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Ozdemir E, Stavileci B, Ozdemir B, Aksoy FA, Kahraman S, Colakoglu Gevher CZ, Ziyrek M, Dogan A. The association between growth differentiation factor 15 and presence and severity of coronary atherosclerosis. Adv Med Sci 2024; 69:56-60. [PMID: 38368744 DOI: 10.1016/j.advms.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Growth differentiation factor 15 (GDF-15) is a member of the transforming growth factor beta superfamily and is faintly expressed under healthy conditions. GDF-15 is markedly elevated in a variety of diseases, including coronary artery disease (CAD), atrial fibrillation and heart failure. Here, we aimed to investigate the association of GDF-15 with the extent and severity of CAD in patients with stable CAD. METHODS We enrolled 129 patients undergoing coronary angiography for the evaluation of stable CAD in the study. SYNTAX and SYNTAX II PCI/CABG scores were calculated. The CAD (+) study group was also stratified into two groups (high and low GDF-15) with respect to the mean GDF-15 value. Correlation and regression analyses were performed for further evaluation. RESULTS Of the 129 patients, 75 had CAD. GDF-15 values were higher in the CAD (+) group (p < 0.001). The two groups were compared according to a cut-off value of 2451.77. SYNTAX and SYNTAX II PCI/CABG scores were significantly associated with the high GDF-15 group (p < 0.001). Additionally, correlation analysis showed a strong positive correlation between GDF-15 and SYNTAX (r: 0.859, p < 0.001), SYNTAX II PCI (r: 0.921, p < 0.001) and SYNTAX II CABG (r: 0.874, p < 0.001) scores. Multivariate analysis identified GDF-15 as an independent predictor of CAD. CONCLUSION GDF-15 is an independent predictor of CAD and is associated with CAD severity in terms of SYNTAX, SYNTAX II PCI and SYNTAX II CABG scores.
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Affiliation(s)
- Emrah Ozdemir
- Department of Cardiology, Biruni University Faculty of Medicine, Küçükçekmece, Istanbul, Turkey.
| | - Berna Stavileci
- Department of Cardiology, Biruni University Faculty of Medicine, Küçükçekmece, Istanbul, Turkey
| | - Bahar Ozdemir
- Department of Internal Medicine, Dr Sadi Konuk Training and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Faik Alper Aksoy
- Department of Cardiology, Medilife Hospital, Beylikdüzü, Istanbul, Turkey
| | - Serkan Kahraman
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Küçükçekmece, Istanbul, Turkey
| | | | - Murat Ziyrek
- Department of Cardiology, Bagcilar Training and Research Hospıtal, Bagcilar, Istanbul, Turkey
| | - Ali Dogan
- Department of Cardiology, Yeni Yuzyil University Faculty of Medicine, Gaziosmanpasa, Istanbul, Turkey
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Rao A, Lokesh J, D’Souza C, Prithvisagar KS, Subramanyam K, Karunasagar I, Kumar BK. Metagenomic Analysis to Uncover the Subgingival and Atherosclerotic Plaque Microbiota in Patients with Coronary Artery Disease. Indian J Microbiol 2023; 63:281-290. [PMID: 37781016 PMCID: PMC10533773 DOI: 10.1007/s12088-023-01082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/25/2023] [Indexed: 10/03/2023] Open
Abstract
The role of periodontal pathogens in the initiation and progression of atherosclerosis has been extensively researched, yet a precise causal mechanism has not been established. The subgingival microbiota may be a source of dissemination and may contribute to the development of atherosclerosis; hence this study attempted to characterize and compare the subgingival and atherosclerotic plaques. Plaque samples were subjected to 16S rRNA-based metagenomics to study microbiota associated with subgingival and atherosclerotic plaques collected from patients with coronary artery disease. The PCoA analysis showed that the microbiomes of subgingival plaques were highly scattered and showed a diverse microbial composition, unlike the atherosclerotic plaques that did not show evident variability in the microbial composition and formed a close distinct group. The abundance of various genera in the subgingival plaques revealed Fusobacterium (11%), Acinetobacter (13%), Veillonella (9%), and Prevotella (11%) among the top ten genera. The atherosclerotic plaques contained Acinetobacter (39%), Chryseobacterium (9%), Rhizobium (5%), and Staphylococcus (4%). All the patients examined in this study had either generalized or localized periodontitis with varying degrees of severity. The community microbiota analysis revealed that 22 bacterial genera were shared between two different plaques, with Acinetobacter being dominant. Based on the Human Oral Microbiome Database, 55% of the shared microbiota in this study have been listed as periodontal microbiota, with some of them found in increased proportions in patients with periodontitis suggesting the translocation of bacteria from the periodontal pockets into the circulation. This study provides valuable insights into the possible relationship between periodontal pathogens and atherosclerotic cardiovascular disease. Graphical Abstract
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Affiliation(s)
- Amita Rao
- Nitte (Deemed to be University), Department of Periodontics, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Deralakatte, Mangalore, 575018 India
| | - Jep Lokesh
- Université de Pau et des Pays de l′Adour, E2S UPPA. INRAE, NUMEA, Saint-Pée-sur-Nivelle, France
| | - Caroline D’Souza
- Nitte(Deemed to be University), Division of Infectious Diseases, Nitte University Centre for Science Education and Research (NUCSER), Deralakatte, Mangalore, 575018 India
| | - Kattapuni Suresh Prithvisagar
- Nitte(Deemed to be University), Division of Infectious Diseases, Nitte University Centre for Science Education and Research (NUCSER), Deralakatte, Mangalore, 575018 India
| | - Kodangala Subramanyam
- Department of Cardiology, Srinivas Institute of Medical Sciences and Research Centre, Mangalore, India
| | - Indrani Karunasagar
- Nitte(Deemed to be University), Division of Infectious Diseases, Nitte University Centre for Science Education and Research (NUCSER), Deralakatte, Mangalore, 575018 India
| | - Ballamoole Krishna Kumar
- Nitte(Deemed to be University), Division of Infectious Diseases, Nitte University Centre for Science Education and Research (NUCSER), Deralakatte, Mangalore, 575018 India
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Tam DY, Ruel M, Fremes SE. Commentary: Does the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score even matter? J Thorac Cardiovasc Surg 2023; 165:1415-1417. [PMID: 34303535 DOI: 10.1016/j.jtcvs.2021.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Xu N, Jiang L, Yao Y, Xu J, Liu R, Wang H, Song Y, Gao L, Gao Z, Zhao X, Xu B, Han Y, Yuan J. Five-year outcomes of biodegradable versus second-generation durable polymer drug-eluting stents used in complex percutaneous coronary intervention. Chin Med J (Engl) 2023; 136:322-330. [PMID: 36848178 PMCID: PMC10106121 DOI: 10.1097/cm9.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND There are few data comparing clinical outcomes of complex percutaneous coronary intervention (CPCI) when using biodegradable polymer drug-eluting stents (BP-DES) or second-generation durable polymer drug-eluting stents (DP-DES). The purpose of this study was to investigate the safety and efficacy of BP-DES and compare that with DP-DES in patients with and without CPCI during a 5-year follow-up. METHODS Patients who exclusively underwent BP-DES or DP-DES implantation in 2013 at Fuwai Hospital were consecutively enrolled and stratified into two categories based on CPCI presence or absence. CPCI included at least one of the following features: unprotected left main lesion, ≥2 lesions treated, ≥2 stents implanted, total stent length >40 mm, moderate-to-severe calcified lesion, chronic total occlusion, or bifurcated target lesion. The primary endpoint was major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction, and total coronary revascularization (target lesion revascularization, target vessel revascularization [TVR], and non-TVR) during the 5-year follow-up. The secondary endpoint was total coronary revascularization. RESULTS Among the 7712 patients included, 4882 (63.3%) underwent CPCI. Compared with non-CPCI patients, CPCI patients had higher 2- and 5-year incidences of MACE and total coronary revascularization. Following multivariable adjustment including stent type, CPCI was an independent predictor of MACE (adjusted hazard ratio [aHR]: 1.151; 95% confidence interval [CI]: 1.017-1.303, P = 0.026) and total coronary revascularization (aHR: 1.199; 95% CI: 1.037-1.388, P = 0.014) at 5 years. The results were consistent at the 2-year endpoints. In patients with CPCI, BP-DES use was associated with significantly higher MACE rates at 5 years (aHR: 1.256; 95% CI: 1.078-1.462, P = 0.003) and total coronary revascularization (aHR: 1.257; 95% CI: 1.052-1.502, P = 0.012) compared with that of DP-DES, but there was a similar risk at 2 years. However, BP-DES had comparable safety and efficacy profiles including MACE and total coronary revascularization compared with DP-DES in patients with non-CPCI at 2 and 5 years. CONCLUSIONS Patients underwent CPCI remained at a higher risk of mid- to long-term adverse events regardless of the stent type. The effect of BP-DES compared with DP-DES on outcomes was similar in CPCI and non-CPCI patients at 2 years but had inconsistent effects at the 5-year clinical endpoints.
