicine, Federal Medical Centre, Abuja, Nigeria
| | - Janefrances Chima Chukwu
- Department of Internal Medicine, Federal Medical Centre, Abuja, Nigeria
- Trinity Health IHA Medical Group, 24 Frank Lloyd Wright Drive, Suite J2000 Ann Arbor, MI 48105, United States
| | - Victor Adekanmbi
- Department of Obstetrics and Gynaecology, University of Texas Medical Branch at Galveston, Texas, United States
| |
Collapse
|
4
|
Moncion K, Pryzbek M, Noguchi KS, Roig M, MacDonald MJ, Richardson J, Tang A. Cardiorespiratory Fitness Benefits of Long-Term Maintenance-Phase Cardiac Rehabilitation in Males and Females: A Retrospective Cohort Study. Physiother Can 2024; 76:124-133. [PMID: 38465298 PMCID: PMC10919366 DOI: 10.3138/ptc-2021-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 03/12/2024]
Abstract
Purpose This study investigated if associations exist between enrolment delay and VO2peak over five years of maintenance-phase cardiac rehabilitation (CR) in males and females. Method Data were extracted from the records of participants who had enrolled for ≥ 1 year in CR and completed ≥ 2 cardiopulmonary exercise tests. Mixed model analyses examined VO2peak trajectories for up to five years of enrolment. Interactions between enrolment delay × enrolment duration, baseline age × enrolment duration, and baseline VO2peak × enrolment duration were explored for inclusion in the model. Results The charts of 151 males (aged 63.9 ± 9.4 y) and 32 females (aged 65.3 ± 9.0 y) were included in the analyses. The enrolment delay following a cardiovascular event was 1.8 ± 3.0 years for males and 1.3 ± 1.7 years for females. No associations were found between enrolment delay × enrolment duration on VO2peak in males (β[SEj, 0.07[0.05]; 95% CI -0.02, 0.16, p = 0.12) or in females (β[SE], 0.07[0.13j; 95% CI -0.18, 0.33, p = 0.57), but predicted trajectories suggest clinically significantly improvements in VO2 peak (range, 1.3 to 1.6 mL/kg/min). Conclusions Early enrolment in CR is recommended and encouraged, but the benefits of long-term CR are possible despite delays.
Collapse
Affiliation(s)
- Kevin Moncion
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mike Pryzbek
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth S. Noguchi
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation, Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maureen J. MacDonald
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Gómez González L, Supervia M, Medina-Inojosa JR, Smith JR, López Blanco ME, Miranda Vivas MT, López-Jiménez F, Arroyo-Riaño MO. Predictors of Rehabilitation Referral Among Cardiovascular Surgical Patients. Front Cardiovasc Med 2022; 9:848610. [PMID: 35592404 PMCID: PMC9110648 DOI: 10.3389/fcvm.2022.848610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Cardiovascular disease (CVD) continues to be the leading cause of mortality globally. Cardiac rehabilitation (CR) programs act by modifying the evolution of CVD and mortality; however, CR programs are under-used. The aim was to determine the profile of patients that received rehabilitation after cardiac surgery. Patients and Methods A retrospective observational study was conducted from January 2017 to December 2017 at a single center. The study sample was chosen among patients admitted to the Intensive Care Unit of the Hospital Gregorio Marañón/Gregorio Marañón General University Hospital. Socio-demographic and clinical variables were collected. Results In the present study, 336 patients underwent cardiac surgery of which 63.8% were men and 87.1% had ≥1 cardiovascular risk factors. Of the total cohort, 24.7% were operated for ischemic heart disease, 47.9% valvulopathy, 11% underwent combined surgery, 3.6% cardiac transplantation, 6.5% aneurysms, and 3.9% congenital disease. In-hospital respiratory rehabilitation was prescribed to all patients. Only 4.8% of the patients received motor rehabilitation and 13.8% were referred to CR. We found higher referral rates among patients with more cardiovascular risk factors, <65 years of age, and those undergoing coronary surgery and heart transplantation. Age, ischemic heart disease, and overweight were independent predictors of CR referral. Conclusion The benefit of CR programs after cardiac surgery is widely described; however, the referral rate to CR remains low. It is crucial to optimize referral protocols for these patients.
Collapse
Affiliation(s)
- Laura Gómez González
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
- *Correspondence: Laura Gómez González,
| | - Marta Supervia
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - José R. Medina-Inojosa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
- Amita St. Joseph Hospital Internal Medicine Residency Program, University of Illinois Chicago, Chicago, IL, United States
| | - Joshua R. Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - M. Esther López Blanco
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - M. Teresa Miranda Vivas
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | - M. Olga Arroyo-Riaño
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| |
Collapse
|
6
|
Zhang M, Yuan Y, Gao Y, Lu R, Deng Y. The effectiveness of Salvianolate injection for in-stent restenosis after percutaneous coronary intervention: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29153. [PMID: 35482985 PMCID: PMC9276184 DOI: 10.1097/md.0000000000029153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In-stent restenosis (ISR) caused by vascular remodeling after percutaneous coronary intervention limits the long-term efficacy of this method. Salvianolate injection is now widely used in the clinical treatment of ISR. However, there is no systematic review or meta-analysis to evaluate the effects of Salvianolate injection on ISR. METHODS We will search articles in 8 electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang Database, and the Chinese Scientific Journal Database for randomized controlled trials of ISR treated by Salvianolate injection from their inception to February 27, 2022. The primary outcome measure will be the restenosis rate. The data meeting the inclusion criteria were analyzed by RevMan V.5.4 software. Two authors evaluated the study using the Cochrane collaborative risk bias tool. We will use a scoring method to assess the overall evidence supporting the main results. RESULTS This study will analyze the clinical effectiveness of Salvianolate injection in the treatment of ISR. CONCLUSION The findings of this systematic review will provide evidence to evaluate the effectiveness of Salvianolate injection for the treatment of ISR. INPLASY REGISTRATION NUMBER INPLASY202220117.
Collapse
Affiliation(s)
- Miao Zhang
- Doctor of Medicine, School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yue Yuan
- Doctor of Medicine, School of Basic Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ying Gao
- Doctor of Medicine, School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ruozhu Lu
- Doctor of Medicine, School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yue Deng
- Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, China
| |
Collapse
|
7
|
Huang H, Lai W, Li Q, Wei H, Remutula N, Tuersun T, Yang Z, Bao K, Yan Z, Wang B, He Y, Chen S, Ou CQ, Yang H, Chen J, Liu J, Liu Y. Sex Difference Trend in 5-Year Mortality Among Patients With Coronary Artery Disease: A 24,432 Chinese Cohort Study From 2007 to 2014. Front Cardiovasc Med 2022; 9:774365. [PMID: 35497987 PMCID: PMC9039363 DOI: 10.3389/fcvm.2022.774365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background The sex difference trend of short-term mortality in coronary artery disease (CAD) is narrowing, which has been reported in the previous studies. However, no studies assess the sex difference temporal trends of CAD mortality in China especially long-term mortality trend. Methods Based on the registry at Guangdong Provincial People's Hospital which is the largest cardiovascular center in South China, this retrospective cohort study included 24,432 hospitalized patients with CAD confirmed by coronary angiography from January 2007 to December 2014. Women and men were followed for 1-year and 5-year all-cause mortality. Results From 2007 to 2014, 5-year age-standardized mortality increased from 10.0 to 11.7% in men (p for trend < 0.001) and from 11.5 to 8.1% in women (p for trend = 0.99). The multivariable-adjusted hazard ratios (95% CI), which compare women with men, were from 1.02 (0.39–2.67) to 0.66 (0.39–1.12) for 1-year all-cause mortality and 1.23 (0.64–2.36) to 0.59 (0.44–0.79) for 5-year all-cause mortality (p for trend = 0.04). Conclusion Our study found that the mortality risk among men and women was similar in the 1-year prognosis of CAD, and there was no significant downward trend. In the 5-year long-term prognosis of CAD, the mortality risk among men continued to rise, while women had reached the peak, which means that the mortality risk continues to be higher among men than women.
Collapse
Affiliation(s)
- Haozhang Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wenguang Lai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qiang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyan Wei
- The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | | | - Tilakezi Tuersun
- The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Kunming Bao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Zelin Yan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Heyin Yang
- The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jin Liu
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Yong Liu
| |
Collapse
|
8
|
Hu MJ, Tan JS, Jiang WY, Gao XJ, Yang YJ. The optimal percutaneous coronary intervention strategy for patients with ST-segment elevation myocardial infarction and multivessel disease: a pairwise and network meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221078088. [PMID: 35295615 PMCID: PMC8918769 DOI: 10.1177/20406223221078088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the optimal percutaneous coronary intervention (PCI) strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. Methods: Trials that randomized patients with STEMI and multivessel coronary artery disease to immediate multivessel PCI, staged multivessel PCI, or culprit-only PCI and prospective observational studies that investigated all-cause death were included. Random effect risk ratio (RR) and 95% confidence interval (CI) were calculated. Results: A total of 13 randomized trials with 7627 patients and 21 prospective observational studies with 60311 patients were included. In the pairwise and network meta-analysis based on randomized trials, immediate or staged multivessel PCI was associated with a lower risk of long-term major adverse cardiac events (MACE; RR: 0.58; 95% CI: 0.45 to 0.74) than culprit-only PCI, which was mainly due to lower risks of myocardial infarction (RR: 0.67; 95% CI: 0.51 to 0.88) and revascularization (RR: 0.38; 95% CI: 0.28 to 0.51), without any significant difference in all-cause death (RR: 0.85; 95% CI: 0.69 to 1.04; I2 = 0.0%). However, short-term outcomes were deficient in randomized trials. The results from real-world prospective observational studies suggested that staged multivessel PCI reduced long-term all-cause death (RR: 0.53; 95% CI: 0.39 to 0.71; I2 = 15.6%), whereas immediate multivessel PCI increased short-term all-cause death (RR: 1.58; 95% CI: 1.22 to 2.05; I2 = 43.8%) relative to culprit-only PCI. Conclusion: For patients in randomized trials, multivessel PCI in an immediate or staged procedure was preferred due to improvements in long-term outcomes. As a supplement, the results in real-world patients derived from prospective observational studies suggested that staged multivessel PCI was superior to immediate multivessel PCI. Therefore, staged multivessel PCI may be the optimal PCI strategy for patients with STEMI and multivessel coronary artery disease.
