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Pacilli G, Piscitelli P, D'Errico MM, Mangiacotti A, Siena A, Buglio AL, Vendemiale G, Fontana A, Copetti M, Mirijello A, De Cosmo SA. Association between R 2CHA 2DS 2-VASc score and three-vessel coronary artery disease in a large population at high cardiovascular risk. Intern Emerg Med 2024:10.1007/s11739-024-03679-4. [PMID: 38970758 DOI: 10.1007/s11739-024-03679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/11/2024] [Indexed: 07/08/2024]
Abstract
Coronary artery disease (CAD), particularly three-vessel coronary disease (3VD), is the main cause of death in industrialized countries. Chronic kidney disease is an independent risk factor for CAD. The CHA2DS2-VASc score shows a good ability to predict CV events in high-risk population independently from atrial fibrillation. The aim of the present study was to evaluate the association between the R2CHA2DS2-VASc score and 3VD in a population of patients at high cardiovascular risk. Monocentric prospective study evaluated 1017 patients undergoing coronary angiography. The R2CHA2DS2-VASc score was obtained by adding 2 points to the CHA2DS2-VASc score in case of eGFR < 60 ml/min/1.73m2. Coronary lesions causing ≥ 50% reduction of a major epicardial vessel diameter were considered significant. Patients were grouped based on R2CHA2DS2-VASc tertiles and according to the severity of CAD: 3VD vs No-3VD. The 3VD group showed significantly higher R2CHA2DS2-VASc score than the No-3VD group (4.20 ± 2.18 vs 3.36 ± 2.06, p < 0.001). The risk of 3VD increased by 21% for every 1-point increase in the score (OR 1.21; 95% CI 1.13-1.28, p < 0.001). The prevalence of 3VD was higher among patients belonging to higher tertiles of R2CHA2DS2-VASc (17.2% vs 26.7% vs 33.6% for first, second, and third tertile respectively, p < 0.001) with a risk more than doubled for the third tertile compared to the first one (OR 2.45; 95% CI 1.71-3.49, p < 0.001). The R2CHA2DS2-VASc score is independently associated with 3VD in patients at high cardiovascular risk. The score could be considered a useful tool for clinicians to identify patients who are at high risk of 3VD.
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Affiliation(s)
- Gabriella Pacilli
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Pamela Piscitelli
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Maria Maddalena D'Errico
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Antonio Mangiacotti
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Antonio Siena
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Antonio Mirijello
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy.
| | - Salvatore A De Cosmo
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy.
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Yousif N, Thevan B, Subbramaniyam S, Alkhayat M, Alshaikh S, Shivappa S, Amin H, Tareif M, Abdulqader F, Noor HA. Outcomes of Unprotected Left Main Percutaneous Coronary Intervention: A Single-Centre Experience. Heart Views 2021; 22:13-19. [PMID: 34276883 PMCID: PMC8254153 DOI: 10.4103/heartviews.heartviews_135_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/18/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction When the baseline anatomical syntax score-I (SxSI) is more than or equal to 33, percutaneous coronary intervention (PCI) of unprotected left main (UPLM) is discouraged and considered as high-risk of adverse cardiac events. We designed this study to compare the outcomes of UPLM-PCI between the low to intermediate-syntax score (SxSIlow/int.) group (defined as SxSI <33) and the high-syntax score (SxSIhigh) group (defined as SxSI more than or equal 33) with a subanalysis to explore the predictive role of intravascular images (IVI). Methods The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients, who were enrolled from January 2018 to December 2018, were analyzed at 1-year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE). An independent committee calculated the SxSI and reviewed all the events. Results Baseline data of 2144 patients were considered for analysis. 1245 underwent PCI and 32 (2.57%) had PCI of UPLM; of these, 24 (75%) were in SxSIlow/int. group and 8 (25%) in SxSIhigh group. The mean SxSI was 20.3 ± 6.5 and 37.1 ± 4.9 for SxSIlow/int. and SxSIhigh groups, respectively. Compared with patients in the SxSIlow/int., patients in SxSIhigh group had a greater syntax score-II (<0.0001), which reflects the expected 4-year mortality after PCI by combining the SxSI and clinical variables.Interestingly, despite the fact that the proportion of subjects who sustained MACCE was almost three times more among the SxSIhigh compared to their SxSIlow/int. counterparts [1 (12.5%) vs. 1 (4.2%), P = 0.444], this difference was not statistically significant.It was noted that a higher proportion of patients in whom intravascular imaging (IVI) was not used to guide PCI sustained MACCE compared with that in whom IVI was utilized (2 [50%] vs. [0%], P = 0.012). There is a strong, negative, statistically significant association between the use of IVI and the occurrence of MAACE (Phi=-0.681), which reflects that the use of imaging is associated with significantly lower probability of developing MACCE. Conclusion As demonstrated in this real-world cohort, PCI of UPLM provides excellent outcome at one year regardless of the initial anatomical syntax score. Furthermore, it appears that IVI utilization during the index PCI procedure of UPLM is a potent and independent predictor of MACCE.