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Affiliation(s)
- Na Xu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Jiang
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Yao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingjing Xu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ru Liu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Huanhuan Wang
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Song
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lijian Gao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhan Gao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xueyan Zhao
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yaling Han
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theatre Command, Shenyang, Liaoning 110016, China
| | - Jinqing Yuan
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Wang H, He Y, Fan JL, Li X, Zhou BY, Jiang TB, He YM. The predictive value of CatLet© angiographic scoring system for long-term prognosis in patients with acute myocardial infarction presenting > 12 h after symptom onset. Front Cardiovasc Med 2022; 9:943229. [PMID: 36211570 PMCID: PMC9532528 DOI: 10.3389/fcvm.2022.943229] [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: 05/13/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWe have recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet©) angiographic scoring system, which is capable of accounting for the variability in coronary anatomy, and risk-stratifying patients with coronary artery disease. This study aimed to clarify whether the CatLet score had a predictive value for long-term prognosis in patients with acute myocardial infarction (AMI) presenting > 12 h after symptom onset.Materials and methodsThe CatLet score was calculated for 1,018 consecutively enrolled AMI patients, who were divided into 3 groups according to the CatLet score tertiles. The primary endpoint was major adverse cardiac events (MACEs), defined as a composite of myocardial infarction, cardiac death, and ischemia-driven revascularization; secondary endpoints were all-cause death, cardiac death, myocardial infarction, and ischemia-driven revascularization.ResultsThe CatLet score was capable of predicting long-term prognosis at a median 4.9-year follow-up alone or after adjustment for risk factors. Multivariable-adjusted hazard ratios (95% CI)/unit higher score were 1.06 (1.05–1.08) for MACEs, 1.05 (1.03–1.07) for all-cause death, 1.06 (1.04–1.09) for cardiac death, 1.06 (1.04–1.08) for myocardial infarction, and 1.06 (1.04–1.08) for revascularization. The univariate model showed good calibration (χ2 = 8.25, P = 0.4091) and good discrimination (area under ROC curve = 0.7086) for MACEs.ConclusionThe CatLet score is an independent predictor of long-term clinical outcomes of patients with AMI presenting > 12 h after symptom onset (http://www.chictr.org.cn; Registry Number: ChiCTR2000033730).
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Raslan M, Elkhashab KA, Mousa MG, Alghamdi YA, Ghareb HS. A Comparison Between Two-Dimensional and Three-Dimensional Regional and Global Longitudinal Strain Echocardiography to Evaluate Complex Coronary Lesions in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Cureus 2022; 14:e24025. [PMID: 35444922 PMCID: PMC9010239 DOI: 10.7759/cureus.24025] [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] [Accepted: 04/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction A preliminary assessment of patients who suffer from severe and complex coronary artery lesions, such as three-vessel disease and/or a left main (LM) artery lesion, plays a critical contribution in determining prognosis and treatment plans for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Therefore, a pre-angiography (i.e., before angiography) predictor was required to cost-effectively evaluate severe and complex coronary lesions to efficiently direct our subsequent dealing. Aim This study aimed to compare two-dimensional (2D) and three-dimensional (3D) global longitudinal strain (GLS) at the regional level to assess extremely complicated coronary lesions using the SYNTAX score as a standard of reference in 100 patients with NSTE-ACS. Materials and methods This research included 100 patients with non-ST-segment elevation acute coronary syndrome who presented at the Cardiology Department at Fayoum University from December 2019 to July 2020. All patients underwent a complete history and physical examination, hemoglobin A1c (HbA1c), lipid profile, creatinine assessment, 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE) to detect global and regional longitudinal strain by 2D and 3D speckle-tracking echocardiography (STE). Coronary angiography was done on all patients within 24 hours of admission after acquiring echo images. Then, the results of 2D and 3D regional and global longitudinal strain (GLS) to predict the severity and coronary lesion complexity in terms of the SYNTAX score were compared. Results This study revealed that 2D GLS was −12.10 ± 3.51, which is significantly higher than 3D GLS of −11.64 ± 4.05 (p < 0. 001). The left anterior descending coronary artery (LAD) and left circumflex artery (LCX) territories revealed a significantly higher value using 2D regional longitudinal strain (−11.13 ± 4.47 and −12.54 ± 4.11, respectively) than using 3D regional longitudinal strain (−10.84 ± 5.18 and −12.05 ± 4.29, respectively) (p= 0.017 and p < 0.001, respectively). There were significantly lower 2D GLS, 3D GLS, global circumferential strain (GCS), area strain, and global radial strain (GRS) in the intermediate and high score group than in the low score group of patients (p < 0.001 for all). Conclusion 2D and 3D strain echocardiography including GLS, GCS, GRS, and area strain are a noninvasive and rapid tool with clinical utility for evaluating coronary lesions in patients with NSTE-ACS. They can be routinely used to diagnose and stratify high-risk patients with NSTE-ACS, thereby potentially resulting in improved patient assessment. GLS as measured by 2D and 3D STE at minimal effort is a significant risk factor for patients with complex NSTE-ACS. In NSTE-ACS cases, the GLS absolute value is significantly associated with the degree of complexity of coronary artery lesions.
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SYNTAX score for clinical decision-making: Necessity, nicety, or neither? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:90-91. [DOI: 10.1016/j.carrev.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/18/2022]
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Askin L. The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2022. [DOI: 10.15212/cvia.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) hassignificantly improved angiographic risk stratification. By analyzing angiographic variables, this score characterizescoronary artery disease qualitatively and quantitatively. To date, combining this score with other non-angiographic clinicalscores has broadened perspectives regarding risk estimation, and future research on this topic appears promising.
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Rao A, Kumar B, Subramanyam K, D'Souza N. Assessment of periodontal disease severity in patients with cardiovascular disease: A cross-sectional study. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_151_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Moezi SA, Azdaki N, Kazemi T, Partovi N, Hanafi Bojd N, Mashreghi Moghaddam HR, Hamidi F, Khosravi Bizhaem S, Soltani M, Niroomand MS, Khazdair MR. The effects of opium uses on syntax score of angiography patients with coronary artery disease (CAD). TOXIN REV 2021. [DOI: 10.1080/15569543.2021.2000434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Seyyed Ali Moezi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nahid Azdaki
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Toba Kazemi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Neda Partovi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nazanin Hanafi Bojd
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Fatemeh Hamidi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeede Khosravi Bizhaem
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Soltani
- Razi Clinical Research Development Unit (RCRDU), Birjand University of Medical Sciences, Birjand, Iran
| | | | - Mohammad Reza Khazdair
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Teng RL, Liu M, Sun BC, Xu JP, He Y, He YM. Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study. Cardiology 2021; 146:690-697. [PMID: 34464951 DOI: 10.1159/000515759] [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: 09/16/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score. The current study aimed at assessing whether 3 clinical variables (CVs) - age, serum creatinine, and left ventricular ejection fraction (LVEF) - improved the performance of the CatLet score in outcome predictions in patients with acute myocardial infarction (AMI). METHODS This study was a post hoc study of the CatLet score validation trial. Primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), and secondary endpoints were all-cause deaths and cardiac deaths. RESULTS Over 1,185 person-years (median [interquartile range], 4.3 [3.8-4.9] years), there were 64 MACCEs (20.8%), 56 all-cause deaths (18.2%), and 47 cardiac deaths (15.2%). The addition of the 3 CVs to the stand-alone CatLet score significantly increased the Harrell's C-index by 0.0967 (p = 0.002) in MACCEs, by 0.1354 (p < 0.001) in all-cause deaths, and by 0.1187 (p = 0.001) in cardiac deaths. When compared with the stand-alone CatLet score, improved discrimination and better calibration led to a significantly refined risk stratification, particularly at the intermediate-risk category. CONCLUSIONS CatLet score had a predicting value for clinical outcome in AMI patients. This predicting value can be improved through a combination with age, serum creatinine, and LVEF (http://www.chictr.org.cn; unique identifier: ChiCTR-POC-17013536).
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Affiliation(s)
- Ruo-Ling Teng
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Liu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bei-Chen Sun
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian-Ping Xu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang He
- Division of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong-Ming He
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Barthélémy O, Rouanet S, Brugier D, Vignolles N, Bertin B, Zeitouni M, Guedeney P, Hauguel-Moreau M, Hage G, Overtchouk P, Akin I, Desch S, Vicaut E, Zeymer U, Thiele H, Montalescot G. Predictive Value of the Residual SYNTAX Score in Patients With Cardiogenic Shock. J Am Coll Cardiol 2021; 77:144-155. [PMID: 33446307 DOI: 10.1016/j.jacc.2020.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In hemodynamically stable patients, complete revascularization (CR) following percutaneous coronary intervention (PCI) is associated with a better prognosis in chronic and acute coronary syndromes. OBJECTIVES This study sought to assess the extent, severity, and prognostic value of remaining coronary stenoses following PCI, by using the residual SYNTAX score (rSS), in patients with cardiogenic shock (CS) related to myocardial infarction (MI). METHODS The CULPRIT-SHOCK (Culprit Lesion Only Percutaneous Coronary Intervention [PCI] Versus Multivessel PCI in Cardiogenic Shock) trial compared a multivessel PCI (MV-PCI) strategy with a culprit lesion-only PCI (CLO-PCI) strategy in patients with multivessel coronary artery disease who presented with MI-related CS. The rSS was assessed by a central core laboratory. The study group was divided in 4 subgroups according to tertiles of rSS of the participants, thereby isolating patients with an rSS of 0 (CR). The predictive value of rSS for the 30-day primary endpoint (mortality or severe renal failure) and for 30-day and 1-year mortality was assessed using multivariate logistic regression. RESULTS Among the 587 patients with an rSS available, the median rSS was 9.0 (interquartile range: 3.0 to 17.0); 102 (17.4%), 100 (17.0%), 196 (33.4%), and 189 (32.2%) patients had rSS = 0, 0 < rSS ≤5, 5 < rSS ≤14, and rSS >14, respectively. CR was achieved in 75 (25.2%; 95% confidence interval [CI]: 20.3% to 30.5%) and 27 (9.3%; 95% CI: 6.2% to 13.3%) of patients treated using the MV-PCI and CLO-PCI strategies, respectively. After multiple adjustments, rSS was independently associated with 30-day mortality (adjusted odds ratio per 10 units: 1.49; 95% CI: 1.11 to 2.01) and 1-year mortality (adjusted odds ratio per 10 units: 1.52; 95% CI: 1.11 to 2.07). CONCLUSIONS Among patients with multivessel disease and MI-related CS, CR is achieved only in one-fourth of the patients treated using an MV-PCI strategy. and the residual SYNTAX score is independently associated with early and late mortality.