Collapse
Affiliation(s)
- Meng-Jin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang-Shan Tan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Yang Jiang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Jin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| |
Collapse
|
9
|
Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series. J Clin Med 2022; 11:jcm11051395. [PMID: 35268485 PMCID: PMC8911187 DOI: 10.3390/jcm11051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center. Numerous studies have been conducted on this topic and have provided contradictory evidence; however, more recently, results from several randomized clinical trials have suggested that performing early CAG has no impact on overall survival in patients without STE.
Collapse
|
10
|
The Clinical Efficacy of Tirofiban Combined with Ticagrelor and Aspirin in Treating Acute Myocardial Infarction by Percutaneous Coronary Intervention and Its Effect on Patients’ Cardiac Function. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4708572. [PMID: 35186231 PMCID: PMC8849904 DOI: 10.1155/2022/4708572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
Objective. To explore the clinical efficacy of tirofiban combined with ticagrelor and aspirin in acute myocardial infarction treatment by percutaneous coronary intervention and its effect on patients’ cardiac function. Methods. We selected 102 patients with acute myocardial infarction who came to The First Hospital of LanZhou University for treatment from July 2018 to May 2021. On the basis of conventional treatment, patients were separated into a joint group (tirofiban combined with ticagrelor and aspirin) comprising 55 cases and a control group (conventional ticagrelor and aspirin dual treatment) involving 47 cases. Blood flow classification of the two groups of patients was immediately recorded and compared after the myocardial infarction thrombolysis test (TIMI). Left ventricular function-related indicators, platelet-related parameters, neutrophil/lymphocyte ratio (NLR), red blood cell distribution width (RDW), and platelet/lymphocyte ratio (PLR) before treatment and 7 days after PCI were evaluated and compared between the groups before treatment and 3 months after treatment. ELISA was utilized to detect the serum levels of inflammatory factors, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and hypersensitive C-reactive protein (hs-CRP) before and after treatment. Incidence of major adverse cardiovascular events (MACEs) and adverse reaction incidence was put into comparison between the two groups in the course of the 3-month follow-up period. Compared with the control group, the joint group accounted for more patients with TIMI blood flow classification level 3 (
) and showed more drastic improvement on the left ventricular function, platelet-related parameters, and serum inflammatory factors (
). Moreover, patients of the joint group suffered less fluctuation from RDW, NLR, and PLR (
), and their incidence of MACE was drastically lower in contrast with the control group (
). No notable changes were presented in terms of incidence of adverse reaction (
). For patients who suffered from acute myocardial infarction and treated with percutaneous coronary intervention, the application of tirofiban combined with ticagrelor and aspirin could effectively reduce the incidence of no reflow or slow blood flow, improve myocardial perfusion function, and have marked curative effects. It is worthy of clinical promotion and application.
Collapse
|
11
|
Dil SV, Vyshlov EV, Ryabov VV. Intracoronary epinephrine and verapamil in the refractory no-reflow phenomenon in patients with acute myocardial infarction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Despite modern advances in performing percutaneous coronary interventions, refractory no-reflow remains a serious problem that worsens in-hospital and long-term prognosis. Low-dose adrenaline may exhibit potent beta-receptor agonist properties that mediate coronary vasodilation.Aim. To evaluate the efficacy and safety of intracoronary administration of epinephrine and verapamil, as well as their combination, compared with standard treatment in patients with ST-segment elevation myocardial infarction (STEMI) and refractory no-reflow during percutaneous coronary interventions.Material and methods. Patients with STEMI and refractory no-reflow will be randomized into 4 groups: standard therapy, intracoronary adrenaline, intracoronary verapamil, intracoronary epinephrine + verapamil. All patients will be assessed for epicardial blood flow using the Thrombolysis in Myocardial Infarction (TIMI) and Myocardial Blush Grade (MBG) scales, peak troponin levels, ST segment changes, echocardiography, magnetic roesnance imaging, and dynamic single photon emission computed tomography.Results. Based on the pharmacodynamic effects of epinephrine and verapamil, their combination is expected to have a more potent vasodilating effect.Conclusion. If the Intracoronary administration of EPInephrine and VERapamil in the refractory no-reflow phenomenon (EPIVER) study will be successful, a novel, more effective method for managing refractory no-reflow phenomenon will appear. This will ensure better preservation of left ventricular systolic function, as well as improve the prognosis and clinical course of the disease.
Collapse
Affiliation(s)
- S. V. Dil
- Cardiology Research Institute, Tomsk National Research Medical Center
| | - E. V. Vyshlov
- Cardiology Research Institute, Tomsk National Research Medical Center
| | - V. V. Ryabov
- Cardiology Research Institute, Tomsk National Research Medical Center
| |
Collapse
|
12
|
MicroRNA-489 Promotes the Apoptosis of Cardiac Muscle Cells in Myocardial Ischemia-Reperfusion Based on Smart Healthcare. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2538769. [PMID: 35035817 PMCID: PMC8759872 DOI: 10.1155/2022/2538769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 01/10/2023]
Abstract
With the development of information technology, the concept of smart healthcare has gradually come to the fore. Smart healthcare uses a new generation of information technologies, such as the Internet of Things (loT), big data, cloud computing, and artificial intelligence, to transform the traditional medical system in an all-around way, making healthcare more efficient, more convenient, and more personalized. miRNAs can regulate the proliferation, differentiation, and apoptosis of human cells. Relevant studies have also shown that miRNAs may play a key role in the occurrence and development of myocardial ischemia-reperfusion injury (MIRI). This study aims to explore the effects of miR-489 in MIRI. In this study, miR-489 expression in a myocardial ischemia-reperfusion animal model and H9C2 cells induced by H/R was detected by qRT-PCR. The release of lactate dehydrogenase (LDH) and the activity of creatine kinase (CK) was detected after miR-489 knockdown in H9C2 cells induced by H/R. The apoptosis of H9C2 cells and animal models were determined by ELISA. The relationship between miR-489 and SPIN1 was verified by a double fluorescence reporter enzyme assay. The expression of the PI3K/AKT pathway-related proteins was detected by Western blot. Experimental results showed that miR-489 was highly expressed in cardiac muscle cells of the animal model and in H9C2 cells induced by H/R of the myocardial infarction group, which was positively associated with the apoptosis of cardiac muscle cells with ischemia-reperfusion. miR-489 knockdown can reduce the apoptosis of cardiac muscle cells caused by ischemia-reperfusion. In downstream targeting studies, it was found that miR-489 promotes the apoptosis of cardiac muscle cells after ischemia-reperfusion by targeting the inhibition of the SPIN1-mediated PI3K/AKT pathway. In conclusion, high expression of miR-489 is associated with increased apoptosis of cardiac muscle cells after ischemia-reperfusion, which can promote the apoptosis after ischemia-reperfusion by targeting the inhibition of the SPIN1-mediated PI3K/AKT pathway. Therefore, miR-489 can be one of the potential therapeutic targets for reducing the apoptosis of cardiac muscle cells after ischemia-reperfusion.
Collapse
|
13
|
Xie B, Wang J, Xi XY, Guo X, Chen BX, Li L, Hua C, Zhao S, Su P, Chen M, Yang MF. Fibroblast activation protein imaging in reperfused ST-elevation myocardial infarction: comparison with cardiac magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2022; 49:2786-2797. [PMID: 34984503 DOI: 10.1007/s00259-021-05674-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to explore the correlation of 18F-labeled fibroblast activation protein inhibitor (FAPI) and cardiovascular magnetic resonance (CMR) parameters in ST-elevation myocardial infarction (STEMI) patients with successful primary percutaneous coronary intervention (PPCI) and to investigate the value of FAPI imaging in predicting cardiac functional recovery, as well as the correlation between FAPI activity and circulating fibroblast activation protein (FAP) and inflammatory biomarkers. METHODS Fourteen first-time STEMI patients (11 men, mean age: 62 ± 11 years) after PPCI and 14 gender-matched healthy volunteers (10 men, mean age: 50 ± 14 years) who had completed FAPI imaging and blood sample collection were prospectively recruited. All patients underwent baseline FAPI imaging (6 ± 2 days post-MI) and CMR (8 ± 2 days post-MI). Ten patients had follow-up CMR (84 ± 4 days post-MI). Myocardial FAPI activity was analyzed for extent (the percentage of FAPI uptake volume over the left ventricular volume, FAPI%), intensity (target-to-background uptake ratio, TBRmax), and amount (FAPI% × TBRmax). Late gadolinium enhancement (LGE), T2-weighted imaging (T2WI), extracellular volume (ECV), microvascular obstruction (MVO), and cardiac function from CMR imaging were analyzed. Blood samples obtained on the day of FAPI imaging were used to assess circulating FAP, TGF-β1, TNF-α, IL-6, and hsCRP in STEMI patients and controls. RESULTS Localized but inhomogeneous FAPI uptake was observed in STEMI patients, which was larger than the edematous and infarcted myocardium, whereas no uptake was detected in controls. The MVO area showed lower FAPI uptake compared with the surrounding myocardium. FAPI activity was associated with the myocardial injury biomarkers T2WI, LGE, and ECV at both per-patient and per-segment levels (all p < 0.05), but was not associated with circulating FAP, TGF-β1, TNF-α, IL-6, or hsCRP. Among the CMR parameters, T2WI had the greatest correlation coefficient with both FAPI% and FAPI% × TBRmax. Baseline TBRmax was inversely correlated with the follow-up left ventricular ejection fraction (LVEF) (r = - 0.73, p = 0.02). CONCLUSION FAPI imaging detects more involved myocardium than CMR in reperfused STEMI, and is associated with myocardial damage and follow-up LVEF.