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Affiliation(s)
| | - Babu Thevan
- Mohammed Bin Khalifa Cardiac Centre, Riffa, Kingdom of Bahrain
| | | | | | | | | | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Centre, Riffa, Kingdom of Bahrain
| | - Mary Tareif
- Mohammed Bin Khalifa Cardiac Centre, Riffa, Kingdom of Bahrain
| | - Fuad Abdulqader
- Mohammed Bin Khalifa Cardiac Centre, Riffa, Kingdom of Bahrain
| | - Husam A Noor
- Mohammed Bin Khalifa Cardiac Centre, Riffa, Kingdom of Bahrain
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Stanetic BM, Ostojic M, Kovacevic-Preradovic T, Kos L, Stanetić K, Nikolic A, Bojic M, Huber K. ApPropRiateness of myOcardial revascUlarization assessed by SYNTAX Scores in patients with type 2 diabetes melliTus: the PROUST study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:153-161. [PMID: 32636899 PMCID: PMC7333192 DOI: 10.5114/aic.2020.96058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Results of currently available trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Current guidelines do not recommend PCI in patients with diabetes and a SYNTAX score ≥ 23. AIM To compare all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics. MATERIAL AND METHODS The study group comprised consecutive patients with three-vessel CAD and/or unprotected left main CAD (≥ 50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG. RESULTS Out of 342 diabetics, 177 patients underwent PCI and 165 patients were referred for CABG. The incidence of all-cause death was different between diabetics treated with PCI or CABG at 4 years (16/177, 9.0% vs. 26/165, 15.8%, respectively, p = 0.03). The difference was not evident in non-diabetics (PCI: 41/450, 9.1% vs. CABG: 19/249, 7.6%, p = 0.173). In diabetics, there was a higher incidence of all-cause mortality in PCI patients with intermediate-high (≥ 23) SYNTAX scores compared with those with low (0-22) SYNTAX scores (10/56, 17.9% vs. 6/121, 5.0%, respectively, p < 0.01). On the other hand, diabetics who underwent CABG showed similar mortality rates irrespective of the SYNTAX scores (SYNTAX 0-22: 3/29, 10.3%; SYNTAX ≥ 23: 23/136, 11.9%, p = 0.46). In the subgroup analysis, there was no interaction according to presence or absence of left main CAD (p for interaction = 0.12) as well as according to diabetes status (p for interaction = 0.38), whereas gender and SYNTAX scores were differentiators between PCI and CABG with a p for interaction < 0.1. CONCLUSIONS Our analysis supports recent evidence that diabetes is not a differentiator between PCI and CABG.