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Affiliation(s)
- Olivier Barthélémy
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | | | - Delphine Brugier
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Nicolas Vignolles
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Benjamin Bertin
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Michel Zeitouni
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Marie Hauguel-Moreau
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Georges Hage
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Pavel Overtchouk
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France
| | - Ibrahim Akin
- First Department of Medicine, Mannheim University Medical Center, Mannheim, Germany
| | - Steffen Desch
- Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Eric Vicaut
- ACTION Study Group, Clinical Research Unit, Lariboisière Hospital, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Holger Thiele
- Leipzig Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Cardiology Institute, University of the Sorbonne, Paris, France.
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Li XQ, Yin C, Li XL, Wu WL, Cui K. Comparison of the prognostic value of SYNTAX score and clinical SYNTAX score on outcomes of Chinese patients underwent percutaneous coronary intervention. BMC Cardiovasc Disord 2021; 21:334. [PMID: 34233618 PMCID: PMC8265139 DOI: 10.1186/s12872-021-02144-w] [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: 02/27/2021] [Accepted: 06/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have validated the capability of SYNTAX score (SS) and clinical SYNTAX score (CSS) in the prediction of clinical outcomes in patients who have undergone PCI; however, studies on comparison of these two scoring systems in Chinese population have been sparse. Methods To study the ability of SS and CSS in prediction of clinical outcomes of Chinese patients underwent percutaneous coronary intervention (PCI). We retrospectively calculated SS and CSS for 547 Chinese patients from a single center who underwent PCI. Patients were stratified into tertiles according to their SS and CSS. We compared the 2-year clinical outcomes in these patients stratified separately by SS and CSS tertiles. Results The incidence of major adverse cardiac and cerebro-vascular events (MACCE) was the highest in patients with SSHIGH (13.5%), comparing to 6.8% in SSMED and 0% in SSLOW (p < 0.0001). The Cox multivariable analysis showed that the SS and CSS were both strong independent predictors for MACCE [1.100 (1.069–1.133), 1.017 (1.010–1.025), both p < 0.0001]. The receiver operating characteristic (ROC) curves showed the areas-under-the-curves for all-cause death by CSS was slightly larger comparing to SS but not significantly (AUC SS, 0.64; AUC CSS, 0.71; p = 0.23). Conclusion We concluded that both the SS and CSS were capable of risk stratification of clinical outcomes in all-comers population as well as in low and moderate risk Chinese patients undergoing PCI with CSS showing slightly better advantage.
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Affiliation(s)
- Xiao-Qin Li
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 108, Xingguang Road, Liangjiang New District, Chongqing, China
| | - Chun Yin
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 108, Xingguang Road, Liangjiang New District, Chongqing, China
| | - Xiao-Li Li
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 108, Xingguang Road, Liangjiang New District, Chongqing, China
| | - Wen-Li Wu
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 108, Xingguang Road, Liangjiang New District, Chongqing, China
| | - Kun Cui
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 108, Xingguang Road, Liangjiang New District, Chongqing, China.
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Mansour H, Nassar AI, Abdel Rehim WA, Roushdy AM, Abobakr M, Zaki HM, Aboubakr El Missiri AM. Can Tei Index Predict High Syntax Score in Patients with Chronic Coronary Syndrome and Normal Left Ventricular Systolic Function? J Cardiovasc Echogr 2021; 31:11-16. [PMID: 34221880 PMCID: PMC8230163 DOI: 10.4103/jcecho.jcecho_73_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/05/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022] Open
Abstract
Objective: Some patients who had chronic coronary syndrome (CCS) and were recognized as low risk, however, developed cardiovascular events, whereas others who were categorized as high risk did not develop any cardiovascular events. Invasive coronary angiography is the gold standard tool for the assessment of coronary artery disease (CAD) severity. The SYNTAX score (SS) was recently recognized as an invasive angiographic-guided scoring system used in risk stratification of patients who have more than one-vessel CAD and undergoing revascularization with percutaneous cardiovascular intervention. It has a good predictive value of adverse cardiovascular events. Exploration for unique noninvasive modalities that may help in a better way for risk stratification of CCS patients by predicting the severity of CAD (as reflected by SS) would be of a paramount value. Tei index is a promising modality for that objective, which is a Doppler-derived time interval index that combines both systolic and diastolic cardiac performance. Methods: We examined the relationship between the severity of CAD as assessed by the SS and Tei index in 100 patients with CCS and normal left ventricular systolic function. Results: All the studied 100 patients had a normal ejection fraction with mean = 58.92 ± 7.88; the mean value of Tei index was 0.84 ± 0.26. There was a statistically significant positive association between Tei index and SS (P = 0.0001); moreover, there was a correlation between left anterior descending (LAD) affection and Tei index (P = 0.0001).The cutoff point of Tei index to detect SS above 22 was >0.93 (with specificity of 86.5% and sensitivity of 42.4%). Conclusion: Tei index significantly correlates with SS and LAD affection. Moreover, it is a cheap, radiation-free, noninvasive technique and may be used as a further risk stratification modality beyond others.
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Affiliation(s)
- Hazem Mansour
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Ibrahim Nassar
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Alaa Mahmoud Roushdy
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Abobakr
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala Mohamed Zaki
- Department of Internal Medicine, National Research Center, Cairo, Egypt
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15
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Bakirci EM, Degirmenci H, Duman H, Demirelli S, Hamur H, Buyuklu M, Ceyhun G, Kutlusoy E. Aortic propagation velocity in the prediction of coronary artery disease severity. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:51-56. [PMID: 33612836 DOI: 10.5507/bp.2021.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). METHODS The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). RESULTS High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P <0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. CONCLUSION APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.
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Affiliation(s)
- Eftal Murat Bakirci
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Husnu Degirmenci
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Hakan Duman
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Selami Demirelli
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Hikmet Hamur
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Mutlu Buyuklu
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Gokhan Ceyhun
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ergun Kutlusoy
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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16
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de Araujo GN, Leiria TLL, Furtado MV, Matte BDS, Machado GP, Krepsky AM, Bergoli LCC, Goncalves SC, Wainstein MV, Polanczyk CA. Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists. Ther Adv Cardiovasc Dis 2020; 14:1753944720924254. [PMID: 32438849 PMCID: PMC7249554 DOI: 10.1177/1753944720924254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left main of three-vessel coronary artery disease. The aim of this study was to compare the inter-observer variation in SS performed by clinical cardiologists (CC), interventional cardiologists (IC), and cardiac surgeons (CS). Methods: Seven coronary angiographies from patients with left main and/or three-vessel disease chosen by a heart team were analyzed by 10 CC, 10 IC and 10 CS. SS was calculated via SYNTAX website. Results: Kappa concordance was very low between CC and CS (k = 0.176), moderate between CS and IC (k = 0.563), and moderate between CC and IC (0.553). There was a statistically significant difference between CC, who classified more cases as low complexity (70%), and CS, who classified more cases as moderate complexity (80%) (p = 0.041). Conclusion: Concordance between SS analyzed by CC, CS and IC is low. The usefulness of SS in decision-making of revascularization strategy is undeniable and evidence supports its use. However, this study highlights the importance of well-trained professionals on calculating the SS. It could avoid misclassification of borderline cases.
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Affiliation(s)
- Gustavo Neves de Araujo
- Department of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil.,Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiago Luiz Luz Leiria
- Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Bruno da Silva Matte
- Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Guilherme Pinheiro Machado
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Maria Krepsky
- Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Luiz Carlos Corsetti Bergoli
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandro Cadaval Goncalves
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Marco Vugman Wainstein
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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17
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Abdelrazek G, Yassin A, Elkhashab K. Correlation between global longitudinal strain and SYNTAX score in coronary artery disease evaluation. Egypt Heart J 2020; 72:22. [PMID: 32415353 PMCID: PMC7229084 DOI: 10.1186/s43044-020-00064-2] [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: 03/19/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Speckle tracking echocardiography may allow the evaluation of myocardial systolic and diastolic dynamics across different physiologic and pathologic conditions beyond traditional echocardiographic techniques. The use of STE longitudinal strain in identification and risk stratification of CAD has good reproducibility and accuracy. The study aims to detect the relationship between SYNTAX score and global longitudinal peak systolic strain (GLPSS) in patients undergoing coronary angiography, with no history of myocardial infarction. RESULTS The study included 70 symptomatic patients suspected to have chronic coronary syndrome aging 20-80 years (excluding those with significant structural heart disease). All patients underwent clinical evaluation, surface ECG, laboratory assessment, transthoracic echocardiographic (TTE), color TDI tracings, two-dimensional speckle tracking, and conventional coronary angiography with SYNTAX score calculation. Patients were divided into 3 groups based on the results of the coronary angiogram: normal CAD on angiogram (n = 10, control group), low SS (n = 25, SS < 22), and high SS (n = 35, SS ≥ 22). The mean age was 55 ± 9.6 years; 54% were males; two third of patients were hypertensive; 52% were diabetic; high percentage of high syntax score were noticed among males, diabetic patients, and smokers; and also low mean of GLS was noticed among diabetic patients and smokers. There was a statistically significant positive correlation between syntax score and each of LVEDD and LVESD and, on the other hand, statistically significant negative correlation between syntax score and each of E/A, GLS, AP2LS, AP3LS, and AP4LS was noticed. Peak GLS cutoff value of 17.8 and 16.5 showed 84% and 93% sensitivity and 70% and 91% specificity to detect high and low syntax score, respectively. CONCLUSION 2D longitudinal strain analysis has incremental diagnostic value over visual assessment during echocardiography in predicting significant coronary artery disease; GLS may offer a potential sensitive tool to detect significant CAD.