Collapse
Affiliation(s)
- Boqia Xie
- Cardiac Center, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Jiaxin Wang
- MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xiao-Ying Xi
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Bi-Xi Chen
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Lina Li
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Cuncun Hua
- Cardiac Center, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Shihua Zhao
- MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Pixiong Su
- Cardiac Center, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Mulei Chen
- Cardiac Center, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
| | - Min-Fu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
14
|
Tehrani BN, Damluji AA, Batchelor WB. Acute Myocardial Infarction and Cardiogenic Shock Interventional Approach to Management in the Cardiac Catheterization Laboratories. Curr Cardiol Rev 2022; 18:e251121198293. [PMID: 34823461 PMCID: PMC9413732 DOI: 10.2174/1573403x17666211125090929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022] Open
Abstract
Despite advances in early reperfusion and a technologic renaissance in the space of Mechanical Circulatory Support (MCS), Cardiogenic Shock (CS) remains the leading cause of in-hospital mortality following Acute Myocardial Infarction (AMI). Given the challenges inherent to conducting adequately powered randomized controlled trials in this time-sensitive, hemodynamically complex, and highly lethal syndrome, treatment recommendations have been derived from AMI patients without shock. In this review, we aimed to (1) examine the pathophysiology and the new classification system for CS; (2) provide a comprehensive, evidence-based review for best practices for interventional management of AMI-CS in the cardiac catheterization laboratory; and (3) highlight the concept of how frailty and geriatric syndromes can be integrated into the decision process and where medical futility lies in the spectrum of AMI-CS care. Management strategies in the cardiac catheterization laboratory for CS include optimal vascular access, periprocedural antithrombotic therapy, culprit lesion versus multi-vessel revascularization, selective utilization of hemodynamic MCS tailored to individual shock hemometabolic profiles, and management of cardiac arrest. Efforts to advance clinical evidence for patients with CS should be concentrated on (1) the coordination of multi-center registries; (2) development of pragmatic clinical trials designed to evaluate innovative therapies; (3) establishment of multidisciplinary care models that will inform quality care and improve clinical outcomes.
Collapse
Affiliation(s)
- Behnam N Tehrani
- Interventional Cardiology, INOVA Heart and Vascular Institute, Virginia, VA 22042, United States
| | - Abdulla A Damluji
- Interventional Cardiology, INOVA Heart and Vascular Institute, Virginia, VA 22042, United States.,Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Wayne B Batchelor
- Interventional Cardiology, INOVA Heart and Vascular Institute, Virginia, VA 22042, United States
| |
Collapse
|
15
|
Li Y, Wang Y, Guo H, Wu Q, Hu Y. IRF2 contributes to myocardial infarction via regulation of GSDMD induced pyroptosis. Mol Med Rep 2021; 25:40. [PMID: 34878155 PMCID: PMC8674697 DOI: 10.3892/mmr.2021.12556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/28/2021] [Indexed: 12/20/2022] Open
Abstract
Interferon regulatory factor (IRF) 2 is a transcription factor belonging to the IRF family, which is essential for gasdermin D (GSDMD)‑induced pyroptosis. Decreasing myocardial cell pyroptosis confers protection against heart damage and cardiac dysfunction caused by myocardial infarction (MI). The aim of the present study was to investigate the involvement of IRF2 in MI and the underlying mechanism of IRF2 in pyroptosis. To mimic MI, ligation of the left anterior descending coronary artery was performed to establish an in vivo mouse model and rat cardiomyocytes H9c2 cells were cultured under hypoxic conditions to establish an in vitro model. Transthoracic echocardiography was used to assess cardiac function. Hematoxylin and eosin staining was used to observe histopathological changes in the myocardial tissue. Immunohistochemistry and western blotting were performed to detect IRF2 expression levels. TUNEL staining and flow cytometry were used to detect apoptosis in myocardial tissue and cells. Chromatin immunoprecipitation and dual luciferase reporter assay were used to verify the effect of IRF2 on GSDMD transcription. IRF2 was upregulated in MI mice. MI induced pyroptosis, as evidenced by increased GSDMD, N‑terminal GSDMD (GSDMD‑N), and cleaved (c‑) caspase‑1 levels. MI increased IL‑1β and IL‑18 levels. These alterations were alleviated by IRF2 silencing. Furthermore, in hypoxia‑treated H9c2 cells, IRF2 silencing significantly decreased the elevated levels of IL‑1β and IL‑18 and pyroptosis‑associated proteins, including GSDMD, GSDMD‑N and c‑caspase1. Moreover, in hypoxia‑treated H9c2 cells, IRF2 directly bound to the GSDMD promoter to drive GSDMD transcription and promote pyroptosis and IRF2 expression may be regulated via the hypoxia inducible factor 1 signaling pathway. In conclusion, the present results demonstrated that IRF2 is a key regulator of MI by mediating pyroptosis, which triggers GSDMD activation.
Collapse
Affiliation(s)
- Yongxing Li
- Department of Cardiovascular Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Yan Wang
- Department of Cardiovascular Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Hua Guo
- Department of Cardiovascular Medicine, Hebei Province Cangzhou Hospital of Integrated Traditional and Western, Cangzhou, Hebei 061001, P.R. China
| | - Qinghua Wu
- Department of Cardiovascular Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Yamin Hu
- Department of Cardiovascular Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| |
Collapse
|
16
|
Tien Hoang A, Quynh Nhu Tran T, Phuong Duy Le C, Ha Vo T. Adherence to dual antiplatelet therapy after coronary stenting: A study conducted at two Vietnamese hospitals. J Cardiovasc Thorac Res 2021; 13:330-335. [PMID: 35047138 PMCID: PMC8749365 DOI: 10.34172/jcvtr.2021.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Adherence to dual antiplatelet therapy (DAPT) is critical after drug-eluting stent(DES) placement. We aimed to assess patient’s knowledge, rates of DAPT adherence, trends in DAPT use over time, and patient‐level factors associated with nonadherence in the patient with acute coronary syndrome (ACS). Methods: ACS patients who received one or more DES between May and September 2018from two hospitals in Vietnam and used DAPT after stent placement were eligible for a direct interview to assess patient’s knowledge on disease and DAPT. Telephone interviews were conducted one, three, and six months following discharge. Nonadherence was defined as premature discontinuation of DAPT. Factors related to nonadherent patients were analyzed using the chi-square test. Results: Of the 200 patients identified, 154 (77%) participated. Of the ten questions related to knowledge, the mean score of correct answers was 8.2 ± 2.3, and 71.7% had good knowledge.Adherence to DAPT was high at one month (94.2%) but declined by three months (44.2%) and then by six months (46.8%). Aspirin adherence was 99.3%-100% throughout. Three factors associated with nonadherence of DAPT following DES placement by six months included: rural location, linactive occupation, and inadequate knowledge on disease and DAPT (p<0.05). Conclusion: DAPT adherence is high at one month but is suboptimal at three and six months.Factors associated with the nonadherence of DAPT will be helpful in the planning of patient education strategies.
Collapse
Affiliation(s)
- Anh Tien Hoang
- PCI Unit, Hue University Hospital, Hue, 52000, Vietnam
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue, 52000, Vietnam
| | - Thi Quynh Nhu Tran
- Department of Pharmacy, University of Medicine and Pharmacy, Hue University, Hue, 52000, Vietnam
| | | | - Thi Ha Vo
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh, V-70000, Vietnam
- Department of Pharmacy, Nguyen Tri Phuong Hospital, Ho Chi Minh, V-70000, Vietnam
| |
Collapse
|
17
|
Huang JY, Huang CK, Yen RF, Chien KL, Wu YW. Diagnostic Effect of Attenuation Correction in Myocardial Perfusion Imaging in Different Coronary Arteries: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:756060. [PMID: 34712715 PMCID: PMC8545877 DOI: 10.3389/fcvm.2021.756060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The aim of this study was to determine whether, and if so how, attenuation correction (AC) improves the diagnostic performance of myocardial perfusion imaging (MPI) in different coronary artery-supplied territories, using coronary angiography as the reference standard. Methods: PubMed and EMBASE were searched until December 2020 for studies evaluating AC MPI for the diagnosis of coronary artery disease (CAD) with vessel-based data. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. For each study, the sensitivity, specificity, diagnostic odds ratios and areas under summary receiver operating characteristic curves (AUC) with 95% confidence intervals were calculated to determine the diagnostic accuracy of AC compared to non-AC MPI. A bivariate mixed-effects model was used to pool the data. Subgroup analyses considering the type of radiotracer and type of AC were performed. Results: A total of 264 articles were screened, of which 22 studies (2,608 patients) were enrolled. Significant improvements in specificity [0.78 vs. 0.58 in overall CAD, 0.87 vs. 0.61 in right coronary artery (RCA)] and diagnostic odds ratios (16 vs. 8 in overall CAD, 18 vs. 7 in RCA) after AC were shown in overall CAD at a patient level and RCA stenosis. Improvements in AUC were also noted. MPI had a similar diagnostic performance for detecting left anterior descending and left circumflex coronary artery stenosis with or without AC. There were trends of decreased sensitivity after AC, but none were significant. Diagnostic odds ratio showed significant improvement after AC only in the technetium-99m subgroup. Conclusion: The results of this study suggest that AC should be applied to MPI to improve the diagnosis of CAD regardless of which type of radiotracer, and that AC MPI can improve the specificity of detecting RCA stenosis.
Collapse
Affiliation(s)
- Jei-Yie Huang
- Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Kai Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,National Yang Ming Chao Tung University School of Medicine, Taipei, Taiwan
| |
Collapse
|
18
|
Rossi C, Berta P, Curello S, Lovaglio PG, Magoni M, Metra M, Roccaro AM, Verzillo S, Vittadini G. The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic. PLoS One 2021; 16:e0257910. [PMID: 34597292 PMCID: PMC8486095 DOI: 10.1371/journal.pone.0257910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied. Preliminary evidence suggests that the time from onset of symptoms to emergency department (ED) presentation has significantly increased in Covid-19 times as well as the 30-day mortality and in-hospital mortality. METHODS We check, in a causal inference framework, the causal effect of the hospital's stress generated by Covid-19 pandemic on in-hospital mortality rates (primary end-point of the study) of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9th 2020) using two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs. Data are drawn from Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. FINDINGS Despite the potential adverse effects on expected mortality due to a longer time to hospitalization and staff extra-burden generated by the first wave of Covid-19, the AMI and stroke mortality rates are overall not statistically different during the first wave of Covid-19 than before the first peak. The obtained results provided by RDD models are robust also when we account for seasonality and unobserved factors with DRD models. INTERPRETATION The non-statistically significant impact on mortality rates for AMI and stroke patients provides evidence of the hospital ability to manage -with the implementation of a dual track organization- the simultaneous delivery of high-quality cares to both Covid and non-Covid patients.