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Affiliation(s)
- Bojan M Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, Bosnia and Herzegovina
| | - Miodrag Ostojic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, Bosnia and Herzegovina
- Institute for Cardiovascular diseases Dedinje, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Tamara Kovacevic-Preradovic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, Bosnia and Herzegovina
| | - Ljiljana Kos
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Kosana Stanetić
- Medical Faculty, University of Banja Luka, Bosnia and Herzegovina
- Primary Health Center, Banja Luka, Bosnia and Herzegovina
| | - Aleksandra Nikolic
- Institute for Cardiovascular diseases Dedinje, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Milovan Bojic
- Medical Faculty, University of Banja Luka, Bosnia and Herzegovina
- Institute for Cardiovascular diseases Dedinje, Belgrade, Serbia
| | - Kurt Huber
- Wilhelminenspital, 3 Medical Department–Cardiology, Vienna, Austria
- Sigmund Freud Private University Medical School, Vienna, Austria
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Xu MX, Teng RL, Ruddy TD, Schoenhagen P, Bartel T, Di Bartolomeo R, Aksoy O, Desai M, von Kodolitsch Y, Escaned J, McCullough PA, Vasudevan A, Shen CX, Zhao X, Zhou YF, Xu HF, Cheng XJ, He YM. The CatLet score: a new coronary angiographic scoring tool accommodating the variable coronary anatomy for the first time. J Thorac Dis 2019; 11:5199-5209. [PMID: 32030237 DOI: 10.21037/jtd.2019.12.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The SYNTAX score for decision makings or outcome predictions in coronary artery disease does not account for the variations in the coronary anatomy, which is a clear fallacy for patients with less typical anatomy than suggested by the SYNTAX score. The current study aimed to derive a new coronary angiographic scoring system accommodating the variability in the coronary anatomy. Methods The 17-myocardial segment model and laws of competitive blood supply and flow conservation were utilized to derive this new scoring system. Results We obtained 6 types of RCA dominance, 3 types of diagonal size and 3 types of left anterior descending artery (LAD) length, which together resulted in a total of 54 patterns of coronary artery circulation to account for the variability in the coronary anatomy among individuals. A Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system has been designed based on the above-mentioned reclassification scheme (htpp://www.catletscore.com, IE browser is required to run this calculator). Conclusions This new CatLet angiographic scoring system accommodated the variability in the coronary anatomy and standardized the collection of the coronary angiographic data, which could facilitate the comparison and exchange of these data between different catheter labs. Its utility for predicting the clinical outcomes and standardizing the angiographic data collection will be investigated in a series of clinical trials enrolling "all-comers" with coronary artery disease (CAD).
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Affiliation(s)
- Ming-Xing Xu
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ruo-Ling Teng
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Terrence D Ruddy
- Division of Cardiology, Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Thomas Bartel
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Roberto Di Bartolomeo
- Cardio-Thoracic and Vascular Department, Division of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Olcay Aksoy
- Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Milind Desai
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Javier Escaned
- Department of Cardiology, Hospital San Carlos, Madrid, Spain
| | - Peter A McCullough
- Division of Cardiology, Heart & Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Anupama Vasudevan
- Division of Cardiology, Heart & Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Cheng-Xing Shen
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xin Zhao
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ya-Feng Zhou
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Hai-Feng Xu
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xu-Jie Cheng
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yong-Ming He
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Ziv-Baran T, Mohr R, Yazdchi F, Loberman D. The epidemiology of coronary artery bypass surgery in a community hospital: A comparison between 2 periods. Medicine (Baltimore) 2019; 98:e15059. [PMID: 30921236 PMCID: PMC6455745 DOI: 10.1097/md.0000000000015059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
During the last decades, the increased number of percutaneous interventions procedures causes a significant change in the profile of patients referred to coronary artery bypass grafting (CABG). We aimed to study changes in patients' characteristics and procedural outcomes of patients referred to CABG in a community hospital during the first 15 years of the millennium.A historical cohort study of all patients who underwent CABG in Cape Cod Hospital was performed. The period was divided into 2 sub-periods, 2000 to 2008 and 2009 to 2014. Patients' characteristics and procedure outcomes were compared. Data on age, sex, comorbidities, Society of Thoracic Surgery risk scores and surgical adverse outcomes (stroke, coma, and 30-days mortality) were collected.During the study period, 1108 patients underwent CABG; 612 were operated before 2009 and 496 after. Age and sex were similar in the 2 periods. The patients in the later period presented lower risk for mortality and stroke (P <.001). Diabetes (DM) was more common in the later period (P <.001) while peripheral vascular disease (PVD) (P <.001) and left main disease (LM) (P = .017) were more common in the earlier period. Mortality rates were similar between the 2 periods. Post-operative stroke (1.8%) and coma (0.8%) were presented only in the later period. In conclusion, a significant change in CABG patients' characteristics was observed.In conclusion, patients in the later period had lower risk score and were more likely to present with DM and less with PVD and LM. Despite the lower risk, the mortality rate was similar.