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18
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Agrawal H, Lange RA, Montanez R, Wali S, Mohammad KO, Kar S, Teleb M, Mukherjee D. The Role of Percutaneous Coronary Intervention in the Treatment of Chronic Total Occlusions: Rationale and Review of the Literature. Curr Vasc Pharmacol 2020; 17:278-290. [PMID: 29345588 DOI: 10.2174/1570161116666180117100635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) of a coronary artery is defined as an occluded segment with no antegrade flow and a known or estimated duration of at least 12 weeks. OBJECTIVE We considered the current literature describing the indications and clinical outcomes for denovo CTO- percutaneous coronary intervention (PCI), and discuss the role of CTO-PCI and future directions for this procedure. METHODS Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL were searched and relevant studies of CTO-PCI were selected for review. RESULTS The prevalence of coronary artery CTO's has been reported to be ~ 20% among patients undergoing diagnostic coronary angiography for suspected coronary artery disease. Revascularization of any CTO can be technically challenging and a time-consuming procedure with relatively low success rates and may be associated with a higher incidence of complications, particularly at non-specialized centers. However, with an increase in experience and technological advances, several centers are now reporting success rates above 80% for these lesions. There is marked variability among studies in reporting outcomes for CTO-PCI with some reporting potential mortality benefit, better quality of life and improved cardiac function parameters. Anecdotally, properly selected patients who undergo a successful CTO-PCI most often have profound relief of ischemic symptoms. Intuitively, it makes sense to revascularize an occluded coronary artery with the goal of improving cardiovascular function and patient quality of life. CONCLUSION CTO-PCI is a rapidly expanding specialized procedure in interventional cardiology and is reasonable or indicated if the occluded vessel is responsible for symptoms or in selected patients with silent ischemia in whom there is a large amount of myocardium at risk and PCI is likely to be successful.
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Affiliation(s)
- Harsh Agrawal
- Division of Interventional Cardiology, Department of Internal Medicine, St. Elizabeth's Medical Center, Tufts School of Medicine, Boston, MA 02135, United States
| | - Richard A Lange
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Ruben Montanez
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Soma Wali
- Department of Internal Medicine, University of California at Los Angeles, Olive View Medical Centre, David Geffen School of Medicine, Los Angeles, CA 90024, United States
| | - Khan Omar Mohammad
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Subrata Kar
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Mohamed Teleb
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Debabrata Mukherjee
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
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19
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part II. EUROINTERVENTION 2020; 16:60-75. [DOI: 10.4244/eij-d-19-00543b] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Liu Z, Qiu C, Xu J, Zhang Y, Cui Q, Guan G, Pan S. Ear Crease Features Are Associated with Complexity of Coronary Lesions. Med Sci Monit 2020; 26:e923343. [PMID: 32281613 PMCID: PMC7171428 DOI: 10.12659/msm.923343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The presence of a Frank's sign ear crease is closely correlated with coronary artery disease (CAD). The SYNTAX score indicates the complexity of coronary lesions. This present investigation sought to identify the correlation between SYNTAX score and several specific ear creases. MATERIAL AND METHODS Four specific types of ear creases - crossing crease not originated from ear hole (CC-NEH), crossing crease originated from ear hole (CC-EH), vertical creases on the face side (VC-F), and vertical creases dividing earlobe and face (VC-EF) - were investigated in patients undergoing coronary angiography. A Frank's sign score system was introduced based on the 4 creases. Demographic data, clinical data, and SYNTAX score were also documented. The association between ear creases and SYNTAX score, as well as the correlation between Frank's score and SYNTAX score, were statistically analyzed. RESULTS CC-NEH had the highest positive predictive value (positive predictive value=0.439), and VC-F had the highest negative predictive value for the detection of intermediate and high SYNTAX score (negative predictive value=1.000). VC-EF and CC-NEH were associated with intermediate and high SYNTAX scores (OR=2.913-7.694, all P<0.05). Only 2.9% of patients with Frank's score=0 had intermediate or high SYNTAX scores, and 52.2% and 50.0% of patients with Frank's sign score=3 and 4 had intermediate or high SYNTAX scores, respectively. The Frank's sign score was significantly and positively correlated with SYNTAX score (r=0.457, P<0.001). CONCLUSIONS Features of specific ear creases and Frank's sign scores were associated with intermediate and high complexity of coronary lesions.
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Affiliation(s)
- Zhongwei Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Chuan Qiu
- Center for Bioinformatics and Genomics, Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jing Xu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Yong Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Qianwei Cui
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Gongchang Guan
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Shuo Pan
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
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21
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Mankerious N, Hemetsberger R, Traboulsi H, Toelg R, Abdel-Wahab M, Richardt G, Allali A. Predictors of In-Hospital Adverse Outcomes after Rotational Atherectomy: Impact of the Target Vessel SYNTAX Score. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:754-759. [PMID: 32139281 DOI: 10.1016/j.carrev.2020.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is an established treatment of calcified lesions, but has some inherent procedural hazards. However, predictors of in-hospital adverse outcomes after RA are poorly investigated. OBJECTIVE To explore the predictors of in-hospital adverse outcomes after RA and to introduce the target vessel SYNTAX score (tvSS) as a potential causal variable. METHODS Patients who underwent RA at our center (n = 323) were divided into two groups according to the occurrence of in-hospital adverse outcomes (a composite of residual stenosis ≥30%, persistent slow flow, dissection requiring additional stenting beyond the primary lesion, perforation, burr entrapment, and in-hospital major adverse cardiac events [MACE]). RESULTS In-hospital adverse outcomes were more frequent in patients with severely-tortuous target vessels or lesions >20 mm, while aorto-ostial and bifurcation lesions, as well as chronic total occlusion rates, were equally distributed among patients with and without adverse outcomes. TvSS was 18 [13-24] vs. 12 [8-17] in patients with vs. without in-hospital adverse outcomes (p < 0.001). A tvSS cut-off value of 15 showed 73% sensitivity and 62% specificity for predicting in-hospital adverse outcomes. TvSS emerged as an independent predictor for in-hospital adverse outcomes along with bailout RA and reduced left ventricular ejection fraction (LVEF). However, after one year, the occurrence of in-hospital adverse outcomes was not associated with an increase in the MACE rate (log-rank p = 0.857). CONCLUSION In-hospital adverse outcomes are higher in patients with more complex target vessel anatomies as indicated by a higher tvSS. Bailout RA and reduced LVEF emerged as additional predictors of in-hospital adverse outcomes.
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Affiliation(s)
- Nader Mankerious
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
| | - Rayyan Hemetsberger
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Hussein Traboulsi
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
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22
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Tsuchida K, Mitsuma W, Sato Y, Ozaki K, Soda S, Hatada K, Tanaka K, Hosaka Y, Imai S, Takahashi K, Matsubara T, Oda H. Impaired glucose tolerance and future cardiovascular risk after coronary revascularization: a 10-year follow-up report. Acta Diabetol 2020; 57:173-182. [PMID: 31375898 DOI: 10.1007/s00592-019-01394-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/25/2019] [Indexed: 01/21/2023]
Abstract
AIMS Practical management guidelines for impaired glucose tolerance (IGT) have not been established. Although IGT is a potent marker of cardiovascular disease (CVD), it is still controversial whether its magnitude of CVD risk is comparable to that of frank diabetes. Moreover, information on long-term clinical outcomes of IGT patients undergoing coronary revascularization is limited. The aim of the present work was to investigate the 10-year prognostic impact of IGT in comparison with diabetes in patients with CAD undergoing coronary revascularization. METHODS This cohort recruited from two Japanese clinical sites included patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) between 2004 and 2008. Patients were categorized into previously known diabetes (PKD, n = 197), newly diagnosed diabetes (NDD, n = 51), and IGT (n = 50) groups according to oral glucose tolerance test results except for PKD. The primary end point was defined as a composite of cardiovascular death, myocardial infarction, stroke, repeat revascularization, and heart failure hospitalization. RESULTS The cumulative risk of the primary outcome was significantly higher in the PKD and IGT than in the NDD (log-rank test p = 0.017). A Cox proportional hazards model demonstrated that IGT (hazard ratio [HR], 7.91; 95% confidence interval [CI], 1.84-27.58) and creatinine clearance (HR, 7.89, 95% CI, 2.73-19.10) were predictors of long-term CVD risk, while NDD and PKD were not. CONCLUSIONS IGT significantly increased the long-term risk of developing CVD in patients with CAD after PCI compared with diabetes.