Collapse
Affiliation(s)
| | - Paolo Berta
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| | | | - Pietro Giorgio Lovaglio
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| | | | - Marco Metra
- ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Stefano Verzillo
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- * E-mail:
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| |
Collapse
|
19
|
Zaman F, Ponnapureddy R, Wang YG, Chang A, Cadaret LM, Abdelhamid A, Roy SD, Makan M, Zhou R, Jayanna MB, Gnall E, Dai X, Singh A, Zheng J, Boppana VS, Wang F, Singh P, Wu X, Liu K. Spatio-temporal hybrid neural networks reduce erroneous human "judgement calls" in the diagnosis of Takotsubo syndrome. EClinicalMedicine 2021; 40:101115. [PMID: 34522872 PMCID: PMC8426197 DOI: 10.1016/j.eclinm.2021.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We investigate whether deep learning (DL) neural networks can reduce erroneous human "judgment calls" on bedside echocardiograms and help distinguish Takotsubo syndrome (TTS) from anterior wall ST segment elevation myocardial infarction (STEMI). METHODS We developed a single-channel (DCNN[2D SCI]), a multi-channel (DCNN[2D MCI]), and a 3-dimensional (DCNN[2D+t]) deep convolution neural network, and a recurrent neural network (RNN) based on 17,280 still-frame images and 540 videos from 2-dimensional echocardiograms in 10 years (1 January 2008 to 1 January 2018) retrospective cohort in University of Iowa (UI) and eight other medical centers. Echocardiograms from 450 UI patients were randomly divided into training and testing sets for internal training, testing, and model construction. Echocardiograms of 90 patients from the other medical centers were used for external validation to evaluate the model generalizability. A total of 49 board-certified human readers performed human-side classification on the same echocardiography dataset to compare the diagnostic performance and help data visualization. FINDINGS The DCNN (2D SCI), DCNN (2D MCI), DCNN(2D+t), and RNN models established based on UI dataset for TTS versus STEMI prediction showed mean diagnostic accuracy 73%, 75%, 80%, and 75% respectively, and mean diagnostic accuracy of 74%, 74%, 77%, and 73%, respectively, on the external validation. DCNN(2D+t) (area under the curve [AUC] 0·787 vs. 0·699, P = 0·015) and RNN models (AUC 0·774 vs. 0·699, P = 0·033) outperformed human readers in differentiating TTS and STEMI by reducing human erroneous judgement calls on TTS. INTERPRETATION Spatio-temporal hybrid DL neural networks reduce erroneous human "judgement calls" in distinguishing TTS from anterior wall STEMI based on bedside echocardiographic videos. FUNDING University of Iowa Obermann Center for Advanced Studies Interdisciplinary Research Grant, and Institute for Clinical and Translational Science Grant. National Institutes of Health Award (1R01EB025018-01).
Collapse
Affiliation(s)
- Fahim Zaman
- Department of Electrical and Electronic Engineering, University of Iowa, Iowa city, IA, United States
| | - Rakesh Ponnapureddy
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, United States
| | - Yi Grace Wang
- Department of Mathematics, California State University Dominguez Hills, Carson, CA, United States
| | - Amanda Chang
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, United States
| | - Linda M Cadaret
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, United States
| | - Ahmed Abdelhamid
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, United States
| | - Shubha D Roy
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, United States
| | - Majesh Makan
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Ruihai Zhou
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, United States
| | - Manju B Jayanna
- Division of Cardiology, Department of Medicine, Lankenau Medical Center, Wynnewood, PA, United States
| | - Eric Gnall
- Division of Cardiology, Department of Medicine, Lankenau Medical Center, Wynnewood, PA, United States
| | - Xuming Dai
- Department of Cardiology, New York Presbyterian Queens/Weill Cornell Medical College, New York City, NY, United States
| | - Avneet Singh
- Division of Cardiology, Department of Medicine, State University of New York, Syracuse, NY, United States
| | - Jingsheng Zheng
- Department of Cardiology, AtlaniCare Regional Medical Center, Pomona, NJ, United States
| | - Venkata S Boppana
- Division of Cardiology, Department of Medicine, University of Kansas-Wichita, Wichita, KS, United States
| | - Feng Wang
- Department of Cardiology, Providence Regional Medical Center, Washington State University, Everett, WA, United States
| | - Pahul Singh
- Department of Cardiology, Northwest Health Medical Center, Bentonville, AR, United States
| | - Xiaodong Wu
- Department of Electrical and Electronic Engineering, University of Iowa, Iowa city, IA, United States
- Corresponding authors.
| | - Kan Liu
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, United States
- Corresponding authors.
| |
Collapse
|
20
|
Fanta K, Daba FB, Asefa ET, Melaku T, Chelkeba L, Fekadu G, Gudina EK. Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study. Front Cardiovasc Med 2021; 8:707700. [PMID: 34604351 PMCID: PMC8484752 DOI: 10.3389/fcvm.2021.707700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant. Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.
Collapse
Affiliation(s)
- Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene Asefa
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
- Department of Clinical Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
21
|
Pregnancy-Associated Myocardial Infarction: A Review of Current Practices and Guidelines. Curr Cardiol Rep 2021; 23:142. [PMID: 34410528 DOI: 10.1007/s11886-021-01579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Pregnancy-associated myocardial infarction is a principal cause of cardiovascular disease with a steadily rising incidence of 4.98 AMI events/100,000 deliveries over the last four decades in the USA. It is also linked with significant maternal and fetal morbidity and mortality, with maternal case fatality rate ranging from 5.1 to 37%. The management of acute myocardial infarction can be challenging in pregnant patients since treatment modalities and medication use are limited by their safety during pregnancy. RECENT FINDINGS Limited guidelines exist regarding the management of pregnancy-associated myocardial infarction. Routinely used medications in myocardial infarction including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and statin therapy are contraindicated during pregnancy. Aspirin use is considered safe in pregnant women, but dual antiplatelet therapy and therapeutic anticoagulation can be associated with increased risk of maternal and fetal complications, and should only be used after a comprehensive benefit-to-risk assessment. The standard approach to revascularization requires additional caution in pregnant women. Percutaneous coronary intervention is generally considered safe but can be associated with high failure rates and poor outcomes depending on the etiology. Fibrinolytic therapy may have significant sequelae in pregnant patients, and hemodynamic management during surgery is complex and adds risk during pregnancy. Understanding the risks and benefits of the different treatment modalities available and their utility depending on the underlying etiology, encompassed with a multidisciplinary team approach, is vital to improve outcomes and minimize maternal and fetal complications.
Collapse
|
22
|
Huotan Jiedu Tongluo Decoction Inhibits Balloon-Injury-Induced Carotid Artery Intimal Hyperplasia in the Rat through the PERK-eIF2 α-ATF4 Pathway and Autophagy Mediation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5536237. [PMID: 34335815 PMCID: PMC8318774 DOI: 10.1155/2021/5536237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022]
Abstract
In-stent restenosis (ISR) is the main factor affecting the outcome of percutaneous coronary intervention (PCI), and its main pathological feature is neointimal hyperplasia. Huotan Jiedu Tongluo decoction (HTJDTLD) is an effective traditional Chinese medicine (TCM) prescription for the treatment of vascular stenosis diseases. However, the precise anti-ISR mechanism of HTJDTLD remains unclear. Here, we investigated whether HTJDTLD can inhibit the excessive activation of endoplasmic reticulum stress (ERS) and reduce the level of autophagy factors through regulating the PERK-eIF2α-ATF4 pathway, thereby inhibiting the proliferation of the intima of blood vessels damaged by balloon injury (BI) and preventing the occurrence of ISR. In this study, a 2F Fogarty balloon was used to establish a common carotid artery (CCA) BI model in male Sprague-Dawley rats. Then, HTJDTLD (16.33 g/kg/d) or atorvastatin (1.19 mg/kg/d) was administered by gavage. Four weeks later, hematoxylin-eosin (HE) and Masson staining of the injured CCA were performed to observe the histological changes in the CCA. Immunohistochemistry (IHC) was used to assess the proliferation and dedifferentiation of vascular smooth muscle cells (VSMCs) in the CCA. Western blotting and RT-PCR were used to measure the expression of ERS- and autophagy-related proteins and mRNAs in the CCA. The results indicated that HTJDTLD significantly alleviated BI-induced carotid artery intimal hyperplasia and fibrosis and reduced the neointimal area (NIA) and NIA/medial area (MA) ratio. In addition, HTJDTLD inhibited the proliferation and dedifferentiation of VSMCs, reduced the expression of proliferating cell nuclear antigen (PCNA), and increased the smooth-muscle-α-actin- (SMα-actin-) positive area. HTJDTLD also significantly reduced the expression of the ERS-related factors: GRP78, p-PERK/PERK, p-eIF2α/eIF2α, ATF4, and CHOP. In addition, the expression of the autophagy-related factors, Beclin1, LC3B, and ATG12, was significantly decreased. In addition, in vitro experiments showed that HTJDTLD inhibited the above-mentioned ERS signal molecules in human umbilical vein endothelial cells (HUVEC) and rat aortic smooth muscle cells (A7R5) induced by tunicamycin (TM) and played a crucial role in protecting cells from damage. HTJDTLD may be a very promising drug for the treatment of ISR.
Collapse
|
23
|
Hu MJ, Yang YJ, Yang JG. Immediate Versus Staged Multivessel PCI Strategies in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Systematic Review and Meta-analysis. Am J Med Sci 2021; 363:161-173. [PMID: 34274323 DOI: 10.1016/j.amjms.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/22/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent guidelines and randomized clinical trials favor the multivessel percutaneous coronary intervention (MV-PCI) strategy undertaken immediately or staged after primary PCI in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, the optimal strategy of MV-PCI remains unknown. METHODS We conducted a search of PUBMED, EMBASE, Web of Science, the Cochrane database (CENTRAL), clinicaltrial.gov, and Google Scholar for studies comparing immediate versus staged MV-PCI in patients with STEMI and multivessel disease. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random-effects models. RESULTS Eighteen (4 randomized clinical trials) studies with 8,100 patients fulfilled the inclusion criteria. Relative to staged MV-PCI, immediate MV-PCI was associated with higher short-term (within 30 days) (OR, 3.96; 95% CI, 2.07-7.59; P<0.0001) and long-term (above 6 months) mortality (OR, 2.12; 95% CI, 1.46-3.07; P<0.0001), short-term major adverse cardiovascular events (MACE)(OR, 1.99; 95% CI, 1.13-3.50; P=0.02) and cardiac death (OR, 4.78; 95% CI, 2.17-10.53; P=0.0001). There was a nonsignificant trend towards higher long-term MACE (OR, 1.23; 95% CI, 0.98-1.54; P=0.07) and cardiac death (OR, 1.75; 95% CI, 0.93-3.30; P=0.08) with immediate versus staged MV-PCI. Revascularization, myocardial infarction, and safety endpoints including stroke, major bleeding, and renal failure were similar between immediate versus staged MV-PCI. However, pooled analysis of randomized clinical trials did not show any significant differences in long-term MACE, all-cause mortality, myocardial infarction, and revascularization. CONCLUSIONS Our meta-analysis suggests that among patients with STEMI and multivessel disease, staged instead of immediate MV-PCI may be the optimal revascularization strategy.