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Affiliation(s)
| | - Rephael Mohr
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Farhang Yazdchi
- Division of Cardiac Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA/Cape Cod Hospital, Hyannis, MA
| | - Dan Loberman
- Division of Cardiac Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA/Cape Cod Hospital, Hyannis, MA
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Colluoglu T, Tanriverdi Z, Unal B, Ozcan EE, Dursun H, Kaya D. The role of baseline and post-procedural frontal plane QRS-T angles for cardiac risk assessment in patients with acute STEMI. Ann Noninvasive Electrocardiol 2018; 23:e12558. [PMID: 29873439 DOI: 10.1111/anec.12558] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/20/2018] [Accepted: 05/02/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To our knowledge, no study so far investigated the importance of post-procedural frontal QRS-T angle f(QRS-T) in ST segment elevation myocardial infarction (STEMI). The aim of our study was to investigate the role of baseline and post-procedural f(QRS-T) angles for determining high risk STEMI patients, and the success of reperfusion. METHODS A total of 248 patients with first acute STEMI that underwent primary percutaneous coronary intervention (pPCI) or thrombolytic therapy (TT) between 2013 and 2014 were included in this study. Baseline f(QRS-T) angle was defined as the angle which measured from the first ECG at the time of hospital admission. Post-procedural (QRS-T) angle was defined according to the treatment strategy as follows: the angle which measured from the post-PCI ECG in patients treated with pPCI; the angle which measured from the ECG taken 90 min after onset of therapy in patients treated with TT. RESULTS The baseline (101.9° ± 48.0 vs. 72.1° ± 49.1, p = 0.014) and post-procedural f(QRS-T) angles (95.7° ± 48.1 vs. 58.1° ± 47.1, p = 0.002) were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality. Also, f(QRS-T) angle measured at 90 min was significantly lower in patients with successful thrombolysis group compared to failed thrombolysis group (53.2° ± 42.8 vs. 77.3° ± 52.9, p = 0.033), whereas baseline f(QRS-T) angle was similar between two groups (78.6° ± 53.4 vs. 78.9° ± 54.0, p = 0.976). Multivariate analysis showed that post-procedural f(QRS-T) angle ≥89.6° (odds ratio: 3.541, 95% confidence interval: 1.235-10.154, p = 0.019), but not baseline f(QRS-T) angle, was independent predictor of in-hospital mortality. CONCLUSION f(QRS-T) angle may be used as a beneficial tool for determining high risk patients in acute STEMI. Unlike previous studies, we showed for the first time that that post-procedural f(QRS-T) can predict in-hospital mortality and TT failure.
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Affiliation(s)
- Tugce Colluoglu
- Department of Cardiology, Karabuk Education and Research Hospital, Karabuk, Turkey
| | - Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Baris Unal
- Clinic of Cardiology, Cumra State Hospital, Konya, Turkey
| | - Emin Evren Ozcan
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Huseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Kolossváry M, Szilveszter B, Merkely B, Maurovich-Horvat P. Plaque imaging with CT-a comprehensive review on coronary CT angiography based risk assessment. Cardiovasc Diagn Ther 2017; 7:489-506. [PMID: 29255692 PMCID: PMC5716945 DOI: 10.21037/cdt.2016.11.06] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/08/2016] [Indexed: 01/07/2023]
Abstract
CT based technologies have evolved considerably in recent years. Coronary CT angiography (CTA) provides robust assessment of coronary artery disease (CAD). Early coronary CTA imaging-as a gate-keeper of invasive angiography-has focused on the presence of obstructive stenosis. Coronary CTA is currently the only non-invasive imaging modality for the evaluation of non-obstructive CAD, which has been shown to contribute to adverse cardiac events. Importantly, improved spatial resolution of CT scanners and novel image reconstruction algorithms enable the quantification and characterization of atherosclerotic plaques. State-of-the-art CT imaging can therefore reliably assess the extent of CAD and differentiate between various plaque features. Recent studies have demonstrated the incremental prognostic value of adverse plaque features over luminal stenosis. Comprehensive coronary plaque assessment holds potential to significantly improve individual risk assessment incorporating adverse plaque characteristics, the extent and severity of atherosclerotic plaque burden. As a result, several coronary CTA based composite risk scores have been proposed recently to determine patients at high risk for adverse events. Coronary CTA became a promising modality for the evaluation of functional significance of coronary lesions using CT derived fractional flow reserve (FFR-CT) and/or rest/dynamic myocardial CT perfusion. This could lead to substantial reduction in unnecessary invasive catheterization procedures and provide information on ischemic burden of CAD. Discordance between the degree of stenosis and ischemia has been recognized in clinical landmark trials using invasive FFR. Both lesion stenosis and composition are possibly related to myocardial ischemia. The evaluation of lesion-specific ischemia using combined functional and morphological plaque information could ultimately improve the diagnostic performance of CTA and thus patient care. In this review we aimed to summarize current evidence on comprehensive coronary artery plaque assessment using coronary CTA.