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Affiliation(s)
- Keiichi Tsuchida
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan.
| | - Wataru Mitsuma
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 757 Ichibancho, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Satoshi Soda
- Department of Endocrinology and Metabolism, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Katsuharu Hatada
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Komei Tanaka
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Yukio Hosaka
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Shunsuke Imai
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Kazuyoshi Takahashi
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Taku Matsubara
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
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Xu M, Ruddy TD, Schoenhagen P, Bartel T, Di Bartolomeo R, Kodolitsch Y, Escaned J, Shen C, He Y. The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study. Catheter Cardiovasc Interv 2020; 96:E220-E229. [PMID: 31943728 DOI: 10.1002/ccd.28724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Ming‐Xing Xu
- Division of CardiologyFirst Affiliated Hospital of Soochow University Suzhou China
| | - Terrence D. Ruddy
- Division of Cardiology, Heart InstituteUniversity of Ottawa Ottawa Canada
| | | | - Thomas Bartel
- Department of Cardiovascular MedicineHeart & Vascular Institute, Cleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Roberto Di Bartolomeo
- Cardio‐Thoracic and Vascular Department, Division of Cardiac Surgery, S. Orsola HospitalUniversity of Bologna Bologna Italy
| | - Yskert Kodolitsch
- Department of CardiologyUniversity Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Javier Escaned
- Department of CardiologyHospital San Carlos Madrid Spain
| | - Chengxing Shen
- Department of CardiologyShanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai China
| | - Yong‐Ming He
- Division of CardiologyFirst Affiliated Hospital of Soochow University Suzhou China
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24
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Arafat Y, Kucukosmanoglu M, Mustafa G. The relationship between the prevalence and complexity of coronary artery disease and aortic stiffness in myocardial infarction patients without ST-segment elevation. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_46_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Dogan A, Kahraman S. Frontal QRS-T angle predicts coronary atherosclerotic burden in patients with ST segment elevation myocardial infarction. J Electrocardiol 2020; 58:155-159. [DOI: 10.1016/j.jelectrocard.2019.11.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 01/11/2023]
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26
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Hsieh MH, Lin SY, Lin CL, Hsieh MJ, Hsu WH, Ju SW, Lin CC, Hsu CY, Kao CH. A fitting machine learning prediction model for short-term mortality following percutaneous catheterization intervention: a nationwide population-based study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:732. [PMID: 32042748 DOI: 10.21037/atm.2019.12.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background A suitable multivariate predictor for predicting mortality following percutaneous coronary intervention (PCI) remains undetermined. We used a nationwide database to construct mortality prediction models to find the appropriate model. Methods Data were analyzed from the Taiwan National Health Insurance Research Database (NHIRD) covering the period from 2004 to 2013. The study cohort was composed of 3,421 patients with acute myocardial infarction (AMI) diagnosis undergoing PCI. The dataset of enrolled patients was used to construct multivariate prediction models. Of these, 3,079 and 342 patients were included in the training and test groups, respectively. Each patient had 22 input features and 2 output features that represented mortality. This study implemented an artificial neural network model (ANN), a decision tree (DT), a linear discriminant analysis classifier (LDA), a logistic regression model (LR), a naïve Bayes classifier (NB), and a support vector machine (SVM) to predict post-PCI patient mortality. Results The DT model was found to be the most suitable in terms of performance and real-world applicability. The DT model achieved an area under receiving operating characteristic of 0.895 (95% confidence interval: 0.865-0.925), F1 of 0.969, precision of 0.971, and recall of 0.974. Conclusions The DT model constructed using data from the NHIRD exhibited effective 30-day mortality prediction for patients with AMI following PCI.
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Affiliation(s)
- Meng-Hsuen Hsieh
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, USA
| | - Shih-Yi Lin
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung.,College of Medicine, China Medical University, Taichung
| | - Meng-Ju Hsieh
- Department of Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung
| | - Shu-Woei Ju
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Department of Family Medicine, and Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Department of Nuclear Medicine and PET Center, and Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung
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27
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Sarak T, Karadeniz M. The relationship between serum NT-proBNP levels and severity of coronary artery disease assessed by SYNTAX score in patients with acute myocardial infarction. Turk J Med Sci 2019; 49:1366-1373. [PMID: 31648513 PMCID: PMC7018338 DOI: 10.3906/sag-1902-26] [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] [Received: 02/04/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background/aim In the present study, we aimed to investigate the relationship between NT-proBNP and SYNTAX score, which is a measure of the complexity of coronary artery disease. Materials and methods We enrolled 405 consecutive patients with myocardial infarction who underwent coronary angiographic examination. Patients were divided into 3 groups according to their SYNTAX scores. Those with SYNTAX score ≤22 were included in the low SYNTAX score group (LSTX), those with a score of 23–32 were included in the intermediate SYNTAX score group (ISTX), and those with a score of ≥33 were included in the high SYNTAX score group (HSTX). Results NT-proBNP levels were found to be significantly higher in the HSTX group compared to the other groups (P < 0.001) and in the ISTX group compared to the LSTX group (P < 0.001). The NT-proBNP levels demonstrated an increase from low SYNTAX score to high SYNTAX score tertiles. Conclusions NT-ProBNP levels in patients with myocardial infarction on admission were independently associated with extent, severity, and complexity of coronary atherosclerosis as assessed by SYNTAX score.
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Affiliation(s)
- Taner Sarak
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Muhammed Karadeniz
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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28
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Mukherjee D. Coronary lesion complexity and the benefit of potent platelet inhibition after percutaneous coronary intervention. Eur Heart J 2019; 39:4122-4124. [PMID: 30202874 DOI: 10.1093/eurheartj/ehy506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Debabrata Mukherjee
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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29
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Yan L, Cao X, Zeng S, Yu J, Li Z, Lian Z, Lv F, Wang J. Association of early menopause with angiographically-derived SYNTAX score: Observational study. Medicine (Baltimore) 2018; 97:e13723. [PMID: 30572509 PMCID: PMC6319991 DOI: 10.1097/md.0000000000013723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Association of early menopause with increased risk of cardiovascular events has been confirmed in previous studies. SYNTAX score (SX-score) can comprehensively quantify severity of coronary artery disease (CAD) and predict the outcomes of patients with CAD. However, the association of early menopause with SX-score has never been reported.We prospectively included 1875 consecutive postmenopausal patients who underwent coronary angiography (CAG) and were angiographically diagnosed with CAD from January 2011 to December 2013. SX-score was calculated using the SX-score algorithm based on diagnostic angiogram. Ordinal logistic regression analysis was used to investigate the association between early menopause and SX-score.Patients with early menopause were more likely to have a history of hypertension, diabetes, hyperlipidemia, and less likely to smoking. Besides, they have higher fasting glucose, hemoglobin A1C (HbA1c), total cholesterol (TC), low-density lipoprotein (LDL), triglyceride (TG), and body mass index (BMI) compared with the patients without early menopause. Moreover, patients with early menopause have higher SX-score and multi-vessel diseases. Ordinal logistic regression analysis showed that age, hypertension, diabetes, and early menopause exerted independent influences on SX-score. The patients undergone oophorectomy, early menopause was highly associated with SX-score.Early menopause was an independent predictor of SX-score in postmenopausal patients with CAD.
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Affiliation(s)
| | | | - Saitian Zeng
- Department of Gynecology and Obstetrics, Cangzhou Central Hospital, Tianjin Medical University, Cangzhou, China
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30
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Cappelletti A, Astore D, Godino C, Bellini B, Magni V, Mazzavillani M, Pagnesi M, Agricola E, Chiesa R, Colombo A, Margonato A. Relationship between Syntax Score and prognostic localization of coronary artery lesions with conventional risk factors, plasma profile markers, and carotid atherosclerosis (CAPP Study 2). Int J Cardiol 2018; 257:306-311. [PMID: 29506713 DOI: 10.1016/j.ijcard.2017.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data concerning the relationship between cardiovascular risk factors, plasmatic markers, carotid disease and extent of coronary lesions are lacking. OBJECTIVES To evaluate the role of cardiovascular risk factors, plasmatic levels of high sensitivity C-reactive protein (hs-CRP), fibrinogen, lipoprotein(a), and carotid plaque extension in predicting the severity of coronary artery disease (CAD). METHODS We analyzed 574 subjects undergoing first coronary angiography. For angiographic analysis, we used the Syntax Score and we defined the prognostic localization of CAD as a critical stenosis of the left main and/or proximal segment of left anterior descending artery. Levels of hs-CRP >3mg/L, lipoprotein(a) plasma levels >30mg/dL and plasma fibrinogen >300mg/dL were considered critical. Significant carotid disease (SCD) was defined by the presence of lesions producing a 50% diameter stenosis with a peak systolic velocity >125cm/s. A mean carotid intima media thickness (IMT) >0.9mm was considered abnormal. RESULTS In the adjusted analysis the presence of SCD was found to be an independent predictor of high Syntax Score (p<0.001), while high fibrinogen levels were independently associated with the presence of CAD in prognostic localization (p=0.04). In the sub-group of patients without SCD, IMT >0.9mm was found to be an independent predictor of the presence of CAD (p<0.001). CONCLUSIONS SCD strongly predicts high Syntax Score, while IMT shows excellent positive predictive value for the presence of CAD. In addition, high plasma fibrinogen levels are associated with coronary stenoses in prognostic localization.