Collapse
Affiliation(s)
- Meng-Jin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Jin-Gang Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
| |
Collapse
|
24
|
Zhang J, Ding G. Improved Cardiac Function and Attenuated Inflammatory Response by Additional Administration of Tirofiban during PCI for ST-Segment Elevation Myocardial Infarction Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:8371996. [PMID: 34221091 PMCID: PMC8221867 DOI: 10.1155/2021/8371996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) is one of the acute coronary syndromes, and it is the main cause of cardiac death worldwide. The purpose of this study was to investigate whether tirofiban improves cardiac function and attenuates inflammatory response in STEMI patients undergoing percutaneous coronary intervention (PCI). From May 2016 to May 2019, a total of 124 patients who admitted into our hospital due to STEMI fulfilled inclusion and exclusion criteria and were randomly assigned to PCI + tirofiban and PCI groups, 62 cases per groups. Intravenous administration of 10 μg kg-1 min-1 tirofiban was performed 30 min prior to PCI. During PCI, tirofiban infusion through a micropump with 0.15 μg kg-1 min-1 lasted for 48 h. It was found that the PCI + tirofiban group was significantly different from the PCI group in total corrected TIMI frame count (CTFC) after PCI (15.88 ± 5.11 vs. 22.47 ± 6.26, P < 0.001). At day 7 and day 30 post-PCI, a significant time-dependent decrease in the levels of brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and creatine kinase isoenzyme (CK-MB) in both groups was observed after PCI (P < 0.001). More importantly, the patients in the PCI + tirofiban group had much lower levels of BNP, cTnI, and CK-MB compared with those in the PCI group at days 7 and 30 post-PCI (P < 0.001). At day 7 following PCI, the left ventricular ejection fraction (LVEF) was statistically higher in the PCI + tirofiban group than in the PCI group (P < 0.05). At day 30 post-PCI, increased LVEF concomitant with reduced left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) was observed in the PCI + tirofiban group compared with the PCI group. At day 7 and day 30 post-PCI, both groups displayed a time-dependent decline in the levels of C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and procalcitonin (PCT) after PCI (P < 0.05). Additionally, the patients in the PCI + tirofiban group had lower levels of CRP, TNF-α, IL-6, and PCT compared with those in the PCI group at days 7 and 30 post-PCI (P < 0.05). All patients in the PCI + tirofiban and PCI groups were followed up for 12 months by outpatient or telephone after discharge. There were fewer patients with LVEF < 50% in the PCI + tirofiban group than the PCI group (P=0.044). Furthermore, it was found that the incidence rate of major adverse cardiovascular events (MACEs) in the PCI + tirofiban group was evidently lower than that in the PCI group (12.90% vs. 29.03%, P=0.028). Taken together, our data suggest that additional administration of tirofiban could improve cardiac function and attenuate inflammatory response in STEMI patients undergoing PCI, which is worthy of promotion in clinic.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Cardiology, People's Hospital of Anji, Huzhou, China
| | - Guomin Ding
- Department of Cardiology, People's Hospital of Anji, Huzhou, China
| |
Collapse
|
25
|
Changal K, Syed MA, Atari E, Nazir S, Saleem S, Gul S, Salman FNU, Inayat A, Eltahawy E. Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States. BMC Cardiovasc Disord 2021; 21:250. [PMID: 34020605 PMCID: PMC8139069 DOI: 10.1186/s12872-021-02068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in theUnited States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach. Methods A detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers. Results A total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p<0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004). Conclusion The shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.
Collapse
Affiliation(s)
- Khalid Changal
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.
| | | | - Ealla Atari
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Sameer Saleem
- Department of Cardiovascular Medicine, University of Kentucky, Bowling Green, USA
| | - Sajjad Gul
- Internal Medicine, St. Francis Medical Center, University of Illinois at Peoria, Peoria, USA
| | - F N U Salman
- Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Asad Inayat
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Ehab Eltahawy
- Professor and Program Director of Cardiovascular Medicine and Interventional Cardiology, University of Toledo, 3000 Arlington Ave., MS 1118, Toledo, 43614, OH, USA.
| |
Collapse
|
26
|
Shah T, Haimi I, Yang Y, Gaston S, Taoutel R, Mehta S, Lee HJ, Zambahari R, Baumbach A, Henry TD, Grines CL, Lansky A, Tirziu D. Meta-Analysis of Gender Disparities in In-hospital Care and Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2021; 147:23-32. [PMID: 33640366 DOI: 10.1016/j.amjcard.2021.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/06/2021] [Accepted: 02/19/2021] [Indexed: 12/26/2022]
Abstract
Gender disparities in ST-segment elevation myocardial infarction (STEMI) outcomes continue to be reported worldwide; however, the magnitude of this gap remains unknown. To evaluate gender-based discrepancies in clinical outcomes and identify the primary driving factors a global meta-analysis was performed. Studies were selected if they included all comers with STEMI, reported gender specific patient characteristics, treatments, and outcomes, according to the registered PROSPERO protocol: CRD42020161469. A total of 56 studies (705,098 patients, 31% females) were included. Females were older, had more comorbidities and received less antiplatelet therapy and primary percutaneous coronary intervention (PCI). Females experienced significantly longer delays to first medical contact (mean difference 42.5 min) and door-to-balloon time (mean difference 4.9 min). In-hospital, females had increased rates of mortality (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.84 to 1.99, p <0.00001), repeat myocardial infarction (MI) (OR 1.25, 95% CI 1.00 to 1.56, p=0.05), stroke (OR 1.67, 95% CI 1.27 to 2.20, p <0.001), and major bleeding (OR 1.82, 95% CI 1.56 to 2.12, p <0.00001) compared with males. Older age at presentation was the primary driver of excess mortality in females, although other factors including lower rates of primary PCI and aspirin usage, and longer door-to-balloon times contributed. In contrast, excess rates of repeat MI and stroke in females appeared to be driven, at least in part, by lower use of primary PCI and P2Y12 inhibitors, respectively. In conclusion, despite improvements in STEMI care, women continue to have in-hospital rates of mortality, repeat MI, stroke, and major bleeding up to 2-fold higher than men. Gender disparities in in-hospital outcomes can largely be explained by age differences at presentation but comorbidities, delays to care and suboptimal treatment experienced by women may contribute to the gender gap.
Collapse
|
27
|
Almas T, Akram A, Ehtesham M, Ahmed R, Khedro T, Malik U, Alshaikh L, Alshaikh L, Sattar Y, Hassan Virk HU. Multi-vessel Versus Culprit-vessel-only PCI for STEMI: Where Does the Jury Stand? Ann Med Surg (Lond) 2021; 65:102343. [PMID: 33996070 PMCID: PMC8100091 DOI: 10.1016/j.amsu.2021.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ayesha Akram
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Maryam Ehtesham
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Reema Ahmed
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lamees Alshaikh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lina Alshaikh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai, NY, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
28
|
Savitz ST, Falk K, Stearns SC, Grove L, Rossi J. Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge. Clin Cardiol 2021; 44:627-635. [PMID: 33755210 PMCID: PMC8119835 DOI: 10.1002/clc.23583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 01/09/2023] Open
Abstract
Background Observational analyses comparing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) among elderly or frail patients are likely biased by treatment selection. PCI is typically chosen for frail patients, while CABG is more common for patients with good recovery potential. Hypothesis We hypothesized that skilled nursing facility (SNF) use after revascularization is a measure of relative frailty associated with outcomes following coronary revascularization. Methods We used a 20 percent sample of Medicare beneficiaries aged 65 years or older who received inpatient PCI or CABG between 2007–2014. Key explanatory variables were the revascularization strategy and SNF use after revascularization. We used Cox regression to evaluate death and repeat revascularization within one year and logistic regression to evaluate SNF use and 30‐day readmissions/death. Results CABG patients were 25.1 percentage points [95% confidence interval: 24.7, 25.5] more likely to use SNF following revascularization than inpatient PCI patients. SNF use was associated with a higher death rate (hazard ratio (HR): 3.19 [3.02, 3.37]) and a 16.2 percentage point (15.5, 16.9) increase in 30‐day readmissions/death. Among patients with SNF use, CABG was associated with a decrease in 30‐day readmissions/death compared to PCI. Conclusions While CABG was associated with higher rates of SNF use and 30‐day readmission/death overall, CABG was associated with significantly lower rates of 30‐day readmissions/death among patients with SNF use. The findings suggest that caution is needed in treatment selection for patients at high‐risk for SNF use and that selection of inpatient PCI over CABG may be associated with frailty and worse outcomes for some patients.
Collapse
Affiliation(s)
- Samuel T. Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
- Division of Health Care Delivery ResearchMayo ClinicRochesterMinnesotaUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
- Department of Health Policy and Management, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kristine Falk
- Division of Cardiology, UNC School of MedicineThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sally C. Stearns
- Department of Health Policy and Management, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Cecil G. Sheps Center for Health Services ResearchThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Lexie Grove
- Department of Health Policy and Management, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Cecil G. Sheps Center for Health Services ResearchThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Joseph Rossi
- Division of Cardiology, UNC School of MedicineThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| |
Collapse
|
29
|
Zhou X, Zheng KI, Shan P. Toward reducing thrombus recurrence rate in management of patients with confirmed left ventricular thrombi. ESC Heart Fail 2021; 8:2359-2360. [PMID: 33749165 PMCID: PMC8120361 DOI: 10.1002/ehf2.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Xiaodong Zhou
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Kenenth I Zheng
- NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peiren Shan
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| |
Collapse
|
30
|
Rahhal A, Mahfouz A, Al‐Amri M, Aljundi A, Khir F, Hamid Y, Alyafei S, Arabi AR. Impact of discharge education by clinical pharmacists on patients' adherence to post‐percutaneous coronary intervention medications: A retrospective cohort study using real‐world data. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alaa Rahhal
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Ahmed Mahfouz
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Maha Al‐Amri
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Amer Aljundi
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Fadi Khir
- Internal Medicine Department Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Yousra Hamid
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Sumaya Alyafei
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Abdul Rahman Arabi
- Cardiology Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| |
Collapse
|
31
|
Roland R, Veselka J. Optical Coherence Tomography of the Coronary Arteries. Int J Angiol 2021; 30:29-39. [PMID: 34045841 DOI: 10.1055/s-0041-1724019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Intravascular imaging, particularly optical coherence tomography, has brought significant improvement in diagnostic and therapeutical approaches to coronary artery disease and has offered superior high-resolution visualization of coronary arteries. The ability to obtain images of intramural and transmural coronary structures allows the study of the process of atherosclerosis, effect of therapies, mechanism of acute coronary syndrome and stent failure, and performance of new devices and enables the interventional cardiologist to optimize the effect of percutaneous coronary intervention. In this review, we provide the summary of the latest published data on clinical use of optical coherence tomography as well as practical algorithm for optical coherence tomography-guided percutaneous coronary intervention for daily interventional practice.