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Affiliation(s)
- Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Collet C, Onuma Y, Miyazaki Y, Morel MA, Serruys PW. Integration of non-invasive functional assessments with anatomical risk stratification in complex coronary artery disease: the non-invasive functional SYNTAX score. Cardiovasc Diagn Ther 2017; 7:151-158. [PMID: 28540210 DOI: 10.21037/cdt.2017.03.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Since the early days of coronary angiography, the extension and severity of coronary artery disease (CAD) have been used for risk stratification. The SYNTAX score objectively characterizes CAD in patients with multivessel disease. Furthermore, recalculating the SYNTAX score by the incorporation of the functional component coronary stenosis (i.e., FFR) increases the discrimination for the risk of adverse events. The calculation of the SYNTAX score derived from non-invasive modalities such as coronary computed tomography angiography (CTA) has emerged as a mean to obtain the SYNTAX score before invasive cardiac catheterization. Likewise, the computation of the non-invasive fractional flow reserve CT (FFRCT) allows for the calculation of the non-invasive functional SYNTAX score. Ultimately, the combination of anatomical and functional evaluations with clinical factors further refines the identification of patients at risk and provides a recommendation for the Heart Team regarding the treatment strategy (i.e., PCI or CABG) based on the predicted 4-year mortality. The purpose of this review is to describe the integration of a novel non-invasive functional coronary assessment with the angiographic risk score in patients with multivessel CAD.
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Affiliation(s)
- Carlos Collet
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Yosuke Miyazaki
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,International Centre for Circulatory Health, NHLI, Imperial College of London, London, UK
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Tanriverdi Z, Dursun H, Kaya D. The Importance of the Number of Leads with fQRS for Predicting In-Hospital Mortality in Acute STEMI Patients Treated with Primary PCI. Ann Noninvasive Electrocardiol 2015; 21:413-9. [PMID: 26568401 DOI: 10.1111/anec.12329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/30/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) has been shown to be related to increased cardiovascular mortality and morbidity. However, limited data are available for evaluating the relationship between the number of leads with fQRS and in-hospital all-cause mortality in patients with acute ST segment elevation myocardial infarction (STEMI). The aim of our study is to investigate the prognostic importance of the number of leads with fQRS in acute STEMI patients treated by primary percutaneous coronary intervention (PCI). METHODS Two hundred ten eligible patients with acute STEMI that underwent primary PCI were enrolled in this study. Each patient's 12-lead electrocardiography (ECG) taken in the first 48 hours was analyzed and the number of leads with fQRS were recorded. RESULTS The number derivations with fQRS were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality (2.6 ± 2.6 vs 0.9 ± 1.3; P = 0.002). Also, patients with ≥3 leads with fQRS had higher rate of in-hospital all-cause mortality (23.5% vs 7.4%, P = 0.009), higher frequency of Q wave (67.6% vs 36.9%, P = 0.001), and higher frequency of fQRS with Q wave (67.6% vs 15.9%, P < 0.001) than those patients with <3 leads with fQRS. By a multivariate regression analysis, the number of leads with fQRS was found to be an independent predictor of in-hospital all-cause mortality (odds ratio: 1.415, 95% confidence interval: 1.049-1.909, P = 0.023). CONCLUSIONS The number of leads with fQRS on 12-lead ECG is an independent predictor of in-hospital all-cause mortality in patients with acute STEMI treated by primary PCI.