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Affiliation(s)
- Alberto Cappelletti
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy.
| | - Domenico Astore
- Department of Vascular Surgery, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Cosmo Godino
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Barbara Bellini
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Valeria Magni
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Monica Mazzavillani
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Matteo Pagnesi
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Eustachio Agricola
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Interventional Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Alberto Margonato
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
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Gargiulo G, Patialiakas A, Piccolo R, Thury A, Colangelo S, Campo G, Tebaldi M, Ungi I, Tondi S, Roffi M, Menozzi A, de Cesare N, Garbo R, Meliga E, Testa L, Gabriel HM, Ferlini M, Liistro F, Dellavalle A, Vranckx P, Briguori C, Windecker S, Valgimigli M. Impact of angiographic coronary artery disease complexity on ischemic and bleeding risks and on the comparative effectiveness of zotarolimus-eluting vs. bare-metal stents in uncertain drug-eluting stent candidates. Int J Cardiol 2018; 277:60-65. [PMID: 30293666 DOI: 10.1016/j.ijcard.2018.09.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of coronary artery disease (CAD) extension/complexity on outcomes and on the comparative benefits/risks of zotarolimus-eluting stent (ZES) versus bare-metal stents (BMS) remains unclear in patients at high risk of bleeding or thrombosis or at low restenosis risk. METHODS We performed a post-hoc analysis of the ZEUS trial. The impact of coronary anatomic complexity measured by the SYNTAX score on the differences in outcomes following ZES and BMS was assessed at 1 year. RESULTS The mean SYNTAX score was 16.3 ± 13.1 with a median of 12 (IQR: 7 to 22). We stratified patients according to SYNTAX tertiles (0-8: n = 563; >8-19 n = 532; >19: n = 511), and observed that the higher the score, the correspondingly higher was the rate of the primary endpoint of major adverse cardiovascular events (MACE) and other ischemic events, but not bleeding after adjustment. The superior efficacy of ZES versus BMS for MACE was consistent across SYNTAX tertiles (tertile 1: HR 0.71, 95% CI 0.44-1.13; tertile 2: HR 0.71, 95% CI 0.46-1.09; tertile 3: HR 0.83, 95% CI 0.61-1.10) without significant heterogeneity (p for trend = 0.55). This between-groups difference mainly reflected a reduction in MI and TVR without effect on mortality. There was no significant interaction between the SYNTAX score and allocated stent type with respect to ischemic and bleeding endpoints. CONCLUSIONS The SYNTAX score was predictor of major adverse cardiovascular events but not bleeding and ZES provided superior efficacy and safety than BMS across the whole spectrum of CAD complexity. SYNTAX score may be routinely used for the assessment of the ischemic risk (but not bleeding) after PCI and should not guide the decision-making for DES versus BMS in patients undergoing PCI.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Advanced Biomedical Sciences, University Federico II of Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Italy
| | - Attila Thury
- Department of Cardiology, University of Szeged, Hungary
| | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Imre Ungi
- Department of Cardiology, University of Szeged, Hungary
| | - Stefano Tondi
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Italy
| | - Marco Roffi
- Division of Cardiology, University Hospital, Geneva, Switzerland
| | - Alberto Menozzi
- Interventional Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | | | - Roberto Garbo
- Interventional cardiology, San Giovanni Bosco Hospital, Torino, Italy
| | | | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Marco Ferlini
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences University of Hasselt, Hasselt, Belgium
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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The Relationship between Inter-Arm Blood Pressure Difference and Coronary Artery Disease Severity Calculated by the SYNTAX Score. Int J Hypertens 2018; 2018:9370417. [PMID: 30302286 PMCID: PMC6158967 DOI: 10.1155/2018/9370417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/28/2018] [Accepted: 08/28/2018] [Indexed: 12/22/2022] Open
Abstract
Objectives The inter-arm systolic blood pressure difference (IASBPD) is closely related to cardiovascular mortality and morbidity. The SYNTAX score indicates the extent and complexity of coronary artery disease, which are determined by coronary angiography. The aim of our study is to examine the relationship between the IASBPD (which is easily calculated in routine practice) and the SYNTAX score. Methods 104 patients were included in this cross-sectional study. The IASBPD was calculated by blood pressure measurements obtained simultaneously from both arms. The SYNTAX score was calculated by coronary angiography. Results Patients were divided into two groups: those with a high SYNTAX score (≥20) and those with a low SYNTAX score (<20). The mean IASBPD values were significantly higher in the group with a high SYNTAX score (≥20) (p<0.001). The patients with IASBPD≥10 were more likely to have a high SYNTAX score compared to the patients with IASBPD<10 (p<0.001). Multiple logistic regression analysis revealed that only the IASBPD values were found to be independently associated with high SYNTAX score (OR: 1.717 (CI: 1.307-2.257), p<0.001). Conclusion The IASBPD values obtained by only blood pressure measurements are closely related to the extent of coronary artery disease.
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Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, Atalay E, Yesin M, Gürsoy MO, Halil Tanboğa I. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal 2018; 32:e22457. [PMID: 29667724 PMCID: PMC6816976 DOI: 10.1002/jcla.22457] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. C-reactive protein (CRP) and albumin are indicators of inflammation, and high levels of them are associated with high SS. We aimed to investigate whether baseline CRP to albumin ratio C-Reactive Protein/Albumin Ratio (CAR), an easily available and novel inflammatory marker, is associated with SS. METHOD A total 403 consecutive patients with stabile angina pectoris, who underwent coronary angiography for suspected CAD from January 2015 to June 2016, were classified into two groups, low SS (≤22) and intermediate-high SS (>22). RESULTS C-Reactive Protein/Albumin Ratio was significantly higher in patients with intermediate-high SS group (P < .001). In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with hypertension and LDL. The predictive performance of CAR, CRP, and albumin was compared by ROC curve analysis. CAR surpassed CRP and albumin in predicting intermediate-high SS group. CAR >6.3 predicted an intermediate-high SS with sensitivity and specificity of 86.8% and 43.4%, respectively. CONCLUSION C-Reactive Protein/Albumin Ratio was more tightly associated with the complexity and severity of CAD than CRP and albumin alone and was found to be an independent predictor for intermediate-high SS group.
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Affiliation(s)
- Yavuz Karabağ
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | - Metin Çağdaş
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | | | | | - İnanç Artaç
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | - Doğan İliş
- Department of CardiologyKafkas University Medical FacultyKarsTurkey
| | - Eray Atalay
- Department of Internal MedicineKafkas University Medical FacultyKarsTurkey
| | - Mahmut Yesin
- Department of CardiologyKars Harakani State HospitalKarsTurkey
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Windecker S, Neumann FJ, Jüni P, Sousa-Uva M, Falk V. Considerations for the choice between coronary artery bypass grafting and percutaneous coronary intervention as revascularization strategies in major categories of patients with stable multivessel coronary artery disease: an accompanying article of the task force of the 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2018; 40:204-212. [PMID: 30165435 DOI: 10.1093/eurheartj/ehy532] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/09/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Peter Jüni
- Department of Medicine and Institute of Health Policy, Management and Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, 30 Bond St, ON, Toronto, Canada
| | - Miguel Sousa-Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, Portugal
- Cardiovascular R&D Unit, Department of Cardiothoracic Surgery, Porto University, Porto, Portugal
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Augustenburger, Platz 1, Berlin, Germany
- Department of Cardiovascular Surgery, Charite Berlin, Charite platz 1, Berlin, Germany
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Calais F, Eriksson Östman M, Hedberg P, Rosenblad A, Leppert J, Fröbert O. Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction. Int J Cardiol 2018; 261:6-11. [DOI: 10.1016/j.ijcard.2018.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/18/2018] [Accepted: 02/09/2018] [Indexed: 11/24/2022]
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Ružičić D, Dobrić M, Vuković M, Hrnčić D, Đorđević S, Ružičić M, Aleksandrić S, Đorđević-Dikić A, Beleslin B. Novel Assessment Tool For Coronary Artery Disease Severity During Screening Mammography. Health Care Women Int 2018; 39:1075-1089. [PMID: 29648938 DOI: 10.1080/07399332.2018.1463226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Breast arterial calcifications (BACs) are common findings on mammography which are associated with an increased risk of the coronary artery disease (CAD). Our aim in the current study was to design measurement instruments of CAD prediction, with or without BACs, and its discriminatory validity in the diagnosis of CAD (expressed by Syntax score) in women. This was observational, prospective study in the women cohort which underwent mammography and angiography. In this study we have demonstrated that the total 'The Breast Arterial Calcification and Coronary Artery Disease Scale' (BACCADS) was good additional diagnostic tool for detection of patients with severe CAD.