Collapse
Affiliation(s)
- Robert Roland
- Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
| |
Collapse
|
32
|
Starting and Operating a Public Cardiac Catheterization Laboratory in a Low Resource Setting: The Eight-Year Story of the Uganda Heart Institute Catheter Laboratory. Glob Heart 2021; 16:11. [PMID: 33598391 PMCID: PMC7879993 DOI: 10.5334/gh.859] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Low- and-middle-income-countries (LMICs) currently bear 80% of the world’s cardiovascular disease (CVD) mortality burden. The same countries are underequipped to handle the disease burden due to critical shortage of resources. Functional cardiac catheterization laboratories (cath labs) are central in the diagnosis and management of CVDs. Yet, most LMICs, including Uganda, fall remarkably below the minimum recommended standards of cath lab:population ratio due to a host of factors including the start-up and recurring costs. Objectives: To review the performance, challenges and solutions employed, lessons learned, and projections for the future for a single cath lab that has been serving the Ugandan population of 40 million people in the past eight years. Methods: A retrospective review of the Uganda Heart Institute cath lab clinical database from 15 February 2012 to 31 December 2019 was performed. Results: In the initial two years, this cath lab was dependent on skills transfer camps by visiting expert teams, but currently, Ugandan resident specialists independently operate this lab. 3,542 adult and pediatric procedures were conducted in 8 years, including coronary angiograms and percutaneous coronary interventions, device implantations, valvuloplasties, and cardiac defect closures, among others. There was a consistent expansion of the spectrum of procedures conducted in this cath lab each year. The initial lack of technical expertise and sourcing for equipment, as well as the continual need for sundries present(ed) major roadblocks. Government support and leveraging existing multi-level collaborations has provided a platform for several solutions. Sustainability of cath lab services remains a significant challenge especially in relation to the high cost of sundries and other consumables amidst a limited budget. Conclusion: A practical example of how centers in LMIC can set up and sustain a public cardiac catheterization laboratory is presented. Government support, research, and training collaborations, if present, become invaluable leverage opportunities.
Collapse
|
33
|
Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry. PLoS One 2021; 16:e0246474. [PMID: 33556136 PMCID: PMC7869989 DOI: 10.1371/journal.pone.0246474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population. OBJECTIVES To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry. METHODS Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women). RESULTS Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p<0.003) but were no longer significant for NSTEMI cohort. CONCLUSION Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.
Collapse
|
34
|
Complete Revascularization in Patients With STEMI and Multivessel Coronary Artery Disease: Is It Beneficial? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Nan J, Jia R, Meng S, Jin Y, Chen W, Hu H. The Impact of the COVID-19 Pandemic and the Importance of Telemedicine in Managing Acute ST Segment Elevation Myocardial Infarction Patients: Preliminary Experience and Literature Review. J Med Syst 2021; 45:9. [PMID: 33404890 PMCID: PMC7785918 DOI: 10.1007/s10916-020-01703-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19), which is caused by a novel coronavirus (SARS-COV-2), has compromised health care systems and normal management of patients with cardiovascular diseases [1-3]. Patients with non-communicable diseases, including acute myocardial infarction (AMI) are vulnerable to this stress [4, 5]. Acute ST segment elevation myocardial infarction (STEMI), the most critical type of AMI, is associated with high mortality even with modern medicine [6-8]. Timely reperfusion therapy is critical for STEMI patients because a short ischemia time is associated with better clinical outcomes and lower acute and long -term mortality [9-12]. The COVID-19 pandemic placed the management of STEMI patients in a difficult situation due to the need to balance timely reperfusion therapy and maintaining strict infection control practices [13, 14]. Telemedicine, which is used to deliver health care services using information or communication technology, provides an opportunity to carry out the evaluation, diagnosis, and even monitor the patients after discharge when social distancing is needed [15]. In this article, we reported our preliminary experience with the usefulness of telemedicine in managing STEMI patients during the COVID-19 pandemic. We also provided a review of this topic.
Collapse
Affiliation(s)
- Jing Nan
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ruofei Jia
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Shuai Meng
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Yubo Jin
- Phillips Academy Andover, Andover, MA, USA
| | - Wei Chen
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| | - Hongyu Hu
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| |
Collapse
|
36
|
Navarese EP, Frediani L, Kandzari DE, Caiazzo G, Cenname AM, Cortese B, Piva T, Muçaj A, Tumscitz C, Paparoni F, Larosa C, Bisceglia T, Menozzi M, Gurbel PA, Kubica J. Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no‐reflow during primary PCI: The RESTORE observational study. Catheter Cardiovasc Interv 2020; 97:602-611. [DOI: 10.1002/ccd.29113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Eliano P. Navarese
- Department of Cardiology, Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
- SIRIO MEDICINE Network Bydgoszcz Poland
- Faculty of Medicine University of Alberta Edmonton Canada
| | - Lara Frediani
- Department of Cardiology Livorno Hospital, Azienda Usl Toscana Nord‐Ovest, Ospedali Riuniti di Livorno Livorno Italy
| | | | | | | | | | - Tommaso Piva
- Department of Cardiologic Azienda Ospedaliero Universitaria "Ospedali Riuniti" Ancona Italy
| | - Andi Muçaj
- Department of Cardiologic Azienda Ospedaliero Universitaria "Ospedali Riuniti" Ancona Italy
| | | | | | - Claudio Larosa
- Department of Cardiology Azienda Ospedaliera Bonomo Andria Italy
| | - Teodoro Bisceglia
- Department of Cardiology Santa Maria della Misericordia Hospital Udine Italy
| | | | - Paul A. Gurbel
- Sinai Center form Thrombosis Research Sinai Hospital of Baltimore Baltimore Maryland USA
| | - Jacek Kubica
- Department of Cardiology, Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| |
Collapse
|
37
|
Residual Right Coronary Artery Stenosis after Left Main Coronary Artery Intervention Increased the 30-Day Cardiovascular Death and 3-Year Right Coronary Artery Revascularization Rate. J Interv Cardiol 2020; 2020:4587414. [PMID: 32607081 PMCID: PMC7313166 DOI: 10.1155/2020/4587414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/06/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022] Open
Abstract
Background The outcomes of patients with concomitant left main coronary artery (LMCA) and right coronary artery (RCA) diseases are reportedly worse than those with only LMCA disease. To date, only few studies have investigated the clinical impact of percutaneous coronary intervention (PCI) on RCA stenosis during the same hospitalization, in which LMCA disease was treated. This study was aimed at comparing the outcomes between patients with and without right coronary artery intervention during the same hospital course for LMCA intervention. Methods and Results From a total of 776 patients who were undergoing PCI to treat LMCA disease, 235 patients with concomitant RCA significant stenosis (more than 70% stenosis) were enrolled. The patients were divided into two groups: 174 patients received concomitant PCI for RCA stenosis during the same hospitalization, in which LMCA disease was treated, and 61 patients did not receive PCI for RCA stenosis. Patients without intervention to the right coronary artery had higher 30-day cardiovascular mortality rates and 3-year RCA revascularization rates compared to those with right coronary artery intervention. Patients without RCA intervention at the same hospitalization did not increase the 30-day total death, 3-year myocardial infarction rate, 3-year cardiovascular death, and 3-year total death. Conclusions In patients with LM disease and concomitant above or equal to 70% RCA stenosis, PCI for RCA lesion during the same hospitalization is recommended to reduce the 30-day cardiovascular death and 3-year RCA revascularization rate.
Collapse
|
38
|
Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Effect of renin-angiotensin system inhibitors on major clinical outcomes in patients with acute myocardial infarction and prediabetes or diabetes after successful implantation of newer-generation drug-eluting stents. J Diabetes Complications 2020; 34:107574. [PMID: 32147394 DOI: 10.1016/j.jdiacomp.2020.107574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/26/2020] [Accepted: 02/26/2020] [Indexed: 12/30/2022]
Abstract
AIM To investigate the comparative effectiveness of renin-angiotensin system inhibitor (RASI) therapy on major clinical outcomes in patients with acute myocardial infarction (AMI) and prediabetes or diabetes after successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). METHODS A total of 11,962 patients with AMI were divided into six groups according to glycemic status and the presence or absence of RASI therapy: normoglycemia (n = 3,080; RASI+ [n = 2,496], RASI- [n = 584]), prediabetes (n = 3,709; RASI+ [n = 2,944], RASI- [n = 765]), and diabetes (n = 5,173; RASI+ [n = 4,133], RASI- [n = 1,040]). The major endpoint was major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction (re-MI), or any repeat revascularization. RESULTS After adjustment, in RASI users, the cumulative incidence of re-MI of the diabetes group was significantly higher than that of the prediabetes group (aHR, 1.999; 95% CI, 1.153-3.467; p = 0.014). However, the cumulative incidences of MACEs, all-cause death, and any repeat revascularization were similar between the two groups during a 2-year follow-up period. CONCLUSIONS In the era of newer-generation DESs, RASI therapy did not reduce re-MI in patients with AMI and diabetes in this study.