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Affiliation(s)
| | - Huseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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10
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Tanriverdi Z, Dursun H, Simsek MA, Unal B, Kozan O, Kaya D. The Predictive Value of Fragmented QRS and QRS Distortion for High-Risk Patients with STEMI and for the Reperfusion Success. Ann Noninvasive Electrocardiol 2015; 20:578-85. [PMID: 25640307 DOI: 10.1111/anec.12265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND QRS fragmentation (fQRS) and QRS distortion were separately shown to be related to increased cardiovascular mortality and morbidity. To our knowledge, no study so far evaluated both parameters together in ST segment elevation myocardial infarction (STEMI). The main goal of our study is to find out if fQRS and QRS distortion can help us to determine high-risk STEMI patients, and the success of reperfusion. METHODS Two hundred forty-eight eligible patients with acute STEMI that underwent coronary angiography consecutively between January 1, 2009, and July 1, 2011, were enrolled in this study. Twelve-lead electrocardiography (ECG) of the patients taken in the first 48 hours were analyzed. Patients with fQRS formed group 1, without fQRS formed group 2; with QRS distortion formed group 3, and without QRS distortion formed group 4. RESULTS Group 1 have lower left ventricular ejection fraction (LVEF; P < 0.001), higher maximum troponin levels (P < 0.001), lower ST segment resolution (P < 0.001), more frequent proximal lesions (P < 0.001) when compared to group 2. Similar findings were observed in group 3 in comparison to group 4. Group 1 had also more frequent three vessels disease (P < 0.001), and higher rates of failed thrombolysis (P < 0.001). In-hospital mortality was found to be higher in group 1 and group 3. CONCLUSION fQRS and QRS distortion may be useful for identifying patients at higher cardiac risk. fQRS can foresee thrombolytic therapy failure and three vessels disease whereas QRS distortion does not possess such quality. These findings may guide the physician deciding initial treatment modality in STEMI.
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Affiliation(s)
| | - Huseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Baris Unal
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Omer Kozan
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Treatment of non-culprit lesions detected during primary PCI: long-term follow-up of a randomised clinical trial. Neth Heart J 2012; 20:347-53. [PMID: 22622701 DOI: 10.1007/s12471-012-0281-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There are conflicting data regarding optimal treatment of non-culprit lesions detected during primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). We aimed to investigate whether ischaemia-driven early invasive treatment improves the long-term outcome and prevents major adverse cardiac events (MACE). METHODS 121 patients with at least one non-culprit lesion were randomised in a 2:1 manner, 80 were randomised to early fractional flow reserve (FFR)-guided PCI (invasive group), and 41 to medical treatment (conservative group). The primary endpoint was MACE at 3 years. RESULTS Three-year follow-up was available in 119 patients (98.3 %). There was no significant difference in all-cause mortality between the invasive and conservative strategy, 4 patients (3.4 %) died, all in the invasive group (P = 0.29). Re-infarction occurred in 14 patients (11.8 %) in the invasive group versus none in the conservative group (p = 0.002). Re-PCI was performed in 7 patients (8.9 %) in the invasive group and in 13 patients (32.5 %) in the conservative group (P = 0.001). There was no difference in MACE between these two strategies (35.4 vs 35.0 %, p = 0.96). CONCLUSIONS In STEMI patients with MVD, early FFR-guided additional revascularisation of the non-culprit lesion did not reduce MACE at three-year follow-up compared with a more conservative strategy. The rate of MACE in the invasive group was predominantly driven by death and re-infarction, whereas in the conservative group the rate of MACE was only driven by repeat interventions.