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Affiliation(s)
- Dušan Ružičić
- a General Hospital Valjevo, Department of Cardiology and Invasive Cardiology
| | - Milan Dobrić
- b Cardiology Clinic , Clinical Center of Serbia, Faculty of Medicine, University of Belgrade
| | - Mira Vuković
- a General Hospital Valjevo, Department of Cardiology and Invasive Cardiology
| | - Dragan Hrnčić
- d Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade
| | | | - Milijana Ružičić
- a General Hospital Valjevo, Department of Cardiology and Invasive Cardiology
| | - Srđan Aleksandrić
- b Cardiology Clinic , Clinical Center of Serbia, Faculty of Medicine, University of Belgrade
| | - Ana Đorđević-Dikić
- b Cardiology Clinic , Clinical Center of Serbia, Faculty of Medicine, University of Belgrade
| | - Branko Beleslin
- b Cardiology Clinic , Clinical Center of Serbia, Faculty of Medicine, University of Belgrade
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Chieng D, Pang J, Ellis KL, Hillis GS, Watts GF, Schultz CJ. Elevated lipoprotein(a) and low-density lipoprotein cholesterol as predictors of the severity and complexity of angiographic lesions in patients with premature coronary artery disease. J Clin Lipidol 2018; 12:1019-1026. [PMID: 29703625 DOI: 10.1016/j.jacl.2018.03.090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elevated lipoprotein(a) (Lp[a]) and low-density lipoprotein (LDL) cholesterol are important inheritable risk factors for premature coronary artery disease (CAD). Lp(a) mediates cardiovascular risk through prothrombotic, proinflammatory, and proatherogenic properties. The association of Lp(a) and LDL cholesterol with angiographic disease severity and complexity in patients with premature CAD has yet to be established. OBJECTIVE To investigate the relationship of Lp(a) and LDL cholesterol with the severity and complexity of coronary artery lesions using the SYNergy between percutaneous coronary intervention with TAXUS and Cardiac Surgery (SYNTAX) and Gensini scores, in patients with premature CAD. METHODS Plasma Lp(a) levels were consecutively measured by an automated latex-enhanced immunoassay in 147 patients with premature coronary events (aged <60 years). Elevated Lp(a) was defined as >0.5 g/L, and elevated LDL cholesterol as an untreated LDL cholesterol of >5.0 mmol/L (>193 mg/dL). Demographical, biochemical, and clinical data were retrospectively collected from medical records. SYNTAX and Gensini scores were independently assessed by 2 investigators. RESULTS Patients were subdivided into tertiles using SYNTAX scores. The proportion of patients with elevated Lp(a) and elevated LDL cholesterol were significantly higher in patients with higher SYNTAX and Gensini scores (P < .05). In multivariate analysis (adjusting for age, diabetes, hypertension, and previous coronary event), elevated Lp(a) and elevated LDL cholesterol remained significant, independent predictors of higher SYNTAX and Gensini scores (P < .05). Patients with both elevated Lp(a) and elevated LDL cholesterol constituted most of the patients in the highest SYNTAX tertile, while patients with nonelevated Lp(a) and nonelevated LDL cholesterol were predominantly in the lowest SYNTAX tertile (P < .05). CONCLUSION In patients with premature CAD, elevated Lp(a) and LDL cholesterol (in a range consistent with familial hypercholesterolemia) were significant, independent predictors of the severity of CAD. Both lipid disorders should be routinely screened for in younger patients presenting to the coronary care unit.
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Affiliation(s)
- David Chieng
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jing Pang
- School of Medicine, Faculty of Health and Medical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Katrina L Ellis
- School of Medicine, Faculty of Health and Medical Science, University of Western Australia, Perth, Western Australia, Australia; School of Biomedical Sciences, Faculty of Health and Medical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Science, University of Western Australia, Perth, Western Australia, Australia; Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; School of Medicine, Faculty of Health and Medical Science, University of Western Australia, Perth, Western Australia, Australia.
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Kamal Y, Elrashid M, Elmasry M. Diagnostic utility of ankle-brachial index and carotid intima-media thickness as non-invasive predictors of the severity of coronary atherosclerosis. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/jccr.2018.11.00375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ružičić D, Dobrić M, Vuković M, Hrnčić D, Đorđević S, Ružičić M, Aleksandrić S, Đorđević-Dikić A, Beleslin B. The correlation of SYNTAX score by coronary angiography with breast arterial calcification by digital mammography. Clin Radiol 2017; 73:454-459. [PMID: 29292048 DOI: 10.1016/j.crad.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the hypothesis that breast arterial calcification (BAC) may predict coronary artery disease (CAD) severity. MATERIALS AND METHODS The study comprised 102 women >45 years (mean age 62±8 years) referred for digital mammography after coronary angiography. BAC was assessed using the Likert scale and CAD severity was assessed using the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial) score. RESULTS In comparison to the low SYNTAX score group (≤22) patients with a intermediate-to-high SYNTAX score (>22) were older (p=0.001), they more often had hypercholesterolaemia (p<0.001), diabetes (p=0.021), and a history of smoking (p=0.048). They also had a statistically higher level of fasting blood glucose (p<0.001), glycated haemoglobin (HbA1C; p<0.001), triglycerides (p=0.002), fibrinogen (p=0.001), whereas high-density lipoprotein (HDLc) was lower than in the group with a SYNTAX score ≤22 (p=0.005). BAC was significantly higher in patients with a SYNTAX score >22 (p<0.001). At multivariate analysis, BAC (odds ratio [OR] 34.24, 95% confidence interval [CI]: 8.05-145.7, p<0.001), hypercholesterolaemia (OR 22.65, 95% CI: 4.18-122.81, p<0.001) and fibrinogen (OR 2.55, 95% CI: 1.28-5.07, p=0.008) were independent predictive factors for patients with intermediate-to-high SYNTAX score. CONCLUSIONS In women >45 years, there was a significant correlation between the severity of CAD as evaluated by the SYNTAX score and BAC as evaluated by the Likert scale. BAC, hypercholesterolaemia, and fibrinogen may be used as an additional diagnostic tool to predict the presence and severity of CAD.
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Affiliation(s)
- D Ružičić
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia.
| | - M Dobrić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - M Vuković
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - D Hrnčić
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Street Višegradska 26, 11000, Belgrade, Serbia
| | - S Đorđević
- General Hospital Valjevo, Department of Radiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - M Ružičić
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - S Aleksandrić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - A Đorđević-Dikić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - B Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
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Arri SS, Patterson T, Williams RP, Moschonas K, Young CP, Redwood SR. Myocardial revascularisation in high-risk subjects. Heart 2017; 104:166-179. [PMID: 29180542 DOI: 10.1136/heartjnl-2016-310487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satpal S Arri
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tiffany Patterson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rupert P Williams
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Christopher P Young
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon R Redwood
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Comparison of patients with multivessel disease treated at centers with and without on-site cardiac surgery. J Thorac Cardiovasc Surg 2017; 155:865-873.e3. [PMID: 29452484 DOI: 10.1016/j.jtcvs.2017.09.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/31/2017] [Accepted: 09/26/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The regional needs and consolidation of cardiac surgery services (CSS) result in an increased number of stand-alone interventional cardiology units. We aimed to explore the impact of a heart team on the decision making and outcomes of patients with multivessel coronary artery disease referred for coronary revascularization in stand-alone interventional cardiology units. METHODS This prospective study included 1063 consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and percutaneous coronary intervention (PCI), with or without on-site CSS. RESULTS Of the 1063 patients, 487 (46%) underwent coronary artery bypass grafting (CABG) and 576 (54%) underwent PCI. A higher proportion of patients underwent PCI in hospitals without on-site CSS compared with those with on-site CSS (65% vs 46%; P < .001). Furthermore, patients referred to CABG from hospitals without on-site CSS had a significantly higher mean SYNTAX score compared with those who underwent CABG in centers with on-site CSS (29 vs 26; P = .018). Multivariate logistic regression analysis consistently showed that the absence of on-site cardiac surgery and a heart team was independently associated with a 2.5-fold increased likelihood for predicting the referral of PCI rather than CABG (odds ratio, 2.54; 95% confidence interval, 1.8-3.6). CONCLUSIONS Patients with multivessel coronary artery disease treated in centers without on-site cardiac surgery services receive a lower rate of appropriate guideline-based intervention with CABG. These findings suggest that a heart team approach should be mandatory even in centers with stand-alone interventional cardiology units.
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Song Y, Gao Z, Tang X, Ma Y, Jiang P, Xu J, Yao Y, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Usefulness of the SYNTAX score II to validate 2-year outcomes in patients with complex coronary artery disease undergoing percutaneous coronary intervention: A large single-center study. Catheter Cardiovasc Interv 2017; 92:40-47. [PMID: 28895284 DOI: 10.1002/ccd.27321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/27/2017] [Accepted: 08/07/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ying Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Zhan Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Xiaofang Tang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yuanliang Ma
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Ping Jiang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Jingjing Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yi Yao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Xueyan Zhao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Bo Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Jinqing Yuan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
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Acute coronary syndromes in the very elderly: Short term prognostic performance of the SYNTAX score. Int J Cardiol 2017; 243:497-501. [DOI: 10.1016/j.ijcard.2017.05.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022]
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Eyuboglu M, Ekinci MA, Karakoyun S, Kucuk U, Senarslan O, Akdeniz B. Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography. Arq Bras Cardiol 2017; 107:299-304. [PMID: 27849256 PMCID: PMC5102475 DOI: 10.5935/abc.20160139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/12/2016] [Indexed: 02/03/2023] Open
Abstract
Background Only a small proportion of patients referred for coronary angiography with
suspected coronary artery disease (CAD) have the diagnosis of obstructive
CAD confirmed by the exam. For this reason, further strategies for risk
stratification are necessary. Objective To investigate the relationship of the presence of fragmented QRS (fQRS) on
admission electrocardiogram with angiographically detected CAD and CAD
severity in patients without known vascular diseases and myocardial
fibrosis, undergoing first diagnostic coronary angiography. Methods We enrolled 336 consecutive patients undergoing coronary angiography for
suspected CAD. The patients were divided into two groups according to the
presence or absence of fQRS on admission. We compared the groups regarding
the presence and severity of CAD. Results Seventy-nine (23.5%) patients had fQRS on admission. There was not a
statistically significant difference between patients with fQRS (41.8%) and
non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there
was a statistically significant difference between patients with fQRS and
non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%,
p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The
frequency of fQRS was significantly higher in patients with SYNTAX score
>22 compared to patients with SYNTAX score ≤22. Conclusions Our findings suggest that fQRS may be an indicator of early-stage myocardial
damage preceding the appearance of fibrosis and scar, and may be used for
risk stratification in patients undergoing first diagnostic coronary
angiography
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Affiliation(s)
| | | | | | - Ugur Kucuk
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Turkey
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Bundhun PK, Sookharee Y, Bholee A, Huang F. Application of the SYNTAX score in interventional cardiology: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7410. [PMID: 28700477 PMCID: PMC5515749 DOI: 10.1097/md.0000000000007410] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Should the SYNTAX score be integrated in Interventional Cardiology? Should it really be considered as a vital decision-making tool in percutaneous coronary intervention (PCI)? To confirm the importance of this score, we aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients who were allotted a low versus a high SYNTAX score. METHODS Randomized controlled trials and observational studies which were published from January 2007 to January 2017 were identified from MEDLINE, EMBASE, and the Cochrane databases using the searched terms 'SYNTAX score and percutaneous coronary intervention.' Adverse cardiovascular outcomes were considered as the major endpoints. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the statistical parameters, and the main analysis was carried out by the RevMan 5.3 software. RESULTS Sixteen studies with a total number of 19,751 participants (8589 participants with a low versus 11,162 participants with a high SYNTAX score) were included. Current results showed mortality to be significantly higher with a higher SYNTAX score (RR 2.09, 95% CI 1.78-2.46, P = .00001). Cardiac death also significantly favored a low SYNTAX score (RR 2.08, 95% CI 1.66-2.61, P = .00001. Similarly, myocardial infarction, major adverse cardiac events, repeated revascularization, and stent thrombosis were significantly higher following a high SYNTAX score (RR 1.71, 95% CI 1.45-2.03, P = .00001; RR 2.03, 95% CI 1.81-2.26, P = .00001; RR 1.96, 95% CI 1.69-2.28, P = .00001; and RR 3.16, 95% CI 2.17-4.59, P = .00001, respectively). Even when patients with ST-segment elevation myocardial infarction were separately analyzed, a low SYNTAX score was still significantly associated with lower adverse outcomes. CONCLUSIONS This analysis is a confirmatory piece of evidence to show that the application of the SYNTAX score in Interventional Cardiology is apparently relevant. The use of this scoring system to grade patients with coronary artery disease and to further guide for revascularization should be encouraged.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| | - Yashna Sookharee
- Tongji Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Anita Bholee
- Tongji Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Feng Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
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Kurtul A, Acikgoz SK. Validation of the CHA2DS2-VASc Score in Predicting Coronary Atherosclerotic Burden and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Am J Cardiol 2017; 120:8-14. [PMID: 28479165 DOI: 10.1016/j.amjcard.2017.03.266] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/24/2022]
Abstract
Although the CHA2DS2-VASc score has been initially recommended for the assessment of the risk of thromboembolic event in patients with atrial fibrillation, in recent years, it is used to predict adverse outcomes in various cardiovascular diseases. However, little is known about its predictive value for coronary atherosclerotic burden in patients with acute coronary syndrome (ACS). The aim of the present study is to investigate whether the CHA2DS2-VASc score could predict higher coronary atherosclerotic burden assessed by SYNTAX score (SS) in ACS. A total of 2,222 ACS patients (mean age 59.8 ± 12.7 years) who underwent coronary angiography were divided into 3 SS tertiles stratified by SS: low (≤22) (n = 1,445); intermediate (23 to 32) (n = 556); and high (≥33) (n = 221). The mean CHA2DS2-VASc score was 2.71 ± 1.51 (range 1 to 9) and CHA2DS2-VASc score was higher in patients with high SS than in those with intermediate and low SS (4.24 ± 1.49, 2.89 ± 1.49, and 2.40 ± 1.36, respectively, p <0.001). In multivariate analysis, CHA2DS2-VASc score ≥4 (odds ratio [OR] 3.048, 95% confidence interval 1.658 to 5.617, p <0.001) was an independent predictor of high SS, as well as body mass index (OR 0.929, p = 0.015), chronic total occlusion (OR 11.363, p <0.001), current smoking (OR 0.476, p = 0.026), and chronic renal disease (OR 1.828, p = 0.033). The CHA2DS2-VASc score was also an independent predictor for in-hospital mortality in multivariate Cox regression analysis. In conclusion, CHA2DS2-VASc, as a simply calculated and reliable score, is independently associated with high SS and in-hospital mortality in patients with ACS. Thus, this score provides an additional level of risk stratification regarding coronary atherosclerotic burden and prognosis beyond that provided by traditional risk factors.
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Kurtul A, Elcik D. Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease. Int J Cardiol 2017; 236:61-64. [DOI: 10.1016/j.ijcard.2017.02.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/11/2017] [Accepted: 02/19/2017] [Indexed: 12/18/2022]
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Burlacu A, Siriopol D, Nistor I, Voroneanu L, Nedelciuc I, Statescu C, Covic A. Clinical SYNTAX Score - a good predictor for renal artery stenosis in acute myocardial infarction patients: analysis from the REN-ACS trial. Arch Med Sci 2017; 13:837-844. [PMID: 28721152 PMCID: PMC5510498 DOI: 10.5114/aoms.2016.60374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/29/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In ST-elevation myocardial infarction (STEMI) patients, multisite artery disease represents a serious issue influencing evolution, outcomes and prognosis. We evaluated for the first time the power of the Myocardial Infarction SYNTAX Score (MI SS) and Clinical SYNTAX Score (MI CSS) as predictors for renal artery stenosis (RAS) in STEMI. We also stratified the study population according to the two scores, and identified the variables correlated with the higher score. MATERIAL AND METHODS We used data from the REN-ACS study, which included 181 consecutive patients prospectively investigated for presence of RAS (through renal angiography), arterial stiffness (carotid-femoral pulse wave velocity, cf-PWV) and hydration status (bioimpedance). MI SS and CSS were computed. RESULTS Multivariate regressions indicated that the independent variables correlated with MI SS were left ventricular ejection fraction < 40%, significant RAS (> 50%, defined as RAS+), history of heart failure, and multivascular coronary disease (CAD, p < 0.03 for each), while those correlated with MI CSS were RAS+, cf-PWV, history of CAD, multivascular CAD, cholesterol, and total body water (p < 0.02 for each). In order to evaluate the ability to predict RAS+ we generated receiver operating characteristics and areas under curves, and the Youden index for MI SS and CSS. CONCLUSIONS Both scores correlated with extensive atherosclerotic disease and presence of RAS+. A lower CSS proved to be a good predictor for exclusion of RAS+, with high specificity (85%) and negative predictive value (92%), and fair sensitivity (60%). We aim to further pursue this line of research and design a better predictor for RAS, with the inclusion of a novel biomarker in order to increase sensitivity.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Dimitrie Siriopol
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
| | - Ionut Nistor
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
| | - Luminita Voroneanu
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
| | - Igor Nedelciuc
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Cristian Statescu
- Department of Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Adrian Covic
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
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Zuin M, Rigatelli G, Picariello C, dell'Avvocata F, Marcantoni L, Pastore G, Carraro M, Nanjundappa A, Faggian G, Roncon L. Correlation and prognostic role of neutrophil to lymphocyte ratio and SYNTAX score in patients with acute myocardial infarction treated with percutaneous coronary intervention: A six-year experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:565-571. [PMID: 28529092 DOI: 10.1016/j.carrev.2017.05.007] [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] [Received: 03/31/2017] [Revised: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND/PURPOSE The neutrophil/lymphocyte ratio (NLR) has been proposed as a prognostic marker in acute myocardial infarction (AMI). The aim of our study is to demonstrates the correlation between SYNTAX score (SXs) and NLR and its association with 1-year cardiovascular (CV) mortality in patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) treated with percutaneous coronary intervention (PCI). METHODS/MATERIALS Over 6 consecutive years, (1st January 2010 and 1st January 2016) 6560 patients (4841 males and 1719 females, mean age 64.36±11.77years) were admitted for AMI and treated with PCI within 24-h. The study population was divided into tertiles based on the SXs. RESULTS Both in STEMI and NSTEMI groups, neutrophils and the SXs were significantly higher (p<0.0001) in upper versus lower among NLR tertiles and a significant correlation was found between the NLR and SXs (r=0.617, p<0.0001 and r=0.252, p<0.0001 for STEMI and NSTEMI groups, respectively). One-year CV mortality significantly raised up among the NLR tertiles in both STEMI and NSTEMI patients (p<0.0001). Multivariate analysis revealed that, after adjusting SXs and PAD, an NLR (≥3.9 and ≥2.7 for STEMI and NTEMI patients, respectively) was an independent significant predictor of 1-year CV mortality (OR 2.85, 95% CI 1.54-5.26, p=0.001 and OR 2.57, 95% CI 1.62-4.07, p<0.0001 for STEMI and NSTEMI respectively.) CONCLUSIONS: NLR significantly correlates with SXs and is associated with 1-year CV mortality in patients with STEMI or NSTEMI treated with PCI within 24-h.
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Affiliation(s)
- Marco Zuin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Unit of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Claudio Picariello
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Fabio dell'Avvocata
- Unit of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Lina Marcantoni
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianni Pastore
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Mauro Carraro
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Aravinda Nanjundappa
- CAMC Vascular Centre of Excellence, West Virginia University, Charleston, WV, USA
| | - Giuseppe Faggian
- Department of Cardiac Surgery, University of Verona, Verona, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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Cavalcante R, Sotomi Y, Mancone M, Whan Lee C, Ahn JM, Onuma Y, Lemos PA, van Geuns RJ, Park SJ, Serruys PW. Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials. Eur Heart J 2017; 38:1969-1977. [DOI: 10.1093/eurheartj/ehx138] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/13/2017] [Indexed: 11/14/2022] Open
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