Collapse
Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| |
Collapse
|
39
|
Body mass index and in-hospital outcomes in patient's ≥80 years with ST Elevation Myocardial Infarction. Results from low income country without coronary intervention. Int J Cardiol 2020; 306:11-14. [PMID: 32111357 DOI: 10.1016/j.ijcard.2020.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/13/2020] [Accepted: 02/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In most scenarios from low/middle income countries, pharmacological approach for ST elevation Myocardial Infarction is still use. In these setting and increase proportion of elderly patients is awaited. So it is also expected to have older patients with suboptimal treatment and risk stratification. OBJECTIVE To investigate the impact of the body mass index (BMI) on in-hospital outcomes in a cohort of elderly (≥80 years) patients, from a center without coronary intervention. METHODS Patient's ≥80 years of age admitted to our institution between June 2014 and May 2019 with STEMI, were divided according BMI tertiles (BMI tertile 1: ≪22.36 kg/m2, BMI tertile2: 22.36-25.71 kg/m2, and BMI tertile 3: ≫25.71 kg/m2). The primary endpoint was all-cause in-hospital mortality RESULTS: Out of 118 patients, 41 (34.74%) were women. Median age was 84.4 ± 3.5 years and median BMI 24.1 ± 3.7 kg/m2. Women had a higher BMI than men (24.4 ± 4.0 vs 24.0 ± 3.6; p: 0.535). All-cause mortality was 33.3%, 2.5%, and 15% for lower, middle, and higher BMI tertiles (p=0.002). To belong to BMI tertile 1 was associated with an increased all-cause mortality (OR: 5.15, 95% CI 1.84-14.28, p = 0.001); and in patients without administration of streptokinase (OR: 9.52, 95% CI 2.34-38.45, p = 0.001). CONCLUSION This study reports association between lower BMI values and increased mortality in elderly patients with and without pharmacological reperfusion with streptokinase.
Collapse
|
40
|
Gaifullin RA, Ivanov SV, Gaifullina EN. Stratification of preoperative risk in elderly patients in cardiac surgery clinic. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2019-2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- R. A. Gaifullin
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. V. Ivanov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. N. Gaifullina
- Research Institute for Complex Issues of Cardiovascular Diseases
| |
Collapse
|
41
|
Firman D, Alkatiri AA, Taslim I, Wangi SB, Pranata R. Effect of thrombus aspiration on microcirculatory resistance and ventricular function in patients with high thrombus burden. BMC Cardiovasc Disord 2020; 20:153. [PMID: 32234015 PMCID: PMC7110617 DOI: 10.1186/s12872-020-01432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Studies have not demonstrated consistent outcomes following thrombus aspiration in Primary Percutaneous Coronary Intervention (PPCI). We investigated the relationship between thrombus aspiration and microvascular obstruction as measured using Index of Microcirculatory Resistance (IMR) immediately following PPCI and Left Ventricle Function Improvement measured using Global Longitudinal Strain (GLS) six months following PPCI. Our aim is to determine microvascular obstruction and left ventricle function improvement six months following thrombus aspiration during PPCI. Methods This was a single-center, observational, prospective non-randomized study involving 45 patients with thrombus score 4–5 (defined as high thrombus burden) and Thrombolysis in Myocardial Infarction (TIMI) flow of 0–2 who subsequently underwent PPCI. Thrombus aspiration was conducted based on physician discretion. The IMR was measured immediately following the procedure. All patients underwent echocardiography to measure GLS at 24 h, 3 months and 6 months following PPCI. Results Thirty-three (73%) patients underwent thrombus aspiration during PPCI and twelve (27%) patients underwent the conventional PPCI. No significant difference in IMR was found between the group that underwent thrombus aspiration and the group that underwent conventional PCI (51.9 ± 41.5 vs 47.1 ± 35.6 p = 0.723). TIMI flow after PPCI was worse in thrombus aspiration group (OR 5.2 [1.2–23.2], p = 0.041). There was no difference in GLS between two groups at 6-month follow-up (− 13.0 ± 3.4 vs − 12.8 ± 4.6, p = 0.912). Conclusion This study indicates no benefit of thrombus aspiration during PPCI in reducing either microvascular obstruction or left ventricular function at 6-month follow-up for patients with high thrombus burden. Nevertheless, further studies are required before definite conclusions can be made.
Collapse
Affiliation(s)
- Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, Barat, 11420, Indonesia.
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, Barat, 11420, Indonesia
| | | | | | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| |
Collapse
|
42
|
Baars T, Sowa JP, Neumann U, Hendricks S, Jinawy M, Kälsch J, Gerken G, Rassaf T, Heider D, Canbay A. Liver parameters as part of a non-invasive model for prediction of all-cause mortality after myocardial infarction. Arch Med Sci 2020; 16:71-80. [PMID: 32051708 PMCID: PMC6963137 DOI: 10.5114/aoms.2018.75678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/29/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Liver parameters are associated with cardiovascular disease risk and severity of stenosis. It is unclear whether liver parameters could predict the long-term outcome of patients after acute myocardial infarction (AMI). We performed an unbiased analysis of the predictive value of serum parameters for long-term prognosis after AMI. MATERIAL AND METHODS In a retrospective, observational, single-center, cohort study, 569 patients after AMI were enrolled and followed up until 6 years for major adverse cardiovascular events, including cardiac death. Patients were classified into non-survivors (n = 156) and survivors (n = 413). Demographic and laboratory data were analyzed using ensemble feature selection (EFS) and logistic regression. Correlations were performed for serum parameters. RESULTS Age (73; 64; p < 0.01), alanine aminotransferase (ALT; 93 U/l; 40 U/l; p < 0.01), aspartate aminotransferase (AST; 162 U/l; 66 U/l; p < 0.01), C-reactive protein (CRP; 4.7 U/l; 1.6 U/l; p < 0.01), creatinine (1.6; 1.3; p < 0.01), γ-glutamyltransferase (GGT; 71 U/l; 46 U/l; p < 0.01), urea (29.5; 20.5; p < 0.01), estimated glomerular filtration rate (eGFR; 49.6; 61.4; p < 0.01), troponin (13.3; 7.6; p < 0.01), myoglobin (639; 302; p < 0.01), and cardiovascular risk factors (hypercholesterolemia p < 0.02, family history p < 0.01, and smoking p < 0.01) differed significantly between non-survivors and survivors. Age, AST, CRP, eGFR, myoglobin, sodium, urea, creatinine, and troponin correlated significantly with death (r = -0.29; 0.14; 0.31; -0.27; 0.20; -0.13; 0.33; 0.24; 0.12). A prediction model was built including age, CRP, eGFR, myoglobin, and urea, achieving an AUROC of 77.6% to predict long-term survival after AMI. CONCLUSIONS Non-invasive parameters, including liver and renal markers, can predict long-term outcome of patients after AMI.
Collapse
Affiliation(s)
- Theodor Baars
- Department for Cardiology, West German Heart and Vascular Centre Essen, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Jan-Peter Sowa
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Ursula Neumann
- Department of Bioinformatics, Straubing Center of Science, University of Applied Science Weihenstephan-Triesdorf, Straubing, Germany
| | - Stefanie Hendricks
- Department for Cardiology, West German Heart and Vascular Centre Essen, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Mona Jinawy
- Department for Cardiology, West German Heart and Vascular Centre Essen, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Julia Kälsch
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department for Cardiology, West German Heart and Vascular Centre Essen, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Dominik Heider
- Department of Bioinformatics, Straubing Center of Science, University of Applied Science Weihenstephan-Triesdorf, Straubing, Germany
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
43
|
Kähkönen O, Kyngäs H, Saaranen T, Kankkunen P, Miettinen H, Oikarinen A. Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients. Eur J Cardiovasc Nurs 2019; 19:339-350. [PMID: 31744316 DOI: 10.1177/1474515119887851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. AIMS The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. METHODS Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. CONCLUSION Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.
Collapse
Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Terhi Saaranen
- Department of Nursing Science, University of Eastern Finland, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Finland
| | | | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| |
Collapse
|
44
|
Wu JW, Hu H, Li D, Ma LK. In-hospital outcomes of delayed stenting in hemodynamically stable patients with ST-segment elevation myocardial infarction: the CCC (Care for Cardiovascular Disease in China) project. Cardiovasc Diagn Ther 2019; 9:462-471. [PMID: 31737517 DOI: 10.21037/cdt.2019.08.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background For hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) who missed the reperfusion window, optimal timing for delayed revascularization remains controversial. Methods We investigated 7,698 consecutive patients without cardiogenic shock, serious heart failure, or thrombolysis who underwent delayed stenting (12 hours to 28 days after STEMI) at multiple centers in China. The patients were divided according to delayed PCI timing into very early (12-72 hours), early (3-7 days), intermediate (7-14 days) and late (14-28 days) groups. The primary outcome was in-hospital rate of major adverse cardiovascular events (MACE); secondary outcomes were in-hospital rates of all bleeding events, heart failure and sudden cardiac arrest (SCA). All endpoint events were a composite of the primary and secondary endpoints. Results In-hospital MACE rate was similar among groups (P=0.588). Patients who underwent late vs. very early, early and intermediate delayed PCI had higher in-hospital rates of secondary events (13% vs. 8.0%, 8.1% and 0.3%, P<0.001) and heart failure (11.8% vs. 6.2%, 6.3% and 7.6%, P<0.001, respectively). For all in-hospital events, the late vs. intermediate group was at higher risk (OR =1.26, 95% CI: 1.02 to 1.56, P=0.029); and in subgroup analysis, patients with Killip class II or III heart failure had similar rates (OR =1.02, 95% CI: 0.74 to 1.40, P=0.908); while women (OR =1.67, 95% CI: 1.07 to 2.62, P=0.024), and smokers (OR =1.46, 95% CI: 1.05 to 2.02, P=0.023) had higher rates. Conclusions Late delayed PCI (14-28 days) after STEMI was associated with a higher incidence of in-hospital adverse events particularly in women and smokers but not with Killip class II-III heart failure, which might allow medical treatment to improve function.
Collapse
Affiliation(s)
- Jia-Wei Wu
- School of Medicine, Shandong University, Jinan 370100, China.,Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Hao Hu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Dan Li
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Li-Kun Ma
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, China
| |
Collapse
|
45
|
Desai R, Amraotkar AR, Amraotkar MG, Thakkar S, Fong HK, Varma Y, Damarlapally N, Doshi RP, Gangani K. Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention. Cureus 2019; 11:e5399. [PMID: 31482044 PMCID: PMC6701902 DOI: 10.7759/cureus.5399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To study the impact of frailty on inpatient outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods The National Inpatient Sample data of all PCI-related hospitalizations throughout the United States (US) from 2010 through 2014 was utilized. Patients were divided into two groups: frailty and no-frailty. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to stratify groups and outcomes. In order to address the substantial difference in the total number of valid observations between the two groups, a propensity-matched analysis was performed at a 1:1 ratio and caliper width of 0.01. Results A total of 2,612,661 PCI-related hospitalizations throughout the US from 2010 through 2014 were identified, out of which 16,517 admissions (0.6%) had coexisting frailty. Only 1:1 propensity-matched data was utilized for the study. Propensity-matched frailty group (n=14,717) as compared to no-frailty (n=14,755) was frequently older, white, and Medicare enrollee (p<0.05). The frailty group had significantly higher rates of comorbidities and complications (p<0.05). All-cause in-hospital mortality was higher in the no-frailty group (p<0.05). Age, white race, non-elective admission, urban hospitals, and comorbidities predicted in-hospital mortality in frailty group (p<0.05). Rheumatoid arthritis, depression, hypertension, obesity, dyslipidemia, and history of previous PCI decreased odds of in-hospital mortality in frailty group (p<0.05). Frailty group had prolonged hospital stay and higher hospital charges (p<0.05). Conclusions Frailty has a significant effect on PCI-related outcomes. We present a previously unknown protective effect of cardiovascular disease risk factors and other health risk factors on frail patients undergoing PCI. Frailty's inclusion in risk stratification will help in predicting the post-procedure complications and improve resource utilization.
Collapse
Affiliation(s)
- Rupak Desai
- Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, USA
| | - Alok R Amraotkar
- Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Melissa G Amraotkar
- Nursing Education, University of Louisville School of Nursing, Louisville, USA
| | | | - Hee Kong Fong
- Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, USA
| | - Yash Varma
- Internal Medicine, Government Medical College, Bhavnagar, IND
| | | | - Rajkumar P Doshi
- Internal Medicine, University of Nevada, Reno School of Medicine, Reno, USA
| | - Kishorbhai Gangani
- Internal Medicine, Texas Health Arlington Memorial Hospital, Arlington, USA
| |
Collapse
|
46
|
Çetin M, Erdoğan T, Kırış T, Özer S, Yılmaz AS, Durak H, Aykan AÇ, Şatıroğlu Ö. Predictive value of fibrinogen-to-albumin ratio in acute coronary syndrome. Herz 2019; 45:145-151. [PMID: 31388710 DOI: 10.1007/s00059-019-4840-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to investigate the predictive value of the fibrinogen-to-albumin ratio (FAR) regarding the development of major cardiovascular events (MACE) in patients treated with percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). METHODS This was a prospective, observational cohort study that included 261 consecutive patients who were treated with PCI. The patients were grouped according to the occurrence of MACE during the follow-up period. RESULTS During follow-up, MACE occurred in 68 (26%) patients. The FAR was independently predictive of MACE (HR: 1.017, 95% CI: 1.010-1.024, p < 0.001). In addition, left ventricular ejection fraction (LVEF) and a diagnosis of ST-segment elevation myocardial infarction (STEMI) were independent predictors of MACE. The area under the curve (AUC) of the multivariable model, including LVEF and diagnosis of STEMI, was 0.707 (95% CI: 0.631-0.782, p < 0.001). When the FAR was added to the multivariable model, the AUC was 0.770 (95% CI: 0.702-0.838, z = 2.820, difference p = 0.0048). CONCLUSION The FAR could be used for the prediction of MACE in patients with ACS who have undergone PCI.
Collapse
Affiliation(s)
- M Çetin
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
| | - T Erdoğan
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
| | - T Kırış
- Ataturk Training and Research Hospital, Department of Cardiology, Izmir Katip Celebi University, Izmir, Turkey.
| | - S Özer
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
| | - A S Yılmaz
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
| | - H Durak
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
| | - A Ç Aykan
- Department of Cardiology, University of Sutcu Imam, Kahramanmaras, Turkey
| | - Ö Şatıroğlu
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
| |
Collapse
|
47
|
Tripathi B, Yeh RW, Bavishi CP, Sardar P, Atti V, Mukherjee D, Bashir R, Abbott JD, Giri J, Chatterjee S. Etiologies, trends, and predictors of readmission in ST‐elevation myocardial infarction patients undergoing multivessel percutaneous coronary intervention. Catheter Cardiovasc Interv 2019; 94:905-914. [DOI: 10.1002/ccd.28344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Byomesh Tripathi
- Division of Cardiology, Banner University Medical CenterUniversity of Arizona Phoenix Arizona
| | - Robert W. Yeh
- Division of Cardiovascular Medicine, Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical Center Boston Massachusetts
| | - Chirag P. Bavishi
- Division of Cardiology, Cardiovascular InstituteWarren Alpert Medical School at Brown University Providence Rhode Island
| | - Partha Sardar
- Division of Cardiology, Cardiovascular InstituteWarren Alpert Medical School at Brown University Providence Rhode Island
| | - Varunsiri Atti
- Department of MedicineMichigan State University East Lansing Michigan
| | - Debabrata Mukherjee
- Division of Cardiology, Texas Tech University Health Sciences Center El Paso Texas
| | - Riyaz Bashir
- Division of CardiologyTemple University Hospital Philadelphia Pennsylvania
| | - Jinnette Dawn Abbott
- Division of Cardiology, Cardiovascular InstituteWarren Alpert Medical School at Brown University Providence Rhode Island
| | - Jay Giri
- Cardiovascular Medicine DivisionHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, Hoffman Heart Institute, Saint Francis HospitalTeaching Affiliate of the University of Connecticut School of Medicine Hartford Connecticut
| |
Collapse
|
48
|
Khalid MF, Khan AA, Khattak F, Ayub MT, Bagai J, Mukherjee D, Helton T, Cohen MG, Banerjee S, Paul TK. Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Acute Myocardial Infarction with Cardiogenic Shock: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:956-964. [PMID: 30638891 DOI: 10.1016/j.carrev.2018.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous studies comparing outcomes between culprit vessel only percutaneous coronary intervention (CV-PCI) versus multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock in the setting of acute myocardial infarction have shown conflicting results. This meta-analysis investigates the optimal approach for management of these patients considering recently published data. METHODS Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all clinical studies published until May 1, 2018, which compared outcomes in patients presenting with acute myocardial infarction and cardiogenic shock. Studies comparing CV-PCI versus MV-PCI in patients with multivessel coronary artery disease were screened for inclusion in final analysis. The primary end point was in-hospital/30 day mortality. Secondary endpoints included long term (>6 months) mortality, renal failure requiring renal replacement therapy, stroke, bleeding, and recurrent myocardial infarction. Odds ratio (OR) with 95% of confidence interval (CI) were computed and p values <0.05 were considered significant. RESULTS Patient who underwent CV-PCI had significantly lower short-term mortality (in-hospital or 30-day mortality) (OR: 0.73, CI: 0.61-0.87, p = 0.0005), and lower odds of severe renal failure requiring renal replacement therapy (OR: 0.76, CI: 0.59-0.98, p = 0.03). There was no statistically significant difference in long-term mortality, stroke, bleeding, and recurrent myocardial infarction between two groups. CONCLUSION This meta-analysis showed lower short-term mortality and decreased odds of renal failure requiring renal replacement therapy with CV-PCI compared to MV-PCI. However, subgroup analysis including studies exclusively assessing STEMI patients revealed no statistically significant difference in outcomes. Further randomized trials are needed to confirm these findings and evaluate long term results.
Collapse
Affiliation(s)
| | - Abdul Ahad Khan
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Furqan Khattak
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Muhammad Talha Ayub
- Department of Internal Medicine, John H. Stroger Cook County Hospital, Chicago, IL, USA
| | - Jayant Bagai
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA
| | - Thomas Helton
- Division of Cardiovascular Medicine, Veterans Affairs Mountain Home, Johnson City, TN, USA
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, USA
| | - Subhash Banerjee
- VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Timir K Paul
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA.
| |
Collapse
|
49
|
Scherillo M, Cirillo P, Formigli D, Bonzani G, Calabrò P, Capogrosso P, Caso P, Esposito G, Farina R, Golino P, Lanzillo T, Mascia F, Mauro C, Piscione F, Sibilio G, Tuccillo B, Villari B, Trimarco B. Lights and shadows of long-term dual antiplatelet therapy in “real life” clinical scenarios. J Thromb Thrombolysis 2018; 46:559-569. [DOI: 10.1007/s11239-018-1707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
50
|
Extracorporeal Shock Wave-Supported Adipose-Derived Fresh Stromal Vascular Fraction Preserved Left Ventricular (LV) Function and Inhibited LV Remodeling in Acute Myocardial Infarction in Rat. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7518920. [PMID: 30416645 PMCID: PMC6207868 DOI: 10.1155/2018/7518920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023]
Abstract
This study tested the hypothesis that extracorporeal shock wave- (ECSW-) assisted adipose-derived stromal vascular fraction (SVF) therapy could preserve left ventricular ejection fraction (LVEF) and inhibit LV remodeling in a rat after acute myocardial infarction (AMI). Adult male SD rats were categorized into group 1 (sham control), group 2 (AMI induced by left coronary artery ligation), group 3 [AMI + ECSW (280 impulses at 0.1 mJ/mm2, applied to the chest wall at 3 h, days 3 and 7 after AMI), group 4 [AMI + SVF (1.2 × 106) implanted into the infarct area at 3 h after AMI], and group 5 (AMI + ECSW-SVF). In vitro, SVF protected H9C2 cells against menadione-induced mitochondrial damage and increased fluorescent intensity of mitochondria in nuclei (p < 0.01). By day 42 after AMI, LVEF was highest in group 1, lowest in group 2, significantly higher in group 5 than in groups 3 and 4, and similar between the latter two groups (all p < 0.0001). LV remodeling and infarcted, fibrotic, and collagen deposition areas as well as apoptotic nuclei exhibited an opposite pattern to LVEF among the groups (all p < 0.0001). Protein expressions of CD31/vWF/eNOS/PGC-1α/α-MHC/mitochondrial cytochrome C exhibited an identical pattern, whilst protein expressions of MMP-9/TNF-α/IL-1β/NF-κB/caspase-3/PARP/Samd3/TGF-β/NOX-1/NOX-2/oxidized protein/β-MHC/BNP exhibited an opposite pattern to LVEF among five groups (all p < 0.0001). Cellular expressions of CXCR4/SDF-1α/Sca-1/c-Kit significantly and progressively increased from groups 1 to 5 (all p < 0.0001). Cellular expression of γ-H2AX/CD68 displayed an opposite pattern to LVEF among the five groups (all p < 0.0001). In conclusion, ECSW-SVF therapy effectively preserved LVEF and inhibited LV remodeling in rat AMI.
Collapse
|