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12
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Koppara T, Mehilli J, Hager A, Kaemmerer H. Left main coronary artery compression in a young woman with Eisenmenger syndrome. HEART ASIA 2011; 3:13-5. [PMID: 27325973 DOI: 10.1136/ha.2009.001578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Rao C, Aziz O, Panesar SS, Jones C, Morris S, Darzi A, Athanasiou T. Cost effectiveness analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ 2007; 334:621. [PMID: 17337457 PMCID: PMC1831990 DOI: 10.1136/bmj.39112.480023.be] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the cost effectiveness of percutaneous transluminal coronary artery stenting with minimally invasive internal thoracic artery bypass for isolated lesions of the left anterior descending artery. DESIGN Cost effectiveness analysis. DATA SOURCES Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005), and reference sources for utility values and economical variables. METHODS Decision analytical modelling and Markov simulation were used to model medium and long term costs, quality of life, and cost effectiveness after either intervention using data from referenced sources. Probabilistic sensitivity and alternative analyses were used to investigate the effect of uncertainty about the value of model variables and model structure. RESULTS Stenting was the dominant strategy in the first two years, being both more effective and less costly than bypass surgery. In the third year bypass surgery still remained more expensive but became marginally more effective. As the incremental cost effectiveness was 1,108,130.40 pounds sterling (1 682,146.00 euros; $2,179,194) per quality adjusted life year (QALY), the additional effectiveness could not be said to justify the additional cost at this stage. By five years, however, the incremental cost effectiveness ratio of 28,042.95 pounds sterling per QALY began to compare favourably with other interventions. At 10 years the additional effectiveness of 0.132 QALYs (range -0.166 to 0.430) probably justified the additional cost of 829.02 pounds sterling (range 205.56 pounds sterling to 1452.48 pounds sterling), with an incremental cost effectiveness of 6274.02 pounds sterling per QALY. Sensitivity and alternative analysis showed the results were sensitive to the time horizon and stent type. CONCLUSIONS Minimally invasive left internal thoracic artery bypass may be a more cost effective medium and long term alternative to percutaneous transluminal coronary artery stenting.
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Affiliation(s)
- Christopher Rao
- Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London W2 1NY
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Dawkins KD, Gershlick T, de Belder M, Chauhan A, Venn G, Schofield P, Smith D, Watkins J, Gray HH. Percutaneous coronary intervention: recommendations for good practice and training. Heart 2006; 91 Suppl 6:vi1-27. [PMID: 16365340 PMCID: PMC1876395 DOI: 10.1136/hrt.2005.061457] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society. Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33,652 to 62,780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field. It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative.
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Affiliation(s)
- K D Dawkins
- British Cardiovascular Intervention Society, London, UK.
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Affiliation(s)
- A H Gershlick
- University of Leicester School of Medicine, Glenfield General Hospital, Leicester, UK.
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16
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Bakhai A, Hill RA, Dundar Y, Dickson RC, Walley T. Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes. Cochrane Database Syst Rev 2005; 2005:CD004588. [PMID: 15674954 PMCID: PMC6485646 DOI: 10.1002/14651858.cd004588.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Coronary artery bypass graft surgery (CABG) replaces obstructed vessels with ones from other parts of the body. Alternatively, obstructions are remodelled using catheter-based techniques such as percutaneous coronary angioplasty with the use of stents. Though less invasive, stenting techniques are limited by the re-narrowing of treated vessels (restenosis). We examined evidence on cardiac-related outcomes occurring after CABG or stenting, with implications for resource use, resource allocation and informing patient choice. OBJECTIVES To examine evidence from randomised controlled trials (RCTs) on benefit of stents or CABG in reducing cardiac events in people with stable angina or acute coronary syndrome (ACS). SEARCH STRATEGY CENTRAL (Issue 2 2004), EMBASE (1990 to 2004), MEDLINE (1990 to 2004) and handsearching to July 2004. SELECTION CRITERIA Only RCTs comparing stents used with PTCA with CABG were included. Participants were adults with stable angina or ACS and unstable angina and had either single or multiple vessel disease. Published and unpublished sources were considered. DATA COLLECTION AND ANALYSIS Outcomes included composite event rate (major adverse cardiac event, event free survival), death, acute myocardial infarction (AMI), repeat revascularisation and binary restenosis as well as information on design and baseline characteristics. Quality assessment was completed independently. Meta-analyses are presented as odds ratios, 95% confidence intervals (CI) using a fixed-effect model. Heterogeneity between trials was assessed. MAIN RESULTS Nine studies (3519 patients) were included. Four RCTs included patients with multiple vessel disease, five focused on single vessel disease. Four studies reported beyond 1 year. No statistical differences were observed between CABG and stenting for meta-analysis of mortality or AMI, but there was heterogeneity. Composite cardiac event and revascularisation rates were lower for CABG than for stents. Odds ratios resulting from meta-analysis of event rate data at 1 year were, odds ratio 0.43 (95% CI 0.35 to 0.54) and at 3 years, odds ratio 0.37 (95% CI 0.29 to 0.48). Odds ratios for revascularisation at 1 year were, odds ratio 0.18 (95% CI 0.13 to 0.25) and at 3 years, odds ratio 0.09 (95% CI 0.02 to 0.34). Binary restenosis at 6 months (single vessel trials) favoured CABG, odds ratio 0.29 (95% CI 0.17 to 0.51). AUTHORS' CONCLUSIONS CABG is associated with reduced rates of major adverse cardiac events, mostly driven by reduced repeat revascularisation. However, the RCT data are limited by follow-up, unrepresentative samples and rapid development of both surgical techniques and stenting. Research on real-world patient population or patient level data meta-analyses may identify risk factors and groupings who may benefit most from one strategy over the other.
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Affiliation(s)
- Ameet Bakhai
- Barnet & Chase Farm NHS TrustBarnet General Hospital Cardiology DepartmentBarnet General HospitalThames House, Wellhouse LaneBarnetEnfieldUKEN5 3DJ
| | - Ruaraidh A Hill
- University of LiverpoolLiverpool reviews and Implementation GroupSherrington BuildingsAshton StreetLiverpoolUKL69 3GE
| | - Yenal Dundar
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolMerseysideUKL69 3GE
| | - Rumona C Dickson
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolMerseysideUKL69 3GE
| | - Tom Walley
- University of LiverpoolPharmacology & TherapeuticsThe Infirmary70 Pembroke PlaceLiverpoolMerseysideUKL69 3GF
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Pell JP, Walsh D, Norrie J, Berg G, Colquhoun AD, Davidson K, Eteiba H, Faichney A, Flapan A, Hogg KJ, Jeffrey RR, Jennings K, McArthur J, Mankad P, Oldroyd K, Pell AC, Starkey IR. Outcomes following coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in the stent era: a prospective study of all 9890 consecutive patients operated on in Scotland over a two year period. BRITISH HEART JOURNAL 2001; 85:662-6. [PMID: 11359748 PMCID: PMC1729765 DOI: 10.1136/heart.85.6.662] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine current outcomes of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG). DESIGN The Scottish coronary revascularisation register provided prospectively collected data on case mix and in-hospital complications for all revascularisation procedures between April 1997 and March 1999 (4775 PTCA; 5115 CABG). Linkage to routine hospital discharge and death data provided follow up information on survival and repeat revascularisation. RESULTS Stents were used in 51% of PTCA procedures. CABG patients were older, had more severe coronary disease, and had greater comorbidity. PTCA was more likely to be undertaken as an urgent or emergency procedure. Perioperative death and urgent surgery followed 0.3% and 0.6% of PTCA procedures, respectively. Case fatality rates were higher following CABG, with 6.7% dead within two years compared with 3.4% following PTCA. PTCA was more often followed by readmission for ischaemic heart disease, repeat angiography, or revascularisation: 22.8% of patients had repeat revascularisation within two years, compared with 1.8% following CABG. CONCLUSIONS The severity of coronary heart disease was greater than in previously published registry studies and randomised trials. Despite this, overall survival figures were comparable and repeat revascularisation rates lower, particularly following PTCA. Perioperative death and urgent surgery following PTCA were also lower. These favourable outcomes may be attributable, in part, to increased use of bail out and elective stenting.
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Affiliation(s)
- J P Pell
- Department of Medical Cardiology, University of Glasgow, Glasgow, UK.